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Mauricare Requires improvement

Reports


Inspection carried out on 19 August 2019

During a routine inspection

About the service

Mauricare is a care home providing personal and nursing care to 13 people aged 65 and over at the time of the inspection. The service at the time of the inspection was not providing nursing care.

The service can support up to 17 people, in one adapted building.

The registered manager was on planned leave at the time of the inspection site visit. The inspection was facilitated by a registered manager from another of the provider’s services, at the request of the provider.

People’s experience of using this service and what we found

Ineffective monitoring of the service by the provider and registered manager, and a lack of oversight by the provider, meant shortfalls in the service were not identified. Plans to bring about improvement were not in place, this impacted on the quality outcomes for people.

An external organisation had issued an enforcement notice, to bring about improvement to promote people’s safety, and bring about compliance.

Systems to promote people’s safety, which included assessment of risk, and safe recruitment practices for staff were not robust. Staff did not fully understand their responsibilities in safeguarding, all of which had the potential to place people at risk.

Audits on infection control were not an accurate reflection of the service. The audits recorded the service was clean, and furnishings and fixtures were in good condition. We found the service was not sufficiently clean, and some soft furnishings, floor coverings and mattresses to be damaged and stained.

People lived at a service that was not sufficiently maintained, both internally and externally.

People’s needs were not regularly reviewed, and their care plans were not written with their involvement. This meant people were not supported to have maximum choice and control of their lives, and staff did not always support them in the least restrictive way possible. The policies and systems in the service did not support this practice.

Opportunities for people to engage in social activities, develop interests within the service and the wider community were limited. Activities, as detailed on the notice board did not take place.

People’s health and welfare were kept under review by staff, who organised health care referrals and appointments on people’s behalf. Staff supported people to access health care appointments, and implemented the guidance given to them to promote people’s well-being.

People’s views about the service were sought. People we spoke with expressed satisfaction with the care they received, and spoke favourably about the staff who worked at Mauricare.

Staff were supported to perform their role through training and supervision.

People’s medicines were managed safely and people were supported to access a range of health care professionals, to monitor and promote their health.

People who were able, accessed the wider community independently or with support from family members.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 22 February 2017)

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to: The effective governance of the service. Effective systems and practices to prevent and control the spread of infection. Maintenance of the premises, to promote the safety of people and their well-being. Effective assessment of potential risk, including staff recruitment practices. And, person centred care, enabling people to be involved in the development and review of their care.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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Inspection carried out on 9 January 2017

During a routine inspection

This inspection took place on 9 January 2017 and was unannounced.

Mauricare provides residential care for up to 17 people who are living with dementia or require support because of their mental health. At the time of our inspection there were 14 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having an en-suite facility.

Mauricare had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider was in the early stages of implementing a quality assurance tool, that if implemented well, should provide an overview as to the service being provided, to enable the provider to further develop the quality of the service people receive.

A range of audits had been undertaken by the provider, registered manager and staff. Whilst some audits checked that equipment such as hoists were well maintained, larger scale issues had not been fully addressed. For example, we found the premises and some equipment to be in need of improvement to meet the needs of people using the service. We found there to be no action plan detailing the improvements with timescales that would improve the facilities with regards to the maintenance and décor of Mauricare.

People who used the service told us their views about the service were sought and that they were happy with the care and support they received. This was supported by the minutes of meetings involving people who used the service and the completed questionnaires we saw which sought people’s views; however the outcome of people’s views had not been shared.

People using the service told us they felt safe and were confident that if they had any concerns about their safety or welfare their concerns would be listened to by the registered manager and staff. People’s medicine was managed well and safely. An audit carried out by the supplying pharmacist had found good management systems in place for people’s medicine.

People’s safety was further supported through a robust recruitment process of staff and by their being sufficient staff to provide the support people required. Staff undertook training and were regularly supervised, which included having their competency assessed to ensure they delivered safe and effective care and support to people.

The registered manager and staff were aware of their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were committed in their approach to supporting people to make informed decisions about their care. People’s capacity to make informed decisions was considered with regards to all aspects of their day to day lives; however there was a lack of awareness as to the appropriate and correct completion of mental capacity assessments. The registered manager said improvements would be made in this area.

People were encouraged to make decisions about their day to day lives. People’s care plans provided information for staff as to what support people required, so that people’s independence was recognised and not undermined by staff. We observed staff supported people to make decisions about their day to day lives and provided encouragement in the promotion of their independence.

People’s health and welfare was promoted through a range of assessments and the development of care plans which were regularly reviewed. People, with the support of staff where required, accessed the services of a range of health care professionals who monitored and promoted their health. People’s nutritional needs were assessed and met

Inspection carried out on 16 December 2015

During a routine inspection

This inspection took place on the 16 December 2015 and was unannounced.

Mauricare provides residential care for up to 17 people, who are living with dementia and or require support because of their mental health. At the time of our inspection there were 15 people in residence. Accommodation is provided over two floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having en-suite facilities. There is a courtyard garden which is accessible and provides areas of interest to the rear of the service.

Mauricare had a registered manager in post at the service at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe in the home; however they were unaware of external agencies they could contact if they had any concerns about their safety. Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service.

Where risks to people’s health had been identified, staff had the information they needed to help keep them safe, however additional information as to how people should be supported when they became anxious or distressed would further promote people’s safety. We found there to be sufficient staff to keep people safe through meeting their needs.

People’s safety was not consistently promoted by systems and processes that audited and monitored the maintenance of the building and its equipment. Recent audits carried out had not identified potential risks to people’s safety with regards to equipment used to move people. An inspection carried out by Leicestershire fire and rescue service had identified areas for improvement, which the provider was in the process of addressing.

People’s plans of care contained information about the medicine they were prescribed. We found people were administered their medication which was stored safely. However we found there was potential for people not to have medicine that was prescribed ‘to be taken as and when required’ administered consistently. This was because there were no protocols in place for its use to provide staff with clear guidance to follow.

People said they thought the staff were well-trained. Records showed staff had an induction and received on-going training. However, we found staff had not received training in the area of dementia care which may impact on the care some people living with dementia receive.

Staff were supported to provide effective care though on-going supervision which was provided by the registered manager. People told us staff were caring and kind and that they had confidence in them to provide the care and support they needed.

We found that appropriate referrals had been made to supervisory bodies where people were thought to not have capacity to make decisions themselves with regards to receiving personal care and treatment. We found that best interest decisions had been recorded as required by the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA 2005 DoLS). Where someone lacked the capacity to make an informed decision. However we found mental capacity assessments in some instances which had been carried out by the registered manager were not sufficiently reflective of the MCA 2005 DoLS as they did provide a clear understanding as to the decision reached.

People we spoke with were in the main complimentary about the meals provided at the service. Records showed people’s views about menus were discussed.

People were supported to attend health care appointments and medical attention was sought on behalf of people where it was required. Representatives of people using the service told us they were kept informed about any changes to their relative’s health by staff of Mauricare.

People told us they made decisions as to their day to day lives, deciding what time they got up or went to bed and that staff respected their decisions.

People told us that staff supported them to access the wider community and to take part in activities within Mauricare, which included sing a long and playing games. However we found the opportunities for people to engage in individual activities reflective of their abilities or needs was limited. People told us they made decisions as to their day to day lives, deciding what time they got up or went to bed and that staff respected their decisions.

People’s needs were assessed prior to them moving into the service and the information gathered was used in the development of plans of care. However people we spoke with had limited involvement within the development and reviewing of their plans of care.

People using the service and relatives said that if they had any concerns or complaints they would tell the registered manager or the staff.

We found people’s views about the level of consultation within the service to be mixed and did not fully recognise the support required by people with complex needs. Where people were able and confident to share their views these were recorded within minutes of meetings.

We found audits were carried out by the registered manager; however shortfalls were not always identified. The provider needs to ensure systems are effective to ensure improvements are identified ensuring the service is well-led.

The Provider Information Return (PIR) identified areas for planned improvement over the next 12 months. It was stated that the involvement of people and their families were a priority in the provision of individual care along with the need for increased opportunities being made available to enable people to comment on the overall service provided.

Inspection carried out on 28 October 2013

During a routine inspection

When we visited Mauricare there were seventeen people using the service, none of which were receiving nursing care.

We spoke with four people who used the service and asked them for their views about the care and support they received. People’s comments included: “I am very happy here, the staff are marvellous and nothing is too much trouble.” “I’ve lived here quite a while and I am very settled.” “I don’t want to leave here, I’m looked after well and the staff are marvellous.”

People who used the service spoke about the Halloween Party that was to take place later in the week, with one person telling us of their intention to ‘dress up’ in a witch’s hat and have their face painted. In the afternoon we saw one person engaged in a game of dominoes with a member of staff, whilst someone else was completing a jigsaw. A third person was being supported and encouraged to undertake exercises which had been recommended by their physiotherapist. Visitors told us that Mauricare organised parties at Christmas and Easter as well as individual birthday parties, to which people’s relatives and friends were invited.

People we spoke with told us they were satisfied with the food. We saw the cook during the morning asking people for their choice from the lunchtime menu.

We asked people if in their view their were sufficient staff on duty to look after them. People told us that when they needed assistance staff were quick to support and help them.

We spoke with visitors who were visiting their relative and asked them for their views about the care and support their relative received. They told us they along with their relative were happy with the care and support provided. They told us they along with other relatives were kept informed about the health and welfare of the person who used the service.

We looked at a range of records, which included people’s care plans and daily records, staff recruitment and supervision records and maintenance records and found records were stored and managed well.

Inspection carried out on 13 December 2012

During a routine inspection

We spoke with three people and one relative. People told us: "I am looked after well." Another person said: "It is good here, staff play the piano." A relative told us: "My mum receives regular visits from the opticians and hairdresser and always looks clean and smart. She loves it here." We spoke with a visiting health professional and she told us staff would follow through all care instructions and ensured people received appropriate care treatment and support. She saw staff were very caring and friendly with people who lived at the home. One relative told us they would be attending the Christmas party as Mauricare parties were always good. Another person told us the care was good but some times the premises lacked a homely feel. The manager accepted the feedback and confirmed they were making ongoing improvements with new decor and furniture.

Inspection carried out on 17 September 2012

During a routine inspection

We spoke with three out of the seventeen people who use services. Some people told us they played board games and cards with staff. One person said there was nothing to do except watch television. We saw staff play a soft ball game with a group of people in the lounge. Another person told us they had been out with staff to join in and celebrate some cultural festivities. They told us, "Staff encourage me to be independent as long as I tell them where I am going." "The meals are beautiful, always plenty to eat."

Inspection carried out on 6 January 2012

During an inspection in response to concerns

People told us they liked living at Mauricare and enjoyed the activities provided. One person said, “This is a nice place. I like the sing-songs we have and sometimes we have a dance too.” Another told us, “The residents get on well with each other. I’m happy to stay here – it’s home to me.”

People also said they had a say in how their care was provided and could choose their own routines. One person said, “The staff say I can go to bed when I like. Sometimes they ask me if I want to go up and I can say no if I like.” Another person told us, “I go to bed at 7.30pm – that’s my choice. Some residents stay up later.”

People who were unable to give their views due to their mental health needs appeared contented in the home. We observed people taking part in activities (art and dominoes) with staff, watching films, and socialising with each other.

People told us they felt safe in the home and knew what to do if they had any concerns. One person said, “I’ve been here for four years and I feel safe and trust the staff.” Another person told us, “If I had a problem I would tell the manager and she would get it sorted.”

One person said they thought the staff had a good approach to people suffering from dementia. They told us, “Some of the residents are confused. The staff are patient with them and I’ve never heard any of them shout. They wouldn’t do that.”

Although the home was clean and warm the interior was in need of re-decoration and refurbishment. The colour schemes were dull and not suited to people suffering from dementia. Some bedrooms were poorly lit which could make it difficult for people to read or see their way around.

People told us the home was always clean and staff worked hard to keep it that way. One person said, “It’s always clean here but some rooms could do with a lick of paint.” Another said, “I like my room and I’ve got my own things there. The staff clean it every day.”

Reports under our old system of regulation (including those from before CQC was created)