Maitland Park Care Home

Maitland Park Care Home is a residential care home providing personal and nursing care to up to 60 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 52 people using the service.

The service is spread across three floors and comprised of six units. People had en-suite facilities and access to communal lounge/dining areas on each floor. People also had access to outdoor paved areas.

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

We found shortcomings in relation to how the service managed medicines. There was a risk people did not always receive their medicines as prescribed.

The service assessed risks to people but risk assessments were not always consistent. Some risk assessments lacked details and staff did not always follow guidance from existing risk assessments.

Staffing levels were assessed regularly but were not always appropriate. Some of the feedback we received from people, relatives and staff suggested that there were times when not enough staff were on shift.

People’s eating and drinking needs were catered for but not everyone was satisfied with the meals they received.

People felt safe at the service, and staff understood their responsibilities regarding safeguarding people from abuse and improper treatment. Processes were followed to protect people from the risk of catching and spreading infections.

People’s needs were assessed and care was delivered in line with best practices. Staff supported people to have access to healthcare services when they needed them.

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 the support they needed to perform their roles.

People received individualised care and were encouraged to make decisions about their care. Staff were kind to people and treated them with respect. Staff helped people to be more independent where possible.

Staff were responsive to people's needs. A variety of activities were provided to people to reduce social isolation.

There was an open and inclusive culture at the service. People, relatives and staff spoke positively of the management and the support they received. The team worked in partnership with healthcare services and other professionals to achieve good outcomes for people.

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 16 February 2021) and there were 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 the provider remained in breach of regulations, and their rating remained requires improvement.

At our last inspection we recommended that the provider arranges further training and ongoing supervision for staff on safeguarding, and assesses and reviews the level of staff deployed to support people at the home. At this inspection we found the provider had improved staff training and supervision, but staffing levels remained an issue.

This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Recommendations and enforcement

We have identified two continued breaches of regulations in relation to safe care and treatment and the governance of the service.

We have made two recommendations. These were in relation to staff deployment and supporting people with eating and drinking.

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 also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Maitland Park Care Home is a care home providing personal and nursing care for up to 60 older people some of whom live with dementia. At the time of the inspection, there were 46 people using the service. The accommodation was provided across three floors, with communal areas located on each floor.

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

We identified several shortfalls during this inspection. More improvements were needed to ensure the home met requirements of previously identified breaches in person-centred care and the governance of the home. However, we saw that the managers were working towards making positive changes at the home. A range of improvement and contingency plans were in place to ensure effective progress. This progress had been slowed down by the COVID-19 pandemic and focus on improving staff dynamics at the home. Additionally, the managerial oversight was reduced with the management team only including the registered manager and periodic support from the senior management team. This had been now addressed as the new deputy manager had been employed. The registered manager informed us that improvement in all identified areas of concern would recommence in January 2021.

At this inspection we identified the staff culture at the home was not always open and transparent. Staff needed to improve how they dealt with matters of concern related to people's safety, care and treatment. We identified staff had not always taken prompt action to ensure people received safe care and they had not always felt comfortable raising concerns when they saw poor practice from their colleagues. The managers were aware of these issues and were acting to support all staff to move towards a shared vision of a person-centred, opened culture at the home. Most staff responded positively and they told us morale was improving.

Family members gave mixed feedback about staff working at the home saying that while some staff were nice and caring, others were less friendly. People and external professionals spoke positively about staff who supported people.

We found medicines at the home were not always managed safely. Improvements were needed to the management of PRN (as required) medicines, creams and ointments, sharing information on medicines administered by external professionals and acting when medicines overly affected people. The provider also needed to assess the risks related to people receiving medicines.

People’s care plans needed to improve to provide staff with person-centred information on how to meet the specific needs of individual people. At the time of our inspection, the provider was in the process of introducing electronic documentation for planning and delivering care. The aim was to reduce the amount of difficult to navigate paperwork and to ensure care plans fully reflected people’s individual needs.

The provider needed to improve systems and procedures related to effective gathering, recording and sharing information about people’s care, task allocation during shifts and effective communication with family members.

Staffing arrangements needed a further review to ensure enough staff were deployed during each shift. Although staffing levels were reviewed regularly to match people’s needs staff told us they had not always had enough time to complete the required care tasks and have time for needed breaks when working. This could affect the quality of care provided.

The managerial oversight had improved since our last visit. Shortfalls had been mostly identified through a range of the quality assurance systems and reflected in improvement plans. Further work was needed to develop additional processes and procedures to ensure the best quality of care and customer support across all areas of service delivery.

The registered manager received positive feedback from all stakeholders including people, most family members, staff and external professionals. We saw they had a good understanding of the governance at the home as well as shortfalls and how to address them.

New staff were recruited safely. Risks to people’s health and wellbeing (with exception to risk around medicines administration) were regularly assessed. Staff had good knowledge of identified risks and allowed people to make risky decisions about their care where appropriate.

The home environment was well maintained. It was clean and in good order. The provider had a process for reporting, recording and effective analysis of accidents and incidents. There were appropriate systems in place to prevent and control the spread of infection. This included additional measures related to reducing the risk of COVID-19 infection and spread.

At the time of our visit, the atmosphere in the home felt calm and peaceful. Staff and residents seemed to be cheerful, however many people longed to see their relatives who they could not see due to Covid-19 pandemic. The home was in the process of arranging rapid COVID-19 testing for family members to enable people to see their loved ones while the pandemic continued.

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 03 September 2019) and there were two 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, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns about the culture at the home that increased the risk of harm to people. As a result, we undertook a focused inspection to review the key questions of the safe and well-led domains. We also reviewed the previous breach in effective domain.

The overall rating for the service has remained the same. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

Enforcement

We have identified a new breach with the management of medicines and two continuous breaches in relation to person-centred care and the governance of the service. We made two recommendations about safeguarding, staffing levels.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will request an action plan for 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 re-inspection approach. If we receive any concerning information we may inspect sooner.

Maitland Park Care Home is a care home providing personal and nursing care to 60 older people some of whom live with dementia. At the time of the inspection there were 57 people using the service. Accommodation was provided across three floors, with communal areas located on each floor.

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

We found there was not always effective management oversight of the nursing needs of people living in the residential unit.

Some people’s care plans lacked sufficient detail including guidance to show that their specific medical needs were being met by the service. Therefore, staff might not have the information they needed to provide people with effective and responsive personalised care and support.

There was a lack of consistency and quality regarding the completion and management of documentation associated with wound care. This information was not easily accessible. Records did not always show that staff had a good understanding of how to use a tool for assessing people’s risk of malnutrition.

The provider’s quality monitoring systems had not identified and addressed the shortfalls we found. However, following our feedback management staff were responsive and changes to improve the service for people were implemented.

People were offered a choice of meals.

Staff knew how to recognise and report any concerns to do with people's welfare. The home was clean and safely maintained.

People were supported to have the relationships that they wanted with family and friends.

People had access to a range of healthcare services. Regular health and safety checks were carried out.

The provider recruited staff carefully to ensure that staff were suitable for their role. Staffing numbers and skill mix were flexible to ensure that people’s needs were met by the service.

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 supported this practice.

More information is in the full report

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 11 September 2018). There were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The provider had addressed the deficiencies we found during that inspection. However, at this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the effective and safe key sections of this full report.

We have identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to shortfalls in the identification and provision of some aspects of personalised care and the need to strengthen auditing processes.

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

You can read the report from our last focused and comprehensive inspections, by selecting the ‘all reports’ link for Maitland Park Care Home on our website at www.cqc.org.uk.

Follow up

We will monitor the service moving forwards by ongoing monitoring, seeking an action plan and working with partner agencies until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out an unannounced, comprehensive inspection of this service on 11 and 13 July 2017. After that inspection we received concerns in relation to tissue viability care provided at the home. As a result, we undertook a focused inspection to look into those concerns. This report covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

We did not identify risks, concerns or areas for significant improvement with regards to the remaining key questions. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The home had a registered manager in post 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. The current registered manager had registered with the Commission in August 2017. The registered manager was supported by the deputy manager who was also a clinical lead at the home, the provider’s senior management team and a team of nurses, team leaders, support workers and other support staff.

Prior to our inspection we received information of concern that related to tissue viability care provided at the home and increased number of falls amongst people who used the service. Therefore, as part of this inspection we looked in detail at arrangements around skin viability care and falls prevention. We found that risks to health and wellbeing of people who used the service had been appropriately assessed. Records showed that staff were provided with guidelines on how to support people safely. These included various assessments related to skin care and the prevention of falls.

However, during this inspection we found issues around some aspects of the safety and leadership at the home. These were related to sharing important information about the care provided to people, staff knowledge of all the home’s policies and procedures and the lack of established procedures when transferring people between units within the home.

We found that information provided by the home to external monitoring bodies, such as, the local authority and the CQC, was not always fully transparent and complete.

We found the home’s representatives had not always made appropriate and prompt safeguarding referrals to respective monitoring bodies. This meant the home had not always worked closely with these monitoring bodies to fully identify and prevent, further potential harm or abuse that people could be subjected to.

The provider had a range of policies and procedures available to staff to guide them of their roles and responsibilities when providing care. However, we found that staff were not always aware of these polices. This could also lead to the lack of a unified approach in providing care across the service.

We found some issues related to the storage of controlled drugs (CDs) and discrepancies in the numbers of medicines administered and stock levels on the day of our inspection. These were addressed and rectified during and shortly after our inspection. We concluded that people received their medicines safely, however, improvements were needed in respect of how the home checked and audited medicines stock to ensure they tallied at all times.

Staff were generally content with the support they received from their line managers and their contribution to the service had been recognised. However, staff we spoke with felt that long working hours versus high needs of people using the service and limited amount of staff comfort breaks impacted on staff ability to provide high quality of care at all times.

The staffing level at the home was allocated depending on the current level of needs of people who used the service. The registered manager told us that staff numbers would be increased if the level of needs of people receiving support would become greater. People we spoke with told us that staff were busy and there was a shortage of staff.

The provider had other systems in place to help to protect people from avoidable harm. These included various health and safety checks, appropriate infection control measures and robust recruitment systems.

There were systems in place to seek feedback about the quality of service provided from people who used the service, their families and staff employed at the home. These included family and resident’s meetings, staff meetings as well as regular quality surveys for people who used the service and the staff.

External professionals spoke positively about care provided at the home. They felt staff provided good quality care to people. However, they told us that the communication from the management team about care provided to people was not always prompt or complete with information requested.

There were a number of quality checks carried out at the home. This included various audits conducted by the home's management team as well as periodic quality monitoring checks carried out by the provider’s quality team.

We found two breaches of Health and Social Care Act Regulations and made one recommendation about the management of medicines.

The service did not have a registered manager at the time of our inspection. The service had a manager who had been in place since June 2017. They had started the process of applying to become the registered manager of the service. 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’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans in place to monitor and reduce risks. People had access to relevant health professionals when they needed them. There were sufficient numbers of suitable staff employed by the service. Staff had been recruited safely with appropriate checks on their backgrounds completed. Medicines were stored and administered safely.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is law protecting people who are unable to make decisions for themselves or whom the state has decided their liberty needs to be deprived in their own best interests. We saw people were able to choose what they ate and drank.

People’s needs were met in a personalised manner. We found that care plans were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

Staff told us the service had an open and inclusive atmosphere and the manager was approachable and open. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff and relative meetings.

At our last visit, it was apparent that there problems with workplace relations at the home. Some of the staff members who had transferred were finding it difficult to adjust to changes associated with working for a new employer. There was little effective communication and staff morale was generally low.

The provider did not effectively support staff to carry out their responsibilities. We could find no records of staff receiving 1-to-1 supervision, allowing them to formally raise concerns and discuss issues relating to their employment. Seven members of staff told us they had not received supervision. Although some staff members were positive in their comments to us, others had said they planned to leave.

We had found that the provider was failing to comply with the requirements of Regulation 23 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following our inspection, the provider sent us a plan of the actions it intended to take to meet the requirements of the regulation. We carried out this visit to check that the actions had been implemented.

At this visit, we found that staff had received at least one supervision session since the last inspection. The provider told us that annual appraisals were due to commence shortly. We saw evidence that regular staff meetings had taken place and staff members we spoke with were much more positive about their experience of working at the home.

We found that the actions taken by the provider were sufficient to comply with the requirements of the regulation.

At the last inspection, we were informed that the local authority was working closely with the provider during the transition. During this visit, were we told that the local authority was continuing to provide support and guidance.

We inspected the home on the 27 and 29 November 2013. We spoke with the scheme manager, who had recently been appointed to have overall responsibility for both the care home and the extra care service. The manager of the care home was on leave. In their absence, we spoke with the provider’s project manager who was helping to set up the service. We also spoke with a number of the staff who had transferred, as well as existing employees of the provider.

People using the service commented, “It’s very nice here” and “I like it. It’s much better than the old place.” A healthcare professional told us “There were a few initial problems, but that’s to be expected. Things are settling down now.”

We saw from the results of a recent residents’ survey that some people had concerns over activities at the home and access to the community, whist others were unhappy with the meals provided. But we noted that books recording people’s views of meals also contained numerous compliments.

The provider recognised that communications between management and staff needed to be improved and was working closely with the local authority to address identified issues of concern.