This inspection took place on 27 and 28 February 2018 and was unannounced.

Maesbrook Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Maesbrook provides accommodation with nursing care for up to 45 people. Accommodation is arranged over three floors with a shaft lift providing access to the first and second floor.

At the time of the inspection there were 42 people living at the home.

At our last inspection in September 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 on-going 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.

People felt safe living at the home. There were sufficient numbers of experienced staff to meet people’s needs. People were protected from the risk of harm or abuse because the provider had effective systems in place which were understood and followed by staff.

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. People were cared for by staff who had the required training to meet their needs. People could eat well in accordance with their needs and preferences. People’s healthcare needs were monitored and met.

Staff treated people with kindness and respect. People lived in an environment which was welcoming and homely and staff respected people’s right to privacy.

People were cared for by staff who knew what was important to them. People were provided with opportunities for social stimulation and trips out. People’s religious and cultural needs were understood and met by staff. Complaints were taken seriously.

Staff told us the management within the home were open and approachable. The registered manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below

This inspection took place on 21 September 2016 and was announced.

Maesbrook Nursing Home provides nursing and personal care for up to 45 people. At this inspection they were providing care and support for 43 people.

A registered manager was in post and present at 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 safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. People had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. People received help with their medicines from staff who were trained to safely support them. The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

People received care from staff that had the skills and knowledge to meet their needs. New staff members received an induction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People's rights were maintained by staff members who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a management team who they found approachable. People and staff felt able to express their views and felt their opinions mattered. People had positive relationships with the staff members who supported them. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly and consistently. People were supported to eat and drink sufficient amounts to maintain good health.

The provider undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People felt confident they were listened to and their views were valued.

An inspector and a pharmacy inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led? We also followed up on the actions taken to achieve compliance from our inspections of 5 and 6 December 2013 and 18 February 2014. We had also received concerns about nutritional care and support in the home.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

Is the service safe?

People living in the home told us they felt safe. One person said, “The home provides a sense of safety and security especially now that I can’t do much for myself.” Another person said, “It’s nice to feel warm and secure.”

The registered manager showed us the system to manage accidents and incidents and learn from them so they were less likely to happen again.

The registered manager understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards and put them into practice to protect people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people living in the home were protected from avoidable harm, abuse and breaches of their human rights.

When people were at risk staff followed effective risk management policies and procedures to protect them. This meant that risks to individuals were managed well so that people were protected and their freedom was supported and respected.

We followed up on issues identified with medicine management from the inspection on 18 February 2014. The registered manager told us that action had been taken and systems for medicine management had improved. This included undertaking regular checks on medicine records to identify any problems and to ensure staff followed safe medicine procedures. A pharmacist from the supplying pharmacy visited the home on 4 April 2014 to provide the service with advice on safe medicine management. We were shown a copy of their report which showed that the service was safely managing medicines. Another review of safe medicine management was also undertaken by Shropshire Clinical Commissioning Group (CCG) on 22 May 2014. The CCG also found that medicines were handled safely. At this inspection, we found improvements had been undertaken with arrangements in place to ensure that medicines were managed safely. This meant that people received their medicines as prescribed.

Is the service effective?

People we spoke with said they felt confident discussing their health needs with staff. We saw records to show that people’s health was regularly monitored to identify any changes that may require additional support or intervention. We looked at records that showed referrals were quickly made to other health services when people’s needs changed, for example, with nutritional support. Records noted that relatives were kept informed. A relative told us, “I am informed of all visits made by GPs and any recommendations made by them.” Another relative said, “ X is doing well, thanks to the action taken by the staff and keeping me fully informed and updated at all times. I am confident X is receiving appropriate, dignified and gentle care both day and night.”

We reviewed records that showed staff were to be updated in training for nutritional support and care. The registered manager recognised the need to include awareness training for staff in respect of people’s religious or cultural backgrounds.

People were provided with understandable information about the medicines they were prescribed and the health care and treatment options available to them.

Records we viewed showed people were involved in discussions about their nutrition and hydration needs. We saw that people were effectively assessed to identify the risks associated with nutrition and hydration, especially those with complex needs. People had access to dietary and nutritional specialists as their assessed needs indicated. This meant that people’s identified needs were monitored and managed well.

Is the service caring?

People living in the home told us that they were treated with kindness and compassion and that their dignity was respected when receiving personal care. We observed as staff went about their work that people were shown kindness and compassion in day to day care. Staff assisted people to eat in a sensitive and caring manner. All levels of staff were engaged in supporting people with their care.

People explained how their individual needs were met, including needs around age, disability, gender, gender reassignment, religion and belief. Staff we spoke with knew the people they were caring for well including their preferences and personal histories. This meant that caring positive relationships were developed with people living in the home.

Records were stored in the office so that people were assured that information about them was treated in confidence. We were shown records that showed staff had been trained in policies and procedures and how to respect people’s privacy, dignity and human rights in the home. This meant people’s privacy and dignity was respected and promoted.

Is the service responsive?

People said that they and their family were encouraged to make their views known about their care and support. Care records detailed how people’s individual needs were regularly assessed and met. Detailed nutritional records were kept with clear instruction for staff.

We viewed records that showed a person’s capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. The way staff interacted with people showed that they actively sought and listened to people’s views and decisions. This meant people were supported to express their views and be actively involved in making decisions about their care and support.

Residents attended meetings so that they could put forward their views for activities that were important and relevant to them and they were protected from social isolation. One person stated, “I am going to make some cards with X, I like doing that.” People were very much enabled to maintain relationships with their friends and relatives. Staff we spoke with recognised the risks of social isolation and loneliness with people and worked hard to balance the risk against this and how they wanted to live their lives. This meant that people received personalised care that was responsive to their needs.

Is the service well led?

Since our inspections of 5 and 6 December 2013 and 18 February 2014 the registered manager had reviewed the service provision and made improvements to the way the service was organised.

Quality monitoring records were available for inspection at the home. Any shortfalls in audits were recorded and what action, if any, had been taken to improve these areas. Records used to document daily care were completed and monitored.

People were able to complain formally and also share their suggestions in frequent meetings. They said they had no reason to complain but would be happy to speak to senior staff at any time. A person told us, “I have no worries but I am sure that if I spoke to staff they would help me out.”

Following the previous inspection on 5 December 2013 we issued the service with a warning notice in relation to safe medicine management and record keeping.

We were told at this visit that arrangements were now in place for the safe storage of medicines. We found that improvements had been made and medicines were stored securely. We found that although there had been some improvements since the previous inspection, medication administration records were not always accurate. It was not always possible to determine if people had been given their medicines as prescribed. We further noted that some medicines had not been obtained and so they were not available to administer as intended by prescribers.

We informed the management team available at the inspection that we recognised that some improvements had been undertaken. However, we found that appropriate arrangements were not always being undertaken in order to manage the risks associated with the unsafe use and management of medicines.

We saw that there had been improvements in the record keeping in the home. This included daily re-positioning charts. Risk assessments were in place for identifying people at risk of malnutrition. However, further improvements were necessary. This was important so that people were fully protected from the risk of unsafe or inappropriate care and treatment.

We spoke with 14 people who lived at the home, four relatives, and nine members of staff, including the registered manager.

People told us that they liked living at Maesbrook. We saw knowledgeable staff supported people promoting their privacy and dignity whilst offering them choices about their care. We saw people enjoyed a wide range of pastimes and therapies.

We viewed records that showed some people or their relatives had been involved in their care and support. People received a care needs assessment prior to being admitted. Relatives said that people received very good care and support from the staff team. One person told us.” It is homely and affordable, I am pleased the way my family member has settled into Maesbrook".

Systems were in place to protect people from the risk of abuse and support people to raise any concerns or complaints.

People told us they were pleased with their accommodation at Maesbrook. We saw wear and tear in various parts of the home being attended to as part of the ongoing home maintenance programme.

We saw checks in place to make sure the home was maintained and health and safety was taken seriously. Some of the checks were not being monitored or kept up to date, and challenged the quality of care given at this home. The registered manager told us about their planned improvements to make sure prompt remedial action would be taken for these matters.

People told us that they were content living at Maesbrook. They told us that they were consulted about their care, that their views were taken into account in the way the service was provided and delivered.

People said their privacy and dignity was very much respected and their independence promoted.

People told us that the home was well run by the manager and her deputy. They said that they wouldn’t hesitate to ask questions or request help with any aspect of their care. “The staff are very caring and I couldn’t choose a better place to be now I need help”.

People told us they were happy with their bedrooms and that they could either remain in the privacy of their own room or join other people in the range of communal areas available. They said their rooms were kept clean and when they moved in they were encouraged to bring in some of their personal belongings if they wished.

People were generally happy with the care and treatment they received. People however told us that they sometimes had to wait a long time for their care due to staff shortages. People were asked for their consent and the provider acted in accordance with their wishes and with legal requirements. Care plans did not always contain enough detail to manage people’s needs. Records did not always demonstrate that people were receiving appropriate care and treatment.

Gaps were found in the medication records so we could not be assured people were being given their medicines as prescribed. We noted some records were incomplete when people were not administered their medicines. One medicine for one person was not available for four weeks. Staff were unable to explain why this was. After our visit, were told that it had been discontinued on the request of the GP. We also noted a lack of written information to assist staff in safely administering some medicines. We found that medicines were not stored securely or safely. We found that areas of medicine management required further improvement.

Better systems were in place for recording and monitoring accidents and incidents and for promoting staff’s professional development. Auditing systems however remained inadequate for assessing and monitoring the quality of service. There continued to be a lack of adequate record-keeping.

A new manager was in post. The Commission had received an application to register the new manager.