Maypole Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents were reported and investigated. Lessons learned were shared with staff in a variety of methods including during handover between shifts, via messaging in group chats and more formally in a written ‘lessons learned file’ and through group supervision sessions. Although not all staff had signed to confirm they had read the lessons learned file, staff we spoke with confirmed they were kept up to date when things went wrong and were informed of how to reduce the risk of something happening again. For example, one staff member said, “There is a group chat, so if I’m not at work I will see that, but incidents are also communicated to us during handover, and through the day it's communicated around the team.”

The deputy manager discussed new processes put in place following an incident. This included a new afternoon review meeting between nurses and care staff and improved oversight of risks and how they were managed.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s care and support plans were regularly reviewed to ensure they were up to date and reflective of people’s needs. This meant staff were able to provide up to date information to healthcare partners when people’s needs changed. There was a weekly GP visit. The deputy manager told us, “We have good communication with the GP. I always do the ward round because I want to know what is happening. The surgery asked for 1 person to be allocated for the GP, and I am happy to do this. I document the outcome of the GP visit and make sure the nurses are informed.”

We saw records that showed people were referred to other health professionals for advice when required. Following some recent concerns in relation to timeliness of referrals, the service had worked hard to make the process as robust as possible. For example, there were ‘link nurses’ for any tissue viability concerns and wound care was carried out by 2 named nurses only. Records showed people were referred to other healthcare professionals when needed, such as the speech and language therapist (SALT).

Overall, people said they were able to see a GP if needed. People told us they had been taken to hospital when required, such as after a fall. An optician visited the service. People’s relatives told us they were generally kept up to date about their loved one’s health. For example, we received comments such as, “If [name] is unwell, the staff always contact me” and “If the doctor comes round, the staff let me know. When [name] was in hospital, they let me know and let me know when [name] was back at the home.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Most people told us they felt safe living at the service. People told us they knew the doors to the outside were locked which made them feel safe. One person told us, “Yes, I’m safe here. It’s a magic word, ‘safe’.” The majority of people’s relatives told us they felt their loved one was safe living at the service, although some did comment about how they felt staffing levels affected the safety. One staff member said, “We have to learn about people, their likes and their dislikes. I like to join in with whatever the residents are doing, and they will then begin to trust me. I want residents to think, ‘ah I'm with [staff name] I'm safe’.”

Staff were trained in safeguarding and understood their responsibilities in reporting safeguarding concerns. One staff member said, “I would tell the nurse in charge about any concerns. Sometimes they will need to assess the person. It’s all part of safeguarding. We need to keep people safe and free from harm and that’s why we need to report bruises for example.”

The provider had appropriate safeguarding and whistleblowing procedures. The management team understood their responsibilities regarding any action needed to protect people from harm. The necessary internal documentation was completed, including accident and incident logs and body maps. The provider ensured referrals and notifications were made to the local authority and the Care Quality Commission in a timely manner.

The provider did not always work well with people to understand and consistently manage risks related to skin integrity. Recent incidents around skin integrity had led to improved processes around oversight, but day to day wound care records were not always completed in full. For example, not all wounds had been photographed at every dressing change, and measuring tools were not always placed adjacent to the wound which meant it would be difficult to monitor the wound dimensions. These inconsistencies meant it might be difficult for staff to easily assess if a wound was improving or deteriorating. The management team told us there were now designated staff responsible for wound care and assessments.

Although the frequency of required position changes was recorded in care plans, position change charts did not always show that care plan guidance was followed. Although staff had documented when people refused support to move, there was nothing recorded to show that staff went back a while later and tried again. Instead, the records showed staff returned at the next scheduled time. In some cases, this meant people could be in the same position for several hours, against care plan guidance, even though this was their choice. We fed this back to the management team. As part of the improvement plan, the service had put in place daily meetings for care staff and nurses where risks were assessed and we were told this included reviewing position change records and fluid intake records so that risks to people could be identified as early as possible and action taken accordingly. Staff understood the importance of position changes to prevent skin damage. For example, one staff member said, “Position changes are in the care plan, and our device tells us when it’s due. If someone refused, I would try and convince them, so that I can give the best possible care.”

In some care plans it was documented that people might experience periods of anxiety or agitation. However, care plans did not always inform staff what steps to take to support people during these periods. For example, in one plan it was documented, “Staff and family to support to meet emotional needs", but there was no description of what this meant in practise.

When people were at risk of choking, care plans provided clear guidance for staff on how to reduce the risks and staff we spoke with understood the risks and how to keep people safe.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There was a maintenance team who undertook regular health and safety checks. There was provider oversight in place to evidence that all necessary routine maintenance and safety checks had been completed. Ongoing fire drills and evacuations were undertaken. Personal emergency evacuation plans were in place.

The service was going through a period of refurbishment. This included communal areas and people’s bedrooms. The environment was not dementia friendly. There was no dementia signage in place to support people with cognitive impairment as they moved around the building. We discussed this with the manager who advised they had ordered the signage, and it would be put in place as part of the redecoration. After the inspection, they told us the service had been reviewed by the provider’s dementia lead and that work would soon begin to make people’s bedrooms and other areas more dementia friendly.

The majority of people and their relatives we spoke with told us they felt the service was short staffed. People referred to having to wait for call bells to be answered, that they felt staff were poorly organised and that staff told them they were “short.” Comments included, “I get sick of hearing, ‘We’re on our own, we’re short staffed’” and “They [staff] come very quickly [when I ring the bell], but not when they’re busy. Then you can wait three quarters of an hour. They’re busy, they’re full up.” One person’s relative said, “There’s not enough care staff. I’ve spent a good few hours at a time visiting [name] and I’m always loitering in the hallways looking for staff.’ Although some people told us they felt staffing levels were acceptable this was minimal.

We had mixed feedback from staff about the staffing levels. Some staff we spoke with referred to not having time to talk with people other than when providing care. Although some staff said staffing levels were “fine” others compared day and night shifts and told us they felt night shifts were short of staff. One person’s relative said, “What [relative] would like is for someone to come in and have a nice chat.”

We fed back the comments from people and their relatives to the manager. They told us, and we saw that the service used a dependency tool to calculate staffing levels. The staff rota reflected the outcome of the dependency tool, and the manager told us the service was technically overstaffed. We saw the call bell response times were analysed and we were told about a “whole home” approach to answering call bells, where staff not directly involved in care were able to answer call bells. The manager told us they would speak with people and their relatives about the feedback received to try and resolve people’s concerns.

Safe recruitment processes were followed. At the last inspection it was noted that gaps in employment histories had not always been explored. At this inspection, we saw this had been rectified.

Staff were trained to carry out their roles. Training compliance was high, and staff told us they had access to on-line and face to face training. Staff told us they were encouraged and supported by the provider to develop professionally.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had been trained in infection prevention and control and told us there was enough personal protective equipment in place. There were audits in place to oversee the cleanliness and safety of the environment. The service was visibly clean and tidy and the manager told us some of the flooring was being renewed in communal areas. There were handwashing signage and facilities throughout the building. There were appropriate clinical waste facilities and colour coded cleaning materials. Housekeeping staff were on duty 7 days a week. Most people we spoke with were happy with the standard of cleaning. One person’s relative said, “Generally it’s fine. I will mention if anything needs cleaning up and they do it. Housekeeping does their very best.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs and preferences.

Staff told us people who were prescribed thickener had this stored in lockable cupboards in their bedrooms. This was to ensure thickener was stored safely. However, not all the boxes we looked at were locked, which meant there was a risk that people could access the thickener. This meant there could be a risk to people’s safety. We fed this back to the management team who replaced the lockable boxes and informed staff to be more vigilant when putting the thickener away. We were informed after the inspection that regular spot checks of the lock boxes were now in place.

Some people were prescribed medicines on an as required (PRN) basis. The protocols we looked at were not consistently person centred and did not always refer to other steps staff should take before resorting to the use of medicines. The management team were aware of this and told us they had begun work to review all PRN protocols. Despite this, when PRN medicines were administered, staff recorded the reasons why and the outcome. This meant it was easy to assess the effectiveness and to identify any trends.

Staff responsible for managing medicines had completed training and had their competence assessed. Medicine incidents were reported and investigated. Medicines were stored, administered, and recorded safely.

Regular medicine audits were carried out. When issues were identified, action plans were put in place. We saw actions were completed in a timely manner.