Maybank Residential Care Home

We found the following examples of good practice:

• Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow test result, proof of vaccination against COVID-19, the requirement to show a COVID-19 pass, hand sanitisation and wearing personal protective equipment (PPE).

• Policies, procedures and risk assessments related to COVID-19 were up to date which enabled staff to keep people safe.

• Staff had received training on infection prevention and control guidance. This included updates on the use of PPE and how to put it on, take it off and dispose of it safely. There was a programme of training refreshers to ensure staff knowledge was kept up to date. Spot checks took place to ensure staff adhered to the training provided.

• The risks of potential exposure to the virus had been assessed for all staff, taking into account their individual health conditions and other relevant, personal circumstances.

• The service was clean and fresh, staff carried out a number of additional tasks, such as cleaning of any regular touchpoint surfaces. Regular infection control audits took place and actions had been followed up when required.

• Staff had been trained and knew how to immediately instigate an enhanced infection control measures to care for people with symptoms to avoid the virus spreading to other residents and staff.

• The registered manager reported good support from the local health professionals and the team at the provider's head office.

Maybank House is a residential care home for adults aged 30 and over with autism and complex needs. The service is able to support up to six people. There were five people using the service at the time of our inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large detached house with six spacious rooms situated on both the ground floor and first floor. There were communal areas for people to socialise in including a living room kitchen and dining area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People we spoke with told us they enjoyed living at Maybank House and they were happy. Comments were, “Staff have helped me through a lot they are better than the other place and “I am happy here I can choose where I go and what I do”.

People received their medicines as the prescriber intended. Where people required their medicines administered covertly; guidance was in place together with best interest decisions.

Staff we spoke with told us they had received training in safeguarding and knew what action to take if they suspected people were being abused.

Risks associated with people’s support needs had been identified and actions taken to minimise risk. Care plans reflected people’s care needs, including specific dietary needs.

We observed kind caring interactions between staff and people using the service. People were supported to attend outside healthcare appointments when required.

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 an induction when they first joined the service and regular training was completed and refreshed when needed. Staff told us they were supported and received regular supervisions.

People were able to access the community and had a range of in-house activities to do during the day. People told us they went out most days to day centres or shopping with members of staff. One person volunteered at a local shop.

There was a complaints procedure in place, and we saw complaints were responded to according to the providers policy. There were no complaints a t the time of our inspection.

The provider had an auditing system in place. Accidents and incidents were documented and reviewed as necessary.

The service applied the principles and values (consistently) of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 18 August 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.

As part of the requirements for registration with us it was necessary for a registered manager to be employed at the home. This requirement had been met. 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.

During our previous inspection in January 2016 we found breaches of Regulation 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not protected against the risks associated with unsafe or unsuitable premises and equipment because of inadequate maintenance checks and audits. Appropriate training and

competency checks had not taken place for staff. The provider had failed to assess, monitor and

mitigate the risks relating to the health, safety and welfare of people. The provider had also failed to implement the Mental Capacity Act 2005 codes of practice.

During this inspection we found there had been improvements in most areas. We had some concerns about the storage and administration of medicines. Following this inspection we were sent an action plan that addressed our concerns and systems had been put in place to ensure people’s safety was maintained. We found these concerns had occurred partly by a lack of oversight from the registered manager. As a result we have made a recommendation about best practice in relation to quality audits.

Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. Staff were trained and knowledgeable about how to protect people from abuse.

Where the provider had to impose restrictions on people’s freedom, appropriate mental capacity assessments had been completed and a Deprivation of Liberty Safeguards (DoLS) had been authorised by the local authority. 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. Records showed best interest meetings had taken place to ensure decisions made on behalf of a person were made with their best interest in mind. People were supported with food and drinks to ensure they remained hydrated and their health was maintained. When people became unwell, the provider ensured appropriate medical and psychological help was sought. Advice given by specialist health professionals was followed by staff.

We observed staff to be kind and considerate in their support with people. People appeared happy and relaxed in the company of staff. We saw positive interactions between both parties. Where people were able to, they were involved in identifying their needs and planning their care. Where people required the assistance of an advocate or family member this was facilitated by the service.

We observed staff treating people in a respectful and dignified way.

People’s care was personalised to their individual needs. Records showed how staff were supported to assist people in their specific areas of need. Systems were being put in place to obtain feedback from people, their representatives and professionals to enable the provider to drive forward improvements to the service. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

Staff, people and their relatives spoke positively about the registered manager. Quality assurance audits were in place to identify any areas of required improvement. The registered manager was aware of the day-to-day culture of the service. There was a value-based approach by both staff and the registered manager to provide person-centred care to people.

Maybank Residential Care Home provides residential care to six adults with a learning disability. It is a requirement of the registration of Maybank that there is a registered manager in place. At the time of the inspection a registered manager was in place. 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 relatives told us the service was safe, it was well managed and people were well cared for.

Some areas of the running of the home required improvements, for example, we found audits had not been completed accurately and where actions were required these were not always acted upon in a timely way. We found some parts of the home required cleaning and that monitoring of the standards of cleaning had not always taken place. We have made a recommendation about the cleaning of the home. Other findings included hot water taps that delivered water that was above the recommended temperature and trip hazards outside the building. Audits had not identified the concerns we found.

Staff were supported to carry out their role through supervision, appraisals and team meetings.

Records showed staff received training both through e-learning and face to face training, however some training for staff was not up to date. This included areas of training such as moving and handling, first aid and safeguarding. Records showed only two staff had completed the practical moving and handling training. This meant the provider was unable to demonstrate that staff knew how to carry out moving and handling techniques safely.

The Mental Capacity Act 2005 code of practice had not been applied consistently in the home. People’s mental capacity had not always been assessed appropriately. Documents showed an attempt had been made to assess people’s mental capacity but the assessments were not decision or time specific. Where people’s liberty had been deprived a deprivation of liberty safeguard application had been made with the local authority to ensure it was lawful and in the person’s best interest.

People were supported with their nutritional needs, food and fluid were available to people, and where people needed additional support due to a risk of choking this was supplied by staff.

Staff treated people in a kind and dignified way. People appeared comfortable and relaxed in the home, there appeared to be a good rapport between staff and people. Staff understood people’s needs and responded appropriately to support people.

Each person had a care plan and risk assessments in place. This enabled staff to meet people’s needs and to know and understand each person’s likes and dislikes. We saw that the needs of one person in relation to their skin integrity were not recorded in their care plan, which placed them at risk of harm.

The provider had a complaints policy in place, but no complaints had been received in the last year. The provider also sought feedback from people, relatives, staff and visiting professionals on how the home provided care and what improvements could be made. Where points were raised that could lead to improvement an action plan was in place.

From our observations people appeared to be well cared for and happy living at Maybank Residential Care Home.

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.

People could be supported in giving feedback or making complaints as staff were informed about the complaints procedure and how to support people in making a complaint.