Maun View

Maun View is a residential care home providing accommodation for persons who require nursing or personal care to up to 77 people. The service provides support to people living with dementia. At the time of our inspection 71 people were living at the home. The home is split over two main floors. Each floor is split into two units with communal areas on all units and an outdoor communal space.

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

There were not always sufficient staff deployed to keep people safe and meet their needs.

Risks were not consistently managed. Safety and medicines risks were not always managed safely.

People did not always receive responsive care. Evidence of their involvement in care planning was limited.

Internal quality assurance processes were not always effective in monitoring the service which meant improvements were not always made.

People we spoke with told us they felt safe. The premises was clean, safe and well maintained. People told us that staff were kind and caring.

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 received induction, training, supervision and appraisal.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 24 October 2019). The service remains rated requires improvement.

This service has been rated requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service and the inspection was prompted in part due to concerns received about the quality of care, safety, medicines, culture of the home, management and care plans. A decision was made for us to inspect and examine those risks.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

The provider took actions during and after the inspection visit to mitigate some of the identified risks.

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

Enforcement

We have identified breaches in relation to safe care and treatment, quality monitoring and staffing at this inspection.

Follow up

We will carry out a follow up inspection to check that actions have been taken 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.

We found the following examples of good practice.

The service facilitated safe visiting in line with current guidance. At the entrance to the home there was clear guidance in place requesting staff and visitors to adhere to government guidance with respect to personal protective equipment (PPE). Temperatures were also taken, and visitors were asked to sanitise their hands and to wear face masks.

Staff had received training on infection control and COVID- 19, and they understood the signs and symptoms that might indicate ill health which would require medical attention. All staff wore appropriate PPE, which was in good supply. Posters and information about COVID-19 was clearly displayed throughout the service.

The layout of the building allowed for clear zoning when someone needed to self-isolate in their own room if they received a positive test result. During the outbreak staff provided additional support and activities in people's rooms at times when people were self-isolating. The service also supported people to maintain contact with their loved ones via telephone and video calls.

Enhanced cleaning practices were in place and the building looked clean and was well ventilated. There were infection preventative and control policies in place which were updated in line with government guidance.

We found the following examples of good practice.

There was a restriction on visiting the service at the time of the inspection due to an outbreak of Covid-19. There were procedures in place for visitors to the service, including healthcare professionals and relatives to reduce and prevent the spread of infection.

The provider ensured people-maintained contact with relatives by staff supporting them with telephone calls. The deputy manager told us they had accommodated visits prior to the infection outbreak and there were arrangements in place for people on end or life or due to their mental health wellbeing.

There was a clear regular programme for staff and people living in the home to be tested for COVID-19. This meant swift action could be taken if or when positive tests were received.

Staff followed procedures for don and doffing PPE and how to dispose of it safely, in line with GOV.uk guidelines. All staff wore appropriate PPE, which was in good supply. Posters and information about COVID-19 was visual throughout the service. The provider was working with Public Health England to ensure they had the appropriate safety measures and waste streams in place.

A robust contingency plan was in place and used for when positive testing or isolation for staff or people arose. There were arrangements to deploy staff across the service to reduce the risk of cross infection. No agency staff were used at this time.

Handover meetings were completed in line with safe distancing guidelines.

Individual risk assessments were in place for people in high risk groups. The deputy manager gave an example of vulnerability for people and the staff team. The Registered manager assured us that adjustments if required to staff working practices would be put in place as and when required to keep them safe. Staff who were noted at risk were shielding at this time.

People using the service had tested positive and were self-isolating in their own rooms or communal areas when appropriate. Arrangements were in place to reduce the spread of infection.

The home was very clean and tidy. Housekeeping staff told us they had increased the cleaning regime. The cleaning schedules had been consistently completed for the weekly and monthly tasks around the home environment. Staff told us they had a process to deep clean to reduce the risk of infection. From speaking with staff, we were assured the cleaning was being completed.

Further information is in the detailed findings below.

Maun View is a residential care home providing personal care to 39 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 77 people.

The care home accommodates people in a purpose-built care home across four separate units over two floors.

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

People spoke very positively of the changes and improvements to the home since the last inspection and particularly since the new manager had been in post. People’s risks and needs were being assessed and supported well with good oversight from management. There was now a clear structure in place which brought stability for staff and people; and ensured good leadership for the home.

People felt safe in the home and were supported to take their medicines in a safe way. The home was clean and tidy with correct infection control procedures being followed.

People spoke very highly of the food and were provided with a good choice. They were also supported to maintain good levels of hydration. Where needed people were supported to access appropriate medical and healthcare.

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.

People were cared for by kind and respectful staff who had people’s best interests at heart.

People received personalised care and their differing needs were met by staff who knew them well. People were supported to engage in meaningful activities. When it came to people’s end of life needs, they and their families were supported in a compassionate way.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 5 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 5 October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

Maun View is a nursing home and accommodates up to 77 people in one building over two floors. Throughout our inspection 72 people were using the service. People had either nursing or residential care needs and many of the people were living with dementia. The home was separated into four units, three of which were for residential care and one was just for those who required nursing.

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

People were not 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.

Medicines were not managed effectively. People were at risk of not having medicines administered as prescribed. The management of medicine in the nursing unit was not safe or effective. The provider was relying on agency nurses who did not know people living at the home. Care plans and risk assessments were not sufficiently robust or detailed to give relevant information on people’s care and any potential risks.

The provider failed to put robust systems in place to monitor and manage risk. Care plans were being developed electronically but did not have enough information in all areas of care needed. Risk assessments did not consider all risk or ways that risk could be mitigated.

Incident and accident reporting was poor and there was no analysis to inform better outcomes and reduce the likelihood of the event reoccurring. There was no management oversight leading to poor recording and no information on when concerns needed to be referred to healthcare professionals.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 22 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made but the provider remained in breach of Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance). Insufficient progress had been made towards the improvement needed. We also found breaches in Regulation 11(Need for Consent) and a breach of the Care Quality Commission (Registration) Regulation 18 (Failure to Notify).

Why we inspected

Prior to the inspection we also received concerns in relation to the management of medicines, insufficient staffing, infection control and care planning. As a result, we undertook a focused, responsive inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report. The provider has taken some action to mitigate the risk but progress has not been efficient and therefore risk has not been reduced sufficiently.

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

Please see the action we have told the provider to take at the end of this report.

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.

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 return to visit as per our reinspection programme. If we receive anything concerning, we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We conducted an unannounced inspection at Maun View on 22 May 2019. Maun View is a nursing home and accommodates up to 77 people in one building over two floors, accessed by a passenger lift. On the day of our inspection, 75 people were present at the service. People had either nursing or residential care needs and some people were living with dementia.

People’s experience of using this service:

The service met the characteristics of requires improvement in all areas we inspected. We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These included how medicines were managed, how people’s nutritional and hydration needs were met, and the effectiveness of systems and procceses that assessed and monitored risks and how records were maintained.

The management of medicines within the nursing unit was not safe or effective. This was in relation to how medicines were ordered, stored, managed and returned to the pharmacy.

Staff levels were found to be insufficient, people had to wait for assistance and staff were task led and did not have time to spend with people. The provider took immediate action and increased staffing levels. Safe staff recruitment procedures were used.

Guidance provided to staff about how to manage known risks to people, either lacked detail or were not available. Staff had received safeguarding training and were aware of their responsibilities to protect people from avoidable harm. However, safeguarding investigations and outcomes were not shared with staff to support learning. There was an analysis of fall incidents to consider themes and patterns. However, the management of falls was not consistent. The risk of the spread of inspection was safely managed.

People’s nutrition and hydration support needs were not effectively managed. Information and guidance provided to staff about people’s care needs in relation to their health conditions lacked detail or was not available.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. However, there were some inconsistencies in the completion on mental capacity assessments, where people lacked capacity to consent to specific decisions.

The environment was bright and spacious.

Whilst staff overall were kind and caring, they were task led and not always responsive to people’s care and support needs.

People were involved with decisions about their care as fully as possible. Advocacy information had been made available. People’s records were stored securely to protect their privacy.

People received an assessment before moving to Maun View. Care plans provided staff with information about people’s preferences, routines and what was important to them but varied in detail and at times was misleading.

People received opportunities to participate in a variety of social activities, including community visits.

The provider’s complaint procedure had been made available for people. Where people were at the end stage of their life, care plans were in place to inform staff of their wishes.

Quality assurance processes were in place; however, these were not always effective in highlighting and addressing the concerns we raised during this inspection. Staff were positive about the new manager who they found to be supportive, approachable and knowledgeable. The manager had a good understanding of the regulatory requirements of their role.

Rating at last inspection:

At the last inspection the service was rated Good (Published 5 March 2018).

Why we inspected:

We carried out this inspection in response to concerns raised by commissioners of this service, who had visited the service and found risks to people’s safety.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.

A registered manager was in post and they were available during the 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The risks to people’s safety were reduced because staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. Risk assessments had been completed in areas where people’s safety could be at risk. Staff were recruited in a safe way and there were enough staff to meet people’s needs and to keep them safe.

Accidents and incidents were investigated. Assessments of the risks associated with the environment which people lived were carried out and people had personal emergency evacuation plans (PEEPs) in place. Safe procedures for the management of people’s medicines were in place. We identified some minor areas which the registered manager needed to address in relation to the cleanliness of the service, however staff had the knowledge and equipment to manage any infection control issues.

People were supported by staff who received an induction, were well trained and received regular assessments of their work. People felt staff understood how to support them effectively. The service used nationally recognised tools to assess the needs of people who lived at the service

People lived in an environment which met their needs and they had access to information in formats which they understood. People’s health and nutritional needs were well managed and staff acted on advice given to them by health professionals to manage people’s health and nutritional needs.

Staff knew how to support people to make decisions and ensure their rights were respected, working in line with the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were cared for by staff who showed kindness and consideration of their needs and had knowledge of their preferences and views on their care. They were supported with respect by staff who maintained their privacy and dignity whilst encouraging and supporting their independency.

People received individualised care from staff who had the information they required to provide that care. People were supported to take part in a range of social activities and maintain relationships that were important to them. People were comfortable when raising concerns or complaints and felt issues raised were addressed to their satisfaction. People’s wishes in relation to their end of life care were supported with care and empathy.

The service undertook a robust auditing process to maintain the quality of the service. The registered manager worked with people, relatives, staff and external professionals to provide an open and transparent service for the people who lived there.

Due to the complex needs of people using the service we were not always able to obtain their views of the care they received. We spent time observing the care provided on each of the four separate units within Maun View to gather evidence of their experience of the service. We checked care records, spoke with people who used the service and three visiting relatives. We also spoke with 12 staff, the manager and deputy manager.

People who used the service, their relatives and their advocates told us they felt people had their needs met by sufficient staff. A person who used the service told us, 'The staff are pretty good. They (the staff) come in good time usually.' (In response to using the call bell).I sometimes have to wait but that's because they've got so many others to help.'

We found that people who used the service could not always expect a consistent number of staff to meet their needs safely.

We found that there had been improvements in the records so that people who used the service could be confident that their personal records were accurate, fit for purpose and held securely.

We found that there were improved systems in place to identify, monitor and manage risks to people who used the service.

We found that medicines were managed safely.

There were improved systems in place to ensure staff received regular training and development and that the quality of the care provided was being monitored.

We spoke with three people who used the service who told us they felt they were supported safely, comments included, 'I feel safe here, I don't want to go home because the staff take such good care of me here.'

Staff we spoke with told us there were sufficient staff available to manage the needs of people who used the service, one person commented, 'The manager has made lots of improvement since she came, it's more organised now, we deploy staff differently and we have time to do the things we need to.'

People who used the service did not at all times have their care planned or delivered in a way that maintained their health and welfare.

The system in place to calculate the number of staff required was not effective in meeting people's needs in a safe and timely way.

The provider had systems in place to identify where improvements were needed, such as, care planning, staff training and supervision but there were delays in making the required improvements.