About the service:

Maristow Nursing Home is a care home with nursing. 13 people were living in the home at the time of the inspection.

What life is like for people using this service:

Some aspects of the service were not always safe. The provider had not ensured the building was safe from the risks associated with the use of gas appliances. Servicing and checking of the gas appliances had not taken place as required. The provider confirmed action was taken to address this issue in the week following the inspection.

Quality assurance systems in the home had not always ensured shortfalls were identified and improvements planned. The system to review feedback people provided through surveys and identify improvements that may be needed was not always effective.

People received a person-centred service. People were supported make choices and have as much control and independence as possible.

People had been supported to develop care plans that were specific to them. These plans were regularly reviewed with people to keep them up to date.

People received caring and compassionate support from kind and committed staff.

People were complimentary about the care they received and about the quality of staff.

Staff respected people’s privacy and dignity.

People felt safe and received support to take their medicines safely.

Risks to people’s well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively.

People’s rights to make their own decisions were respected. People were supported to maintain good diet and access health services if needed.

The registered manager provided good support for staff to be able to do their job effectively.

More information is in Detailed Findings below.

Rating at last inspection:

Good. Report published 26 August 2016.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We have told the provider they need to make improvements to the service. We will monitor all intelligence received about the service and complete a further comprehensive inspection within 12 months.

Maristow Nursing Home provides accommodation and nursing or personal care for up to 17 older people. At the time of our inspection 16 people were living at Maristow. The home was last inspected in May 2013 and was found to be meeting all of the standards assessed.

This inspection took place on 30 June 2016 and was unannounced. We returned on 4 July 2016 to complete the inspection.

There was a registered manager in post at 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.

Medicines were stored and administered safely and staff kept an accurate record of medicines they had supported people to take. We found that action was needed to provide clearer instruction to all staff about when they should support people to take ‘as required’ medicines. This information was not recorded, but staff we spoke with had a good understanding of people’s needs and when they needed certain medicines. Although current staff were aware of this, there was a risk that this information would not be passed on to new or temporary staff. The registered manager said they would take action to address this discrepancy.

Risks people faced were well managed and people received the support they needed. Staff knew what action to take to keep people safe; however, we found some areas where this had not been fully recorded in people’s care records. The registered manager had taken action to address these shortfalls by the second day of the inspection.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments included, “The staff are very kind” and “I am well looked after”. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for support. Relatives also told us they though people were well cared for, with one person commenting, “The staff are excellent and provide very good care”.

People told us they felt safe when receiving care and were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them. Comments included ‘‘I feel safe. They (staff) provide the care I need” and “I feel safe living here. I would speak to staff if I had any problems”. One person gave us a thumbs up sign when we asked whether they were well treated and felt safe. We observed people interacting with staff in a confident way and people appeared comfortable in the presence of staff. The relatives we spoke with also said they thought people were safe living at Maristow.

Staff understood the needs of the people they were providing care for. People’s needs were set out in care plans they had been involved in developing. Staff followed these plans, which helped to ensure people received care in the way they preferred.

Staff were appropriately trained and had the right skills to provide the care people needed. They received a thorough induction when they started working for the home and demonstrated a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. People had regular group and individual meetings to provide feedback about their care and there was an effective complaints procedure. A relative told us, “I have no concerns about the home but I’m sure (the registered manager) would sort any problems out very quickly”.

The provider regularly assessed and monitored the quality of care provided at Maristow. Feedback from people and their relatives was

We walked around the home and saw two people were in the lounge and all others were asleep in bed. We did not disturb those people who were asleep. The people in the lounge, due to their frailty, were not able to talk to us in detail. This meant we were unable to gain people’s views about the cleanliness of the home.

We saw significant improvements had been made. All areas including those less visible were clean. Arrangements had been made for items such as commodes and wheelchairs to be routinely steam cleaned.

A schedule of monthly infection control and environmental audits was in place. Any identified shortfalls from the audit which followed the last inspection, had been addressed.

Items which presented a risk of infection had been replaced.

Staff had undertaken refresher training in infection control. They undertook an assessment to demonstrate their learning and understanding of the topic.

Staff were knowledgeable in the measures to be taken to minimise the risk of infection.

Due to their frailty and nursing needs, people were not able to talk to us in detail about the care they received.

People looked comfortable and well cared for. Their rights to privacy and dignity were maintained. People were given assistance to eat and drink in a sensitive, attentive manner. Those people being nursed in bed had their position changed at regular intervals, to minimise their risk of developing a pressure ulcer.

The home was generally clean yet there were certain areas which required greater focus. This particularly applied to less visible areas such as the undersides of bath hoists and around the beading of small tables.

Staff felt well supported in their role. There were a range of training opportunities in place to ensure staff had the knowledge and skills to do their job effectively.

The informal ethos of the home enabled concerns to be addressed before escalating to a more formal level. Staff were aware of their responsibilities when managing complaints.

We received a concern about the general standard of cleanliness within the home. The person commented that the home was dirty, bins were over flowing and the provider’s dogs took food that people had dropped on the floor. There was no evidence of these concerns during our visit.

People told us the home was always clean. They said staff vacuumed and polished their room every day. A relative, the provider and two members of staff told us they were satisfied with the standard of cleanliness within the home.

The home was clean and free from any unpleasant odours. The stairs and landing carpet however was stained and discoloured in places and there was brown staining on the light pull chords in the bathrooms. The provider said these issues would be addressed.

Cleaning schedules were being developed to ensure an effective standard of cleaning was carried out. There was one housekeeper who worked every week day during the morning. Care staff also completed some housekeeping tasks when the housekeeper was not on duty. Cleaning schedules were being used to determine if additional staffing hours were required.

Staff told us they had the equipment and cleaning materials to do their job properly. They said disposable protective clothing was readily available. Staff told us there were infection control policies and procedures in place. They said they also received regular infection control training.

We saw positive interactions between staff and people in the home, with members of staff taking time to ensure people understood and could agree to assistance being offered. All the people we spoke with said staff took time to spend time with them individually.

A person who had been staying for three weeks described their experience as “friendly and comfortable; what they’ve done is what I said I wanted them to do; it’s very casual, you get up and go to bed when you want”. Another person said their care was “all organised around my times”.

A regular visitor to the home considered they and the home worked in partnership to meet their relative’s needs.

Where people needed assistance to eat, this was given in a pleasant and unhurried manner. Meals were hot, and there was a choice of drinks. A person staying for a short period said the lunches were “just like I would cook”. People confirmed they had hot or cold drinks as they wanted them, throughout the day.

One member of staff was employed as a welfare officer. Their role included accompanying people to outside appointments, and ensuring the home provided for people’s individual social and activity needs and wishes. The relative of a person living in the home said they never had any anxiety about leaving their relative in the service’s care.

A person who spent most of their time in their personal room told us their room was vacuumed daily and received a thorough clean every week. We saw that cleaning was ongoing in different parts of the home throughout the day.