This comprehensive inspection took place on 23 and 24 October 2018 and was unannounced. The last comprehensive inspection took place in March 2016. The service was rated requires improvement in the key question, ‘is the service caring?’ but there were no breaches of the regulations. At this inspection we found the provider had improved the rating for this key question but has been rated requires improvement overall and in the key questions of ‘is the service safe?’ and ‘is the service well-led?’

Maryville 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 the time of our inspection 37 people were using the service.

There was 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 and associated Regulations about how the service is run.

During the inspection we found the door to the sluice room, where cleaning materials were stored, was open and the main door to the kitchen and laundry room was unlocked. This meant people were not protected from the potential hazards and risks in these rooms.

The provider had a number of systems in place to monitor, manage and improve the care and support provided to people. This included a complaints system and service audits. However, these were not always effective in identifying concerns such as the ones identified during the inspection.

The provider had policies and procedures in place to protect people from abuse. Staff we spoke with had received training and knew how to respond to safeguarding concerns. People had risk assessments and risk management plans in place to minimise risks.

Safe recruitment procedures were followed to ensure staff were suitable to work with people and we saw there were enough staff to meet the needs of people using the service.

Medicines were managed safely and staff had appropriate training and competency assessments to manage medicines safely.

Staff had up to date training, supervision and annual appraisals to develop the necessary skills to support people using the service.

Staff had completed training in infection control and food hygiene so they could reduce infections and cross contamination.

People's dietary and health needs had been assessed and recorded so any dietary or nutritional needs could be met. People were supported to maintain healthier lives and access healthcare services appropriately.

The provider generally worked within the principles of the Mental Capacity Act (2005). People were supported to have choice and control over their day to day decisions and staff were responsive to individual needs and preferences.

Before coming to the service, the provider undertook an assessment to determine if the service could meet the person’s needs. Care plans were personalised and kept up to date. Some people’s end of life care wishes were recorded. In other cases, no information was available about end of life care or about whether people should be resuscitated in an emergency and if they stop breathing. We have made a recommendation about this.

There was a complaints procedure in place and the provider responded to complaints as per their procedure.

People using the service and staff told us the registered manager was available and listened to them.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 29 March 2016 and was unannounced.

The last inspection was 25 October 2013 at which time the service was meeting the assessed standards.

Maryville Care Home is part of the Frances Taylor Foundation and is registered to provide accommodation and personal care for up to 39 adults over three floors. The service was at capacity on the day of the inspection. Some people who used the service were living with dementia and others required nursing care.

There was 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.’

We saw the majority of the medicines were stored safely, however we observed an unsecured fridge with medicine in it accessible to people who used the service and visitors.

Staff were sufficiently deployed and appropriately trained.

The service had a safeguarding policy and procedures in place.

The environment was clean and well maintained.

There was evidence of regular meetings with staff, people who used the service and their families.

Staff had regular supervisions and yearly appraisals.

Health needs were being met through assessments, monitoring and support from the relevant professionals.

Staff were kind and caring. They knew the people who used the service well and were able to meet their needs.

The majority of people had person-centred care plans and we saw evidence that staff followed them to meet people’s needs.

The service did not have an activities co-ordinator. There were activities but staff did not always feel they had enough time to support people with activities.

People who used the service, staff and relatives told us the manager was approachable and they could raise concerns with them.

Monitoring and auditing records were well maintained.

During our visit on 6 March 2013 we found that the service was not meeting standards in relation to care planning, medication practices and taking proper steps to monitor the quality of the service. We requested following our visit the provider send us an action plan detailing how improvements would be made.

We received an action plan on the 20 March 2013. The provider told us they would update people's care records to ensure all needs were planned for and would provide training to staff. We were also told medication practices would improve by introducing further quality audits to ensure unused medication was brought forward on a monthly basis and people who self-medicated had appropriate risk assessments in place. The provider told us they would ensure additional monitoring of the service was implemented.

We carried out our recent visit to ensure improvements had been made and we also checked that other standards were being met. People told us since our last visit that improvements had been made. One person told us "we had a meeting with the manager she seemed to listen to what we had to say, she is good".

A person who had recently been admitted to the home said "it's very nice here, it's not like

my own home but the staff are good, they make sure I am safe."

Following our recent visit we found that improvements had been made to the running of the service, we also found standards were being met in additional areas that had not been previously inspected.

During the inspection we talked with five people using the service, one relative and six members of staff to find out about the service provided.

People who spoke with us said they were pleased with the care and support they received at the home. We saw that people appeared well cared for and that their privacy and dignity was respected and their independence and rights were promoted by staff. One relative said “we are lucky that our family member is in the home”. A person said “if there is something wrong I can tell staff and they will do something about it”. The standard of care planning was however not adequate to demonstrate that people’s care was planned and delivered in line with their assessed needs.

Staff supported people with their healthcare needs and monitored their conditions when they were not well to ensure their wellbeing. We however found that the management of medicines did not always ensure that people were protected against risks associated with medicines.

People had opportunities to express their views and make suggestions about the provision of the service in a number of ways such as in meetings that were arranged for them and in satisfaction surveys. We however found that the provider did not have an up to date quality assurance procedure and effective quality management systems to assess and monitor the quality of services provided to people.

People who use the service told us they could choose how they spent their time and that they could have privacy when they wanted it. They said that there was a good range of activities to choose from and that they had regular opportunities to go out, which was important to them. One person told us, “I like it here – it’s lovely”.

People told us that they felt well looked after and that they were supported by staff that knew their needs well. They said that staff were caring and kind and always available when they needed them.

People told us that they were asked for their opinions about the care they received and the way the home is run. They said that their concerns had been addressed if they had ever been unhappy about something at the home.

All the visitors we met spoke highly of the care their friend or relative received at the home. One visitor told us, “We very, very pleased with it. They’re all extremely kind” and another said, “It’s always clean, welcoming and friendly. My mother’s very well looked after and very happy here. It’s hard to fault a place like this - the people who live here are given the best”.