What life is like for people using this service:

• We received a number of notifications about the service which caused concern as to the standard of care that people may be receiving. When we inspected we found that while there were areas that would benefit from improvement the service met the characteristics of a good rating in all areas.

• When things went wrong the registered manager would facilitate reflective learning opportunities so that staff could consider actions and improve them in future.

• A range of activities were provided for people however due to staffing pressures there were limited opportunities for people being cared for in their rooms or in bed to participate in meaningful activities.

• The registered manager and management team had skills and qualities that complimented each other and were working towards improving support for the wider staff team through recruiting additional senior care staff and care practitioners.

• More information is in the full report below.

Rating at last inspection: Good (report published 10 August 2017)

About the service: Maypole Care Home is a residential home that was providing personal and nursing care to 60 people aged 44 and over at the time of the inspection.

Why we inspected: We bought forward the inspection in response to concerns and risks we were aware of from information supplied by the provider and third parties. Areas of concern raised included would care and skin integrity, personal care, cleanliness of the premises, medicines and nutrition.

Follow up: We will follow up on this inspection as per our re-inspection programme, and through ongoing monitoring of information received about the service.

The inspection took place on the 17 and 18 July 2017 and was unannounced.

Maypole Care Home provides accommodation and nursing care for up to 68 older people, some of whom may have mental health needs or have a physical disability. At the time of our inspection 64 people were living at the home.

The service had a registered manager. 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.

There were sufficient numbers of staff deployed to meet people's individual needs. New staff had been employed following robust recruitment and selection procedures and this ensured that only people considered suitable to work with vulnerable people were working at the home.

Since our previous inspection we found improvements had been made in relation to staff training, support and supervision.

People received end of life care to a good standard and the staff had strong working relationships with external healthcare professionals.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns.

The registered manager, care staff and nursing staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff were supported by the registered provider and registered manager, and felt that they were valued.

Staff had received induction training when they were new in post and told us they were happy with the training provided for them.

Medicines were stored, recorded and administered safely.

People told us that staff were caring and that their privacy and dignity was respected. They said that they received the support they required from staff.

People's nutritional needs had been assessed and people told us they were very happy with the food provided. People’s individual food and drink requirements were met.

Complaints made to the home had been thoroughly investigated and people had been provided with details of the investigation and outcome.

There were systems in place to seek feedback from people who lived at the home, relatives and staff.

People were supported to participate in a variety of activities.

Staff, people who lived at the home, relatives and a social care professional told us that the home was well managed. Quality audits undertaken by the registered provider and registered manager were designed to identify any areas of improvement to staff practice that would promote people’s safety.

We carried out this out this inspection of the Maypole Nursing Centre because we had received information of concerns. It was alleged that people living at the home had not received the care and treatment they required and hygiene and cleanliness standards at the home had not been maintained.

At the time of our inspection visit there 44 people accommodated at the home. During our inspection we spoke with 16 people who lived at the home in order to hear about their experiences of living there. We spoke with two visitors to hear their opinions about the care and support their relative received. We also received feedback from a relative and healthcare professionals.

We spoke with several members of staff. They included three cleaning staff, one laundry assistant, four registered nurse and eight health care assistants. We also spoke with the home’s manager and a quality manager. This was in order to obtain views about the sufficiency of staffing levels at different times of the day and how infection control and hygiene standards were maintained.

We took the opportunity to speak with a GP from a local surgery who regularly visited the home to hear what they had to say about the care people received.

At this inspection we looked at care and welfare of people, safeguarding people form abuse, infection control, medicines, staffing, the process for assessing and monitoring the quality of service and records.

We used the information to answer the five questions we always ask:

Is the service caring?

Staff were seen to support people in a kind, caring and compassionate way. People told us the staff were “very kind”. Visitors told us their relatives were “very well looked after”. We were told the staff were “lovely” and took good care of their relatives. A person told us “they (the staff) look after you very well”. We observed staff supporting people with their meals, this was carried out in a respectful manner and people were not rushed. We also observed friendly interaction between the staff and people using the service.

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Is the service responsive?

People were supported to access healthcare services as required. People said they were seen regularly by a doctor an “it is never a problem to access medical help. The service was not always responsive to people’s changing needs. The staff did not always carry out reviews of people's care plans and action taken to address any changes in their needs.

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 arrangements for the planning and reviewing people's care to meet their needs.

Is the service safe?

The provider’s systems for maintaining cleanliness and hygiene and prevent and control the spread of infections were not effective. Consequently the safety and welfare of people living and working at and visitors to the home had been compromised.

The care and medicines management were not adequate. People were not protected against the risks associated with medicines and put them at risk to their welfare.

There were mostly sufficient staff to meet the needs of people using the service.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received appropriate training in safeguarding vulnerable adults and we found the manager had responded appropriately to an incident of potential abuse.

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 safe and effective management of people's medicines and the prevention and control of infection.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager told us there was no one who was receiving care, under this safeguard at the time of our inspection.

Is the service effective?

The service was not always managed in an effective way. Care planning was not adequate in order for people’s needs to be met effectively. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning and reviews of people's needs.

Is the service well led?

There were systems in place to check the provider’s procedures were followed, they included audits to assess risks to people’s welfare. However where shortfalls in care had been identified by these checks, action plans put in place to remedy them had not been implemented. People’s records were not managed safely and securely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing the quality of the service provision and the safe maintenance of staff and people's records.

We carried out an inspection to follow up on the compliance actions which were set following our inspection in March and June 2013. During those inspections we found people did not receive adequate information in order to make an informed choice about their care and treatment. People’s privacy and dignity were not always respected when receiving care. Some of the care and support plans did not contain the relevant information about people’s needs such as moving and handling and falls. The staff were not following the safe handling of medicines procedures and ensuring named medicines were not used for other people. Records were not stored in a secure and accessible way and could not be located quickly when needed.

During this inspection, we spoke with 11 people, three relatives, seven staff, and the manager. To help us to understand people's experiences of the service we observed the care people were receiving at different times of the day. A person said the care was "very good" and the staff looked after them well. We observed staff supporting people in a respectful manner. People’s privacy and dignity was respected. A person said they had lived at the home for a number of years and “I have everything I need here”. A visitor commented the staff looked after their relative “very well”. Another visitor said “things are improving”.

Care plans contained adequate information to enable the staff to provide care. Risk assessments had been completed and action plans were in place to assist in safe delivery of care.

Arrangements were in place for the management of people’s medicines. Prescribed medicines were available to people and medicines were stored safely and securely.

Records were stored safely and they were updated at regular intervals to ensure they remained current and up to date.

We carried out a follow up inspection to check on the actions that the provider had taken following an inspection on 14 March 2013. We spoke with the staff and three people using the service. We looked at the arrangements for the management of people’s food and fluids. We spoke to management and staff about the staffing levels and observed care and support people were receiving.

We found people were receiving support with their food and fluids to meet their needs. A review of staffing had been undertaken and we observed call response times had improved. People's records were not always maintained accurately and were not fit for purpose.

To help us to understand people’s experiences of the service we spoke with twelve people who use the service, five relatives and eight staff who were providing care to people. During the visit we observed how people spent their time, the support they received from the staff and whether they had positive outcomes. Four people told us they were satisfied with the care they were receiving. Three people told us they were offered choices with the activities of daily living.

We found people's privacy and dignity was not always respected. Relatives had raised concerns about privacy and dignity as they felt at times this was not managed properly. People and their relatives told us the staff were “helpful and kind” and they “tried their best”. We were told staff shortages in the last few weeks had impacted on the care people received. We saw staffing levels were not sufficient to meet people's needs. This led to long delays in receiving care and support when they pressed their call bells. There were long periods of time when no staff were present and people were left unattended in communal areas.

Arrangements were in place to manage people’s medicines. We saw nutritional assessments had been completed and some care plans developed. People did not always receive help with their food and fluids. The food and fluids records were not always completed and did not demonstrate people were receiving adequate amounts of food and fluids.

People told us they were able to be involved in choices and decisions about the care they subsequently received. People told us they felt safe in the service and could raise issues if they had any and they would be addressed. They were positive about most of the individual care and support from members of staff. However one person living in the home and one relative told us that communication was on occasion affected when some members of staff with English as a second language had not been clear or had not understood what they were told. Ten people (including a relative) told us that they had experienced slow responses to call bells meaning that people, at times had to wait for their needs to be met. Two people linked this to staff shortages when members of staff were ill or on leave.

The inspection took place on 18, 19 and 24 February 2015 and was unannounced.

The last inspection of this service was in June 2014 when we judged the service to be in breach with five regulations. The provider sent us their action plan showing how they would meet the regulations. Our visit in February 2015 showed they had implemented improvements in all the areas concerned and there were no breaches of regulations.

The service provides accommodation with personal or nursing care for up to 68 people. People living at this service included younger adults, older people and people with physical disabilities. When we visited there were 49 people living at the home. The new manager had been appointed in November 2014 and they were applying to be 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 and associated Regulations about how the service is run.

The home is located near the village of Hedge End, near Southampton and is a two-storey building. Each floor has a dining room and a lounge and the ground floor lounge opens onto an enclosed, central courtyard. There is a passenger lift and stairs to the first floor. People’s rooms have en-suite facilities.

Overall, we rated the home as good and a range of improvements had been implemented since our last inspection. We have made a recommendation that further staff development is required, as staff training and supervision had lapsed in some cases. This had been identified by the management team and plans were in place to renew focus on staff development.

People living at the home and their relatives said staff were attentive and caring, and if they had any concerns they were addressed promptly. People told us they felt safe, the food was good and the organisation of the home had improved under the new manager.

Appropriate risk assessments were completed and action was taken to minimise avoidable harm. This included in relation to people’s individual health and wellbeing as well as with regards to the management of the home and premises. People’s care was personalised to meet their specific needs, taking account of their medical history, interests and preferences. Safe systems were in place for managing medicines and staffing levels had been increased to support people’s care safely and effectively. Staff recruitment was safe.

People’s health needs were looked after, and medical advice and treatment was sought promptly when necessary. The home involved health and social care professionals and followed their advice and guidance. This included making decisions on behalf of people when they lacked the mental capacity to make decisions for themselves about important matters. Staff supported people to make decisions and to have as much control over their lives as possible. Staff understood the key requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards.

Staff provided personalised care and the environment was homely and cheerful. People living at the home, their visitors and visiting health care professionals were all complimentary about the quality of care and the management of the home. Staff said the morale was good and they worked well as a team.

Governance systems were in place to identify areas for improvement. There were checks at different levels of management to monitor the quality of care to promote continuing improvement in care delivery.