Archived: Maxey House Residential Home

We found the following examples of good practice.

Staff changed into their uniform and put on their personal protective equipment (PPE) before starting work.

All professionals have their temperature checked when entering the building and are escorted to the person they are coming to see.

End of life visits were arranged with a family member accessing their relatives room using the nearest entrance and exit to reduce meeting people in corridors where possible.

Where people needed to isolate due to having COVID -19 symptoms or positive COVID-19 test a member of staff moved in to the service to provide care and support. This ensured that there was less risk to others in the service.

The service looked clean. Staff cleaned frequently touched areas such as handrails, chairs, tabletops, handles and furniture.

Maxey House Residential Home is a residential care home providing personal care to 27 people at the time of the inspection in one adapted building over two floors. The service can support up to 31 people.

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

Staff followed the systems in place to monitor and manage people’s risks and keep people safe from avoidable harm. Staff used their training and knowledge to prevent the spread of infections. Staff who had been trained and were competency checked, managed and administered people’s prescribed medicines safely.

Staff received training, supervisions and appraisals from the registered manager to develop their skills and knowledge. Staff were encouraged and supported to give people a good-quality service. Checks were made to monitor the quality of care being given including provider visits to the service. Any actions required were either completed or on-going. This included a roiling programme of maintenance work and redecoration to the building.

Staff treated the people they supported kindly and with patience. People and their relatives had positive opinions of the staff and registered manager who cared for them. Staff promoted and maintained people’s privacy and dignity. People enjoyed the activities that went on at the service. Links were established with the local community and relatives and people from the community were encouraged to attend events held at the service.

People were supported to eat and drink enough amounts and were involved in making decisions about their care. Staff gave and respected people’s choices. Their preferences on how staff delivered their care was recorded in care records for staff to follow.

No complaints had been received since the last inspection, but people and their relatives told us they knew how to raise any concerns. People, their relatives and staff were given opportunities to give their view of the service and from this feedback action was taken to make any improvements.

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

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 7 December 2018). 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 regulation.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Maxey House Residential Home provides personal care and support to up to 31 older people, some of whom live with dementia. At the time of our inspection there were 28 people in one adapted building, being supported by staff.

At our last inspection on 17 June 2016 we rated the service ‘Good’. At this unannounced inspection we found evidence from our inspection that demonstrated risks or concerns. This was in relation to CQC not being notified of incidents that the provider is legally obliged to notify us about. We also had concerns over the decoration of the building in areas, suitably skilled staff available for all shifts and the suitability of the laundry area and safe medication support. The overall rating of the service has changed since our last inspection to ‘Requires Improvement.’

The service had a registered manager in post. 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 registered manager had failed to notify the CQC about important events such as serious injuries and safeguarding concerns which the provider is required to send us.

Staff implemented infection control processes to reduce the risk of infection. However, the laundry room had no sink for staff to wash their hands in immediately after handling items requiring laundering. This increased the risk of cross contamination.

Adaptations had been made to the building to meet people’s needs. However, areas of the building needed repair or redecoration. This was because we found broken windows boarded up, a curtain hanging down from a curtain rail, large cracks in plasterwork and marked paintwork.

People were supported by enough staff who were recruited safely. However, we have made recommendations that the provider seeks advice and guidance to ensure that the right skills mix of staff are available to support people using the service safely.

Most people’s medicines were managed safely and people received them promptly. However, risk assessments looking at potential risks to people, without taking away each person’s right to take risks, were not always in place. This increased the risk of unsafe medicines management.

People's confidential information was stored securely. People were supported by enough staff who were recruited safely. However, we have made recommendations that the provider seeks advice and guidance to ensure that the right skills mix of staff are available to support people using the service safely. Staff received an induction, training, supervisions and appraisal. Staff felt supported by the registered manager.

People and visiting relatives told us that staff were caring and kind. People’s privacy and dignity was promoted and maintained by staff. Visitors to the service were made very welcome.

People were supported by staff who knew how to recognise and report any discrimination and risks to people’s well-being. Accidents and incidents were reviewed and actions put in place and were shared with staff, to help reduce recurrence.

People were happy with the activities that were offered, but when activities staff were not available, there was a lack of activities to engage people. The provider encouraged people to fulfil their wishes with special outings organised.

People enjoyed a variety of food and drink that met their dietary needs. There was appropriate access to external health and social care professionals. Staff had an understanding of the Mental Capacity Act 2005 and adhered to its principles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and relatives of people said they were involved in the care and support plans and that these met their, their family members, needs. Care and support plans were personalised and gave information from the person’s view-point to guide staff. People were supported at the end of their life with compassion and care.

People and their relatives were positive about the registered manager and the staff. Complaints received were responded to and resolved where possible. The views of people and their relatives were sought and these views were considered to ensure improvement. The service worked in partnership with other organisations such as the local GP practice and district nurses to provide people with joined-up care.

The registered manager monitored the quality of the service provided. However, provider visits to the service and any improvements found needing identified during these visits, were not recorded nor an action plan created to monitor any actions taken.

As a result of our findings we found 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.

This unannounced inspection took place on 16 May 2016. There were 29 people receiving care at that time.

The last registered manager cancelled their registration with the Care Quality Commission (CQC) in April 2016. 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. A new manager took up post on 1 March 2016. They were present throughout the inspection and told us they had almost completed their application to be the registered manager and would submit this to CQC shortly.

There were sufficient staff to ensure people’s needs were met safely. However, people were put at risk because not all pre-employment checks had been obtained prior to staff working with people.

Staff were well trained, and well supported, by their managers. Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People received their prescribed medicines appropriately and medicines were stored safely. People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Staff respected people choices and staff were aware of the key legal requirements of the MCA and DoLS.

People received care and support from staff who were kind, caring and friendly to the people they were caring for. People were involved in every day decisions about their care.

Care records were detailed and provided staff with sufficient guidance to provide consistent care to each person. Changes to people’s care was kept under review to ensure the change was effective. There were various organised and impromptu activities for people to join in with in groups or on their own.

The manager was supported by a staff team that including care workers, and ancillary staff. The service was well run and staff, including the manager, were approachable. People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on. Concerns were thoroughly investigated and plans actioned to bring about improvement in the service.

The provider and manager had implemented innovative measures to try to improve people’s quality of life.

Below is a summary of what we found. The summary describes the number of different methods we used to help us understand the experiences of people using the service. We looked at records; we undertook observations throughout our visit, we spoke with five people and one relative of a person using the service and three staff members. We also spoke with the registered manager and owner of Maxey House Residential Home during our visit.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

In the three out of 27 people's care records we looked at we saw that risk assessments regarding people's individual support and care needs were carried out and that measures were in place to minimise those risks.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The provider informed us that no applications had been made to date and we saw that staff training was undertaken and proper policies and procedures were in place.

The provider was able to demonstrate to us that necessary safety checks were undertaken prior to a new staff member being deemed suitable to work with vulnerable people.

Is the service effective?

People living in this home and their relatives made positive comments about the care people received. One relative told us that, 'Staff will listen if a concern is raised. Communication is good.' From our observations and on speaking to staff we saw that staff understood people's care and support needs.

Is the service caring?

Our general observations demonstrated to us that people were supported by kind staff. One person we spoke with told us that they were, 'Happy here. (I'm) settled' Another person said that, 'Staff speak nicely and are polite.' We observed that people were supported by staff at a pace that they were comfortable with and did not appear rushed.

Is the service responsive?

People's care records we looked at confirmed people's interests and preferences and we saw that people's diverse needs had been recorded. We found that the care and support met people's wishes.

The home encouraged visitors to help support people maintain relationships with their relatives and friends and we saw that people had access to activities should they wish to take part.

Since our previous inspection which we carried out on 25 February 2014 we found that the main bathroom which was poorly presented now had a new floor which had turned it into a wet room. Work on replacing the bath to a new bath was still on-going.

Is the service well-led?

People we spoke with told us how staff assisted them with the care and support that they had agreed to.

We found that quality monitoring systems were in place so that people were listened to and were safe from the risk of unsafe and inappropriate support and care.

People using the service and their relatives were asked for their feedback on the service provided. People we spoke with said that they were aware of how to raise a concern and that they would be confident that they would be listed to.

Maxey House Residential Home is regulated as a care home service without nursing. During our inspection we spoke with the owner and registered manager about whether the homes other regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury were correct. The owner and registered manager agreed that they do not undertake these regulated activities and that they will amend their registration to only include the regulated activity ' Accommodation for persons requiring nursing or personal care.'

Staff had consulted with people who used the service (and their representatives) about what assistance was to be provided. This helped to ensure that their dignity and independence were promoted.

People said they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe and responsive way.

People's medication was managed in a safe and reliable way.

People who used the service, staff and visitors were not fully protected against the risks of unsafe or unsuitable premises.

There were enough qualified, skilled and experienced staff to meet people's needs.

Quality checks had been completed to help ensure that people safely received all of the care they needed.