This was a comprehensive inspection which took place on 11 September 2018 and was unannounced. We previously inspected Maycroft Manor on 14 and 15 December 2015 and the service was rated as good. At this inspection we found areas of practice that need improvement, and the service is now rated as requires improvement. Maycroft Manor is a ‘care home’ that provides personal and nursing care for up to 105 people, on the day of inspection there were 98 people living at the service. 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. The service is a large purpose-built premises, with private bedrooms, shared communal areas and bathrooms. Some people living at the service were living with dementia, frailty or chronic health conditions.

Medicines were not managed safely, improvements were required in relation to recording and stock control. This was an area of practice that requires improvement.

The service had quality assurance systems and processes in place to assess, monitor and drive improvements in the quality of care people received. However, systems of audit for managing medicines were not robust. This was an area of practice that needs improvement.

The service had a registered manager in post. 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.

Staff had a good understanding of safeguarding and there were systems and process in place to keep people safe. The provider ensured staff were suitable to work at the service before they started. We observed people’s needs being responded to in a timely manner. The service was clean and infection control procedures followed.

People’s needs and choices were assessed prior to people moving into the service, and they were supported to have maximum choice and control of their lives. Staff continued to support people in the least restrictive way possible. People continued to enjoy a balanced diet and remained supported to access healthcare services as and when needed.

Care continued to be personalised to meet the needs of individuals including their care, social and wellbeing needs. The provider ensured there were systems in place to deal with concerns and complaints. End of life care was considered at the service and people’s wishes were documented in their care plans.

We observed positive interactions between people and staff, staff knew people well and had built trusting relationships. People’s independence continued to be promoted, staff supported people in a dignified manner and people’s privacy continued to be respected.

People, staff and relatives remained engaged and involved in the service provided. The culture of the home continued to be positive and respected people’s equality, diversity and human rights.

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.

We undertook this unannounced focused inspection on 26 July 2016, in light of information of concern we received. The service had been confirmed as having a serious infectious outbreak. Our inspection allowed us to confirm whether a breach of the health and social care act 2008 (HASC) had taken place, in respect to how people were protected by the prevention and control of infection. It also helped us to ensure that best practice requirements were being followed by the provider.

Maycroft Manor provides care and support to people with personal care and nursing needs, many of whom were living with dementia. The home was arranged over three floors and offered residential and nursing care based on people’s particular needs and requirements. Individual units were referred to as ‘communities’. One area was a specifically designed unit which provided an environment that supported people living with dementia. The home provided care and support for up to 99 people. There were 86 people living at the service on the day of our inspection. Maycroft Manor belongs to a large corporate organisation called Hallmark Care Homes. Hallmark Care Homes provide residential and nursing care across England.

A registered manager was not in post. 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 and associated Regulations about how the service is run. The registered manager had left the service approximately two months previously, and day to day management of the service was carried out by a peripatetic manager and clinical care manager. The provider was in the process of recruiting another registered manager.

The service was clean and well maintained, with clear guidance displayed for people and staff in relation to the prevention and control of the serious infectious outbreak. People told us they understood that the service had a serious infectious outbreak and that they had been provided with information about this. They told us they understood that visiting was restricted and that there may be some temporary changes to the way their care was provided. One person told us, “They told us all about it (the outbreak), they’ve been wonderful. They have done everything they can to sort it out. It seems like they’ve gone over the top, but they have to”. The provider had also ensured that up to date and relevant information updates in relation to the outbreak were prepared and distributed to staff, visitors and people living at the service.

The provider had actively engaged with and followed guidance and protocols dictated by professional bodies such as Public Health England (PHE), Environmental Health (EH) and the local Clinical Commissioning Group (CCG) in order to contain the outbreak, and to obtain samples for screening people, staff and pets at the service.

The provider had sensitively and appropriately gathered stool samples for screening from everybody living and working at the service. Arrangements had also been made to provide specialist equipment and take isolation precautions for people who had been infected.

The provider had implemented appropriate refresher training for staff in relation to hand washing and infection control, and had also liaised with PHE to provide specific training around the effects of a serious infectious outbreak.

Effective management procedures had been put in place in light of the outbreak. A team of four managers had been put together to specifically deal with the issues in the service and to liaise with staff and external bodies. Staff told us that they felt well supported and listened to during the outbreak, and had clear lines of management and communication available to them. A member of staff told us, “Everything has been handled really well, especially around giving us good information a

Our inspection team was made up of three inspectors and a pharmacist. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with eight people who used the service and four visiting friends or relatives. We also spoke with the managing director, the regional manager, the clinical care manager, the hospitality services manager, two registered nurses, a kitchen assistant, a chef and seven care workers.

Is the service safe?

People indicated to us that they felt safe living at the home and that they were treated with dignity and respect. Risk assessments were in place for people and were regularly reviewed.

The service had a system in place to set the staff rotas, which took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required.

Medicines were stored appropriately, however associated records showed that medicines were not ordered, administered and recorded in line with regulations.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to medicines.

Is the service effective?

People’s health and care needs were assessed with them, and they or their relatives had been involved in writing their care plans. Their current health needs were reviewed and monitored regularly.

People had a choice of food at mealtimes. However, their food and fluid intake was not recorded and managed robustly. Some of the food and fluid recording had not been completed thoroughly and contained gaps. It was therefore not possible to confirm that all people’s needs were being met.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to meeting nutritional needs.

Is the service caring?

People were cared for by staff with kindness and compassion, and they were treated with respect and dignity. People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff knew people well and linked with professionals, families and friends to undertake reviews of people’s care.

People’s preferences, interests, aspirations and diverse needs had been recorded.

Is the service responsive?

People were assessed prior to admission so that staff could have a comprehensive picture of their health and care needs, likes and dislikes and cultural needs.

Care plans reflected people’s needs, choices and preferences and had been reviewed.

Is the service well-led?

The service had a registered manager in post at the time of our inspection. Staff we spoke with told us they were clear about their roles and responsibilities, and had a good understanding of the ethos of the home.

People were involved in developing the service and were supported to do so.

The service worked with other agencies and services to make sure people received their care in a joined up way.

Our inspection team was made up of three inspectors. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with four people who used the service and ten visiting friends or relatives. We also spoke with a manager, the acting regional director, a maintenance worker, two kitchen staff, eight care workers, a domestic worker, a team leader, two nurses, a hairdresser, a laundry worker and two speech and language therapists.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were being safeguarded as required.

The service was safe, clean and hygienic. Equipment had been well maintained and serviced regularly therefore did not put people at unnecessary risk. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Some staff did not know about the risk management plans that had been written for some people with particular needs. This was putting these people at unnecessary risk of harm.

The service had a system to set the staff rotas, which took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This system was not robust, there were regularly not enough care staff on duty, and the service was not managing levels of sickness and absence appropriately. This meant that people’s needs were not always met.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staffing.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

We saw that visitors were able to see people in private and that visiting times were flexible.

People’s health and care needs were assessed, but they were not always involved in writing their care plans. Some of the care plans had not been updated thoroughly and contained gaps. It was therefore not possible to confirm that all people’s needs were being met.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning and recording of care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “The staff listen to me and accept my choices”. Another person told us, “The staff are wonderful, they are all well-chosen. I think the care here is excellent”.

People who used the service, their relatives or friends involved with the service had been invited to complete a satisfaction survey, which was in the process of being analysed to identify any shortfalls or concerns.

On the whole people’s preferences, interests, aspirations and diverse needs had been recorded. However we found that care and support had not always been provided in accordance with people’s wishes.

Is the service responsive?

People regularly completed a range of activities in and outside the service . The home had dedicated ‘lifestyles’ workers, and people told us that they had regular activities planned and trips out of the home, which helped to keep them involved with their local community.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open, thorough and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance systems, records seen by us showed that identified shortfalls were addressed promptly.

Staff we spoke with told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. However, we identified some shortfalls around communication between staff, which impacted on the care being provided to people.

We inspected Maycroft Manor on the 14 and 15 December 2015. Maycroft Manor provides care and support to people with personal care and nursing needs, many of whom were living with dementia. The home was arranged over three floors and offered residential and nursing care based on people’s particular needs and requirements. Individual units were referred to as ‘communities’. One area was a specifically designed unit which provided an environment that supported people living with dementia. The home provided care and support for up to 99 people. There were 75 people living at the home on the days of our inspections. Maycroft Manor belongs to a large corporate organisation called Hallmark Care Homes. Hallmark Care Homes provide residential and nursing care across England.

A registered manager was in post. 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 and associated Regulations about how the service is run.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “Yes we are very safe here”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including diabetes management and the care of people with dementia. Staff had received both one-to-one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “I think the training is really good and it’s always encouraged. They’ve put me on an NVQ 2 course (National Vocational Qualification)”.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is good. The kitchen is basically open all day and you can always have something to eat whenever you want”. Special dietary requirements were met, and people’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the service and the community. People told us they enjoyed the activities, which included Tai Chi, quizzes, singing, exercises, films, arts and crafts and themed events, such as reminiscence sessions. One person told us, “There is lots going on, I like to go to the cinema and I love it when we have entertainers coming in. We had children from a local school performing Christmas carols in the cinema last week and it was just lovely”. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “It’s marvellous and the staff are wonderful, they do anything for you”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.