Archived: Mandalay Care Home

Mandalay is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Mandalay Care Home accommodates up to 46 people in one building including the use of an attached small dementia suite called the Sunflower unit. There were 40 people using the service, 10 people living in the Sunflower unit and 30 people in the main building. People cared for were all older people; some living with dementia and some who could show behaviours which may challenge others. People had a range of care needs, including diabetes. Some people needed support with all personal care and some with eating, drinking and their mobility needs, while other people were more independent.

Bedrooms are situated over three floors and can be accessed by the passenger lift; the premises are suitable for people with physical mobility problems. People had access to assisted bathrooms and a dining room/lounge/conservatory and enclosed rear garden.

The registered manager worked at the service each day and was supported by a deputy manager. A registered manager is a person who has registered with CQC 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 comprehensive inspection on 4 and 5 April 2017 the overall rating of the service was, ‘Requires Improvement’. We found there was one breach of the regulations. This referred to shortfalls in the systems and processes intended to check and improve the quality service provided. That inspection also identified other shortfalls about the management of mattresses and equipment intended to help protect people at risk of skin damage. There was also underdeveloped guidance for staff about how to support some people whose behaviours could challenge.

We asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions of Safe and Well-Led to at least ‘Good’.

At this inspection, improvements in monitoring and resolving problems in the running of the service resulted in sufficient progress to meet the previously breached regulation. However, we concluded that more progress was still needed to ensure these processes were fully embedded so that consistency of records and development of the service was maintained. Previous areas identified as requiring improvement, about mattress equipment and guidance for staff, had suitably improved. However, we identified other areas requiring improvement relating to the safe storage of an oxygen cylinder and some medicine records checks. These were resolved on the day of the inspection.

People were protected from harm by staff who were trained to recognise signs of abuse. Where risks to people were identified, staff acted to minimise them. There were enough staff to meet people's needs and staff were recruited safely. Medicines were stored, given to people as prescribed and disposed of safely by properly trained staff. People were protected from the risk of infection by robust prevention and control measures. Analysis and reflective practice meant lessons were learned when things went wrong.

People's needs were assessed before they moved into the service. These needs were met by staff who had the skills and knowledge to deliver effective support. People were supported to eat and drink enough to have a balanced diet, including those with complex health needs. People were supported to have healthier lives by having timely access to healthcare services. People lived in an environment which was suitable for people living with dementia. People were supported to have maximum choice and control of their lives, staff supported them in the least restrictive way and the policies and systems in the service reflected this practice.

People received a service which was caring, they were treated with dignity and respect. Staff were compassionate and caring, this was commented upon positively by people and their visitors. Staff treated people's private information confidentially. People, where possible, made decisions about how their care was provided and were involved in reviews of their care together with people important to them.

Care was personalised to people’s individual needs and preferences. A range of activities were

available for people to participate in if they wished and people enjoyed spending time with staff. Staff knew people's interests and needs well. There was a complaints policy available to people. Staff were open to any complaints and understood that responding to people's concerns was a part of good care.

People and staff were positive about the culture of the service, people and relatives felt the staff team were approachable and polite. The staff team worked with other organisations to make sure they followed current good practice. Maintenance records for equipment and the environment were up to date. Policies and procedures had recently been updated and were available for staff to refer to. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and were always made to feel welcome and involved in their relative’s care. People were supported at the end of their life to have a dignified and comfortable death.

The provider's vision and values were embedded into the service, staff and culture. Governance systems were largely effective in ensuring shortfalls in service delivery were identified and rectified. The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

There were 39 people living at the service at the time of our inspection. There is a small separate dementia unit in the service called the Sunflower unit. There were eight people living in the Sunflower unit and 31 people in the residential unit. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. People were living with a range of care needs, including diabetes. Some people needed support with all of their personal care, and some with eating, drinking and their mobility needs.

Bedrooms are spread over three floors, these can be accessed by the use of a passenger lift; the premises are suitable for people with physical mobility problems. People had access to assisted bathrooms and a dining room/lounge/conservatory. There is parking to the front of the property and further on street parking available nearby.

The service has an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 previous inspection was carried out in April 2016 and concerns relating to storage of medicines, Deprivation of Liberty Safeguarding authorisations had not been applied for where people were unable to consent to restrictions in place; and mental capacity assessments did not meet with the requirements of the Mental Capacity Act 2005 and auditing of the service provided had not been wholly effective.

At this inspection we found actions had been taken to make these improvements, however, some areas required further improvement. There were shortfalls around some record keeping and checks to ensure pressure reduction mattresses were operating at correct pressures.

Although staff were able to tell us how some people with more challenging needs should be supported, records of how this should be done were not always complete which introduced a risk of inconsistency about how support should be provided.

Some measures identified in audits had not been introduced and processes intended to assess the quality and safety of the service had not always had the required effect.

Medicines were correctly stored and proper processes and checks were in place to ensure they were correctly administered.

A survey of people living in the service found they felt safe. Staff knew how to recognise signs of abuse and how to report it. They told us how they protected people from financial abuse and supported people to be safe.

There were enough staff on duty to support people, proper pre-employment checks had taken place to ensure that staff were suitable for their roles.

Assessments had been made about physical and environmental risks to people and actions had been taken to minimise these. There were low levels of incidents and accidents and these were managed appropriately with action or intervention as needed to keep people safe.

Equipment including the electrical installation, gas safety certificate, portable electrical appliances, fire alarm and fire fighting equipment were checked when needed to help keep people safe. The service was well maintained and comfortable.

The registered manager had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards. They understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were protected and upheld.

New staff underwent an induction programme and shadowed experienced staff, until they were competent to work on their own. There was a continuous staff training programme, which included courses relevant to the needs of people supported by the service.

Care plans were reviewed regularly and included the views of people and their relatives or advocates when needed. Staff showed an awareness of people’s changing needs and sought professional guidance.

People were able to choose their food each meal time, snacks and drinks were always available. The food was home-cooked. People told us they enjoyed their meals, describing them as “lovely” and “home cooking”.

The service was led by a registered manager who worked closely with the care team and provider. Staff were informed about the ethos of the service and its vision and values. They recognised their individual roles as important and there was good team work throughout the inspection. Staff showed respect and valued one another as well as people living at the service.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. We also identified other areas where improvement was required and made recommendations the service should adopt.

There were 40 people living at the service at the time of our inspection. There is a small separate dementia unit in the service called the Sunflower unit. There were ten people living in the Sunflower unit and 30 people in the residential unit. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. People were living with a range of care needs, including diabetes. Some people needed support with all of their personal care, and some with eating, drinking and their mobility needs.

The service had a registered manager in post. A registered manager is a person who is 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.

Mandalay Care Home was last inspected on 21 and 22 July 2014, when concerns were identified about a lack of risk assessments and guidance for staff about how to support people safely and ineffective support for some people at meal times. The provider sent us an action plan telling us how they had addressed these shortfalls.

At this inspection we found required improvement had been made in these areas. However, we identified other shortfalls where some regulations were not being met.

Medicines were not stored at below the maximum temperature; records showed this was a longstanding problem that had not been resolved.

Deprivation of Liberty Safeguarding authorisations had not been applied for where people were unable to consent to restrictions in place; and mental capacity assessments did not meet with the requirements of the Mental Capacity Act 2005.

Auditing, carried out for the purpose of identifying shortfalls in the quality and safety of the service provided, had not been wholly effective.

Management of water within the service, intended to safeguard against the development of Legionella, did not fully meet with the requirements of the services’ policy. Other checks were in place to limit the risk of Legionella; however, we made a recommendation that the measures set out in the services’ policy are fully adopted.

People’s health needs were well managed and referrals to outside healthcare professionals were made in a timely way.

People were supported by enthusiastic staff who received regular training and appropriate supervision. There were enough staff to meet people’s needs.

Staff were caring, compassionate and responsive to people’s needs and interactions between staff and people were warm, friendly and respectful. Staff spent time engaging people in communication and activities suitable for their current needs.

People enjoyed their meals, they were supported to eat when needed and risks of choking, malnutrition and dehydration had been adequately assessed and addressed.

People commented positively about the openness of the management structure and were complimentary of the staff.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection, we found that the home had undertaken a detailed review of the fire risk assessment to identify the fire safety arrangements that were required to minimise risks to people, staff and visitors. We found that the home had taken action to implement a range of measures and procedures in accordance with the requirements of the fire risk assessment, including fire safety checks and tests that were clearly recorded.

We found that records were kept to identify the checks and tests that were regularly undertaken of the hot water temperatures in the home, to help protect people from the risks of scalding.

We found that the home had introduced detailed staff training records that identified a range of training that had been undertaken since our last inspection. Staff told us that their training was up-to-date and that they felt able to support people appropriately and in accordance with their needs. A visitor to the home told us 'staff are well trained'.

We spoke with eight people who used the service, and three visiting relatives. People we spoke with who used the service told us that they were happy with the care and support they received and their comments were mostly positive. One person said 'they treat me very kindly and are very patient with me'. A visiting relative told us 'the manager is very approachable; I felt involved from the start'.

We looked at people's care plans and saw that they were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

We found that people who lived in the home were happy with their accommodation. However, we had some concerns about the fire risk assessment and safety testing of the premises. We also had some health and safety concerns regarding the laundry facilities within the home.

We found that staff had supervision and they told us that they felt supported by the manager. We found that staff had undertaken most of the training needed to keep their skills and knowledge up to date. However, we found that some important training was overdue at the time of our inspection and training records had not been fully completed.

We found that the manager had introduced a range of checks and audits to monitor cleanliness and the quality of the service provided for people who lived in the home.