Maycroft Care Home is a residential care home that provides accommodation and personal care for 25 older people with dementia or a physical or sensory impairment. There were internal and external communal areas for people and their visitors to use. The service is situated over two floors and these were accessible by stairs or a passenger lift.

Maycroft Care Home 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.

At our last inspection on 18 February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post at the time of this 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.

People were supported by staff who knew about safeguarding and its reporting processes. Risk assessments were in place as guidance for staff to support and monitor people’s assessed risks. People’s care records were held securely to ensure confidentiality. People had technology in place to help assist them to receive safe care and support.

Staff had been recruited safely prior to working at the service. People’s needs were met as there were enough staff with, right skills and knowledge. Staff were trained to meet people’s care and support needs. Actions were taken to learn any lessons when things did not go as planned.

People’s medicines were administered as prescribed and managed safely. Systems were in place to maintain infection prevention and control.

People were involved in their care decisions and staff promoted people’s independence as far as practicable. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported with their eating and drinking to promote their well-being.

Staff supported people to access external healthcare services. Staff worked with other organisations to help ensure that people's care was coordinated. Staff also worked with other external health professionals to make sure that peoples end-of-life care was well managed and dignified.

People received a caring service by staff who knew them well. People’s privacy and dignity was maintained by staff.

Activities were in place to support people’s interests and well-being, including links and trips out to the local community.

Compliments were received about the service and people were happy with how their complaints were managed as any complaints were responded to and resolved where possible.

The registered manager led by example and encouraged an open and honest culture within their staff team. Audit and governance systems were in place to identify and drive forward any improvements required. The registered manager and their staff team worked together with other organisations to ensure people’s well-being.

Further information is in the detailed findings below.

Maycroft Care Home is a care home that provides accommodation and personal care to up to 25 older people, some of whom are living with dementia. It is not registered to provide nursing care. There were 23 people living at the home at the time of this visit. There are internal and external communal areas, including a lounge and separate dining area, a garden and court yard for people and their visitors to use. The home is made up of two floors which can be accessed by stairs or a lift. All bedrooms have a hand wash basin. There are two communal bathrooms and a wet room for people to use.

This unannounced inspection took place on 18 February 2016.

There was a registered manager in place during this 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 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. Where people had been assessed as lacking capacity to make day-to-day decisions, decisions were made in their best interest. Applications had been made to the local authorising agencies to lawfully restrict people’s liberty where appropriate. Staff demonstrated to us that they respected people’s choices about how they wished to be supported. Staff were able to demonstrate a sufficient understanding of MCA and DoLS to ensure that people would not have their freedom restricted in an unlawful manner.

Plans were put in place to minimise people’s identified risks, to assist people to live as independent and safe a life as possible. Arrangements were in place to ensure that people were supported with their prescribed medicines safely. People’s medicines were managed and stored appropriately. People’s nutritional and hydration needs were met. Records were in place for staff to monitor people’s assessed risks, care and support needs.

When needed, people were referred and assisted to access a range of external health care professionals. People were supported to maintain their health and well-being. Staff supported people with their interests and to maintain their links with the local community to promote social inclusion. People’s friends and families were encouraged to visit the home and staff made them feel very welcome.

People were supported by staff in a caring and respectful manner. People’s care and support plans gave guidance to staff on any individual assistance a person may have required. How they wished to be supported and what was important to them.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, competency checks and appraisals. This was to ensure that staff were competent and confident to deliver people’s support and care.

Staff understood their responsibility to report any poor care practice or suspicions of harm. There were pre-employment safety checks in place to ensure that all new staff were deemed suitable and safe to work with the people they supported. There was a sufficient number of staff to provide people with safe support and care.

The registered manager sought feedback about the quality of the home provided from people, and their relatives as they were able to raise any suggestions or concerns that they had with the registered manager and staff and they felt listened to.

Staff meetings took place and staff were encouraged to raise any concerns or suggestions that they may have had. Quality monitoring processes to identify areas of improvement required within the home were in place and formally documented any action required.

An adult social care inspector carried out this this inspection on 01 August 2014. The purpose of this inspection was to follow up on a compliance action made at the last inspection on 15 April 2014. The focus of this inspection was to answer one of our five key questions; is the service safe?

As part of this inspection we spoke with a relative visiting a family member, the manager, administrator and three members of staff. We reviewed records relating to the management of the home which included records of cleaning schedules and staff training regarding infection control. We visited the laundry room.

This is a summary of our findings. If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

Staff understood their roles and responsibilities in making sure people were protected from the risk of infection. The provider ensured that all staff were kept up to date with infection control training and were aware of the documentation to be completed regarding cleaning schedules. The premises were clean and the laundry room had undergone considerable refurbishment.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. It is based on our observations during the inspection, speaking with people who used the service; the staff supporting them and from looking at a range of records.

SAFE

We found that there were enough staff on duty to ensure that people’s needs were met safely and in a timely way. One relative commented, “There’s at least two staff on and whenever mum needs the loo, they’re there quickly”.

Most staff had received recent training in the Mental Capacity Act 2005 so that they understood their responsibility when supporting people who could not make decisions for themselves. We found that people’s mental capacity had been monitored regularly to determine whether or not they were able to make decisions for themselves.

Potential risks to people had been identified and recorded clearly in their plans of care. We saw that these risks had been reviewed regularly to ensure that people were kept safe.

We found that the cleanliness issues identified during our previous inspection in October 2013 had been fully addressed by the provider. However, we noted a number of new issues during this inspection which compromised good infection control and put people at unnecessary risk of infection. In light of this, we have decided not to take further enforcement action in light of the continued breach of the regulations, but to issue another compliance action on this occasion. We were confident that the new manager would take the required action to improve levels of cleanliness in the home’s laundry.

EFFECTIVE

We found that people’s health and well-being had been closely monitored and that they received good support both from the staff team and from a range of external health care professionals. Staff were now receiving supervision, support and training to enable them to meet people’s needs more effectively.

CARING

One GP told us, “A lot of the staff live locally and have known the residents personally and so are very caring of them.” We noted that people looked well cared for, were dressed appropriately and showed good signs of emotional well-being and activity throughout our visit. Staff treated people respectfully and with dignity.

People’s relatives had been involved in their care where appropriate, and were kept informed by staff of any changes to their family member’s care.

RESPONSIVE

People told us that staff were readily available and responded to their requests for help when needed. Throughout our inspection we saw that people’s requests for assistance were met quickly by staff.

Health care professionals told us that they received appropriate referrals from staff at the home and that staff were good at spotting and responding to people’s potential health problems.

We found that people’s complaints were thoroughly investigated and responded to in an open and professional way.

WELL-LED

A new manager had recently been appointed for the home and was in the process of submitting her application to be registered with us. She is an experienced manager and qualified nurse, who has previously been registered with us. Although only in post five weeks, she had already implemented a number of changes for the better and had a clear vision of how the home could be improved further. Staff had confidence in the new manager’s abilities and reported that their morale had improved as a result. We noted that staff supervision, training and support had increased since her arrival.

We found that there were a number of systems in place to monitor and assess the quality of service provided to people. However, the provider may wish to note that these had been ineffective in identifying serious infection control and hygiene issues in the home’s laundry.

The manager told us that all of the twenty residents who lived at Maycroft Care Home were living with dementia.

The general atmosphere of the home was very friendly and staff were welcoming. We observed that staff treated people with dignity and respect.

People we spoke with who lived in the home told us their care and support was satisfactory. A relative we spoke with was positive about the care their family member received and told us the home was: “Very homely”.

Care records we looked at showed that there was insufficient information available to staff to help them to manage possible risks to people’s health and welfare.

During our inspection we found that the standards of cleanliness and hygiene in the home were not adequate to keep people safe.

People who lived in the home were protected from the risk and likelihood of abuse.

Staff told us that they enjoyed working at the home and felt supported by their new manager. However, staff told us that some staff had not had much training to meet people’s care and support needs. The manager confirmed there were gaps in staffs’ training and told us that action had been taken to address this.

The provider had put in place some quality assurance systems to measure the quality of the service provided. However, the manager told us that some aspects of the service had not been audited recently and this would be looked at.

During our inspection on 05 February 2013, we spoke with six people who lived in the home, relatives who were visiting and with the manager and four staff. People told us they had been involved in the planning of their care. We saw that staff encouraged and supported people to be independent. One person told us, "It’s wonderful here. The Staff are lovely”

We observed staff supporting people in a kind and calm manner. Staff spoke respectfully with people. Staff told us they very much enjoyed working at the home and felt well supported by the management. They said they had been given adequate training to carry out their roles to support people to meet their care and support needs.

The organisation had systems in place to monitor any complaints and to ensure that staff received appropriate training and support.