Maranatha Residential Home

Maranatha Rest Home is a residential care home providing the regulated activity of accommodation and personal care to up to 15 people in one adapted building. The service provides support to older people and people living with dementia. At the time of our inspection there were 15 people using the service, this included two people who were in hospital.

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

Not all risks to people’s safety and wellbeing were assessed and recorded or documented in enough detail to mitigate the risks for people’s safety. People were not fully supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments did not evidence the exact decision being assessed, the rationale why this was in the person’s best interests and had not been reviewed. The deployment of staff meant communal lounge areas were not always staffed and there was a lack of social activities facilitated.

Auditing systems were in place to assess and monitor the quality of the service, but senior members of staff were not involved in this process. In the absence of the registered manager there were no contingency plans in place to oversee the quality of the service provided. No information was available to demonstrate the provider had oversight of the service.

People told us they felt safe and relatives confirmed they had no concerns relating to the safety of their family member. Medication practices were safe, but improvements were required where people received PRN [when required] medication. Appropriate arrangements were in place relating to the service’s recruitment practices but improvements were required to ensure DBS checks were appropriate. We have made a recommendation about this. Relatives were complimentary about the registered manager and the care people received. Staff told us they felt valued and supported.

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 9 November 2021].

Why we inspected

The inspection was prompted in part due to notification of a specific incident. The information CQC received about the incident indicated concerns relating to risk management. A decision was made for us to inspect and examine those risks. We have found evidence the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Maranatha Residential Home is a residential care home that provides personal care to up to 15 people in one adapted building. There were 13 people living at the service at the time of our inspection, some of whom required support with dementia.

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

People and relatives were positive about their experiences at the service. Feedback from one relative was ‘The staff are courteous, helpful and hardworking.'

Care and treatment were planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Staff had received appropriate training. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. Medication was dispensed by staff who had received training to do so.

The registered manager had put systems in place to monitor and provide good care and these were reviewed on a regular basis.

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 requires improvement (published 12 November 2019). At this inspection the service has improved to good.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maranatha Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Maranatha Residential Home is a residential care home that provides personal care to up to 15 people in one adapted building. There were 14 people living at the service at the time of our inspection, most of whom were living with dementia.

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

Improvement was needed around the providers management of risk to ensure the premises remained safe and fit for purpose. The laundry required attention to prevent and control the risk of infection and we have made a recommendation for the provider to refer to the Code of Practice Prevention and Control of Infection.

The registered manager and staff had developed positive and trusting relationships with people that helped to keep them safe. They had a full awareness and understanding of abuse and their responsibilities to protect people. Safe recruitment practices were carried out. There were not enough staff at night to ensure the safety of people.

The atmosphere of the service was comfortable, homely and clean but additional environmental adaptations were needed to better support people living with dementia. We have made a recommendation for the provider and registered manager to consider creating a more enabling, stimulating and dementia friendly environment for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, and in their best interests; the policies and systems in the service supported this practice.

Staff treated people with kindness and compassion and respected their privacy and dignity. Positive relationships had developed between people and staff. The home encouraged and supported people to maintain relationships that were important to them.

The staff worked well with external health care professionals and people were supported with their needs and accessed health services when required. People received their medicines in a safe and supportive way.

The culture of the service was positive, open and transparent with good leadership. Governance systems needed further development to inform an on-going plan for improvement, particularly in dementia care.

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 29 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager. 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.

At the last inspection the service was rated as Good. At this inspection the service remained Good.

The service was safe. Staff showed knowledge of safeguarding procedures and knew what actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with everyday risks. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. There were sufficient numbers of staff on duty. People’s medication was well managed and people received their medication as prescribed.

The service was effective. Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker. They also received regular support and felt well supported by management.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People were supported to maintain their health and had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.

The service was caring. People had agreed to their care and had been asked how they would like this to be provided. Where this had not been possible family and other healthcare professionals had been involved. People were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner. Meetings had been held for the people living at the service, relatives and for the staff. People felt listened to and that their views and opinions had been sought and the service had made appropriate improvements.

The service was responsive. Assessments had been carried out and care plans were developed around people’s needs and preferences. The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response.

The service was well-led. Staff, relatives, healthcare professionals and those living at the service spoke positively about the registered manager and felt the service was well managed. There were systems in place to regularly assess the quality of the service and that people were kept safe.

Concerns raised included the provider’s audit and governance systems, which were found not to be effective and had not highlighted the areas of concern that were found during the inspection. Although the service had some quality assurance systems and audits in place, these were not adequate as they did not identify the areas of concern regarding risks in the environment, people’s deprivation of liberty, and complaints as part of this process. We also found that the service had not ensured that the premises and equipment used had been well maintained and kept safe. There were a number of issues raised around risks in the environment and also infection control.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulation and also improvements they were to make with their quality assurance. We undertook a focused inspection on 19 April 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these requirements. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Maranatha Residential Home on our website at www.cqc.org.uk

Maranatha Residential Home offers both personal care and accommodation for up to 15 older people who may also have care needs associated with dementia care.

The service 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.

At our focused inspection on 16 April 2016, we found that since our last inspection, audit and governance systems had been put in place to support the management and running of the service. Improvements had been put in place with regard to quality assurance and to rectify concerns raised regarding risks in the environment, people’s deprivation of liberty, and complaints management.

We looked at four people's care records. Other records viewed included staff training records, menus, health and safety checks and staff and resident meeting minutes. We considered our inspection findings to answer five key questions; is the service safe, effective, caring, responsive and well-led? This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. Staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS.) This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

The premises were suitable, accessible and safe for people, but continued improvements to the environment would be beneficial to people.

The service was kept clean and staff practice ensured that people were protected, as far as possible, from the risk of infection.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People made comments such as, "This is the best home I have been in so far," "The staff are caring," and, "It's small and you feel you can get to know people."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

We found that people were supported to eat and drink well with any concerns about their nutritional well-being addressed.

Staff working in the service were supported through induction, on-going training and supervision to offer people care and support to meet their needs.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect.

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken in to account and listened to.

We saw that staff were responsive to people's changing wishes and needs and supported them well.

People told us that they felt able to raise any issues they might have and felt that the service would act upon their concerns.

People's care records showed that where concerns about their well-being had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had not benefited from having a registered manager in post to provide good and stable leadership for some time. However, an application was in the process of being submitted.

People had the opportunity to express their views about the service.

We found that improvements were needed to ensure that peoples' individual needs were properly identified and planned for with their involvement wherever possible. Activities needed to continue to develop taking into account peoples' individual needs and backgrounds.

People were given choices in their day to day lives and able to follow their own preferred routines.

Improvements were needed to ensure that the service was kept properly clean. Robust systems needed to be developed to ensure that the risks of the spread of infection were minimised through proper monitoring. The premises also needed improvements to ensure that people lived in a pleasant environment.

Medicines were stored, administered and disposed of safely but some attention to detail was needed to provide a fully robust system.

Improvements were needed to ensure that staff were properly trained and supported to care for people consistently.

There were not effective systems in place for monitoring and improving the quality and safety of the service, taking into account the views and suggestions of people living there.

You can see our judgements on the front page of this report.

During our inspection we saw that people received good care and that staff treated them with respect. We found that staff were trained in safeguarding vulnerable adults and worked in ways that kept people safe.

We spoke with five people who use the service and four relatives. People told us staff treated them with dignity and respect. They advised the care was "good". People gave positive comments, stating they were “happy” or, “liked” living at the home. A person said “I’m quite content”. Relatives told us, “The care is good”, and, “We are very happy”.

We found that people were not cared for by staff that were supported to deliver care and treatment safely to an appropriate standard. Not all quality assurance systems in place were effective in monitoring and improving the service.