The inspection took place on 9 January 2019 and was unannounced. The inspection continued 10 January 2019 and was announced.

Maumbury Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Following a change in their registration the home no longer provides nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 37 people across two floors, each of which has separate adapted facilities. At the time of our inspection 24 people were living at the home.

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.

Over the last three years the home has been rated requires improvement on three occasions and inadequate in June 2017 when it was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During the December 2017 inspection the service demonstrated to us that improvements had been made and it was no longer rated as inadequate overall or in any of the key questions. Therefore, this home was taken out of Special Measures. As we required the home to demonstrate that it could sustain the improvements we observed it was rated requires improvement.

Since the June 2017 inspection the provider had, on request, submitted monthly action plans to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led. We found that during the December 2017 inspection the action plan had been followed and improvements had been made.

People, relatives and staff felt the home was safe and well led.

The home had advised us and the local authority safeguarding team of notifiable events such as serious injury or safeguarding incidents between people living at the home. These notifications are a legal requirement.

Systems and processes were in place to assess, monitor and improve the service, such as audits and daily checks. Required actions had been taken following audits.

The home used a dependency tool to work out how many staff to deploy to meet people’s needs. Although some staff told us they felt rushed in the mornings the dependency tool indicated there were enough staff to meet people’s needs. At the time of the previous inspection staffing levels exceeded people’s needs. Now that numbers of people living at the home had slowly been increasing staffing levels now matched requirements. People, and their relatives, told us they felt their family member’s needs were being met and did not raise any concerns with staffing levels at the home.

People were supported by staff who understood the individual risks they faced and valued their right to live as full lives as possible. People’s personalised risk assessments were updated following accidents or incidents such as falls.

Medicines were managed safely. People received their medicines on time and at the prescribed dose.

Staff knew how to recognise and report signs of potential harm or abuse and had received safeguarding training. They told us that they would feel confident raising concerns internally and, if needed, to external agencies such as CQC, the local authority or police.

Staff received appropriate support through a combination of supervision, training, team meetings and competency checks to help them carry out their duties effectively.

Staff supported people in line with the principles of the Mental Capacity Act 2005 (MCA 2005). Where required mental capacity assessm

The inspection took place on 5 December 2017 and was unannounced. The inspection continued 6 December 2017 and was announced.

Maumbury Care 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.

The care home accommodates up to 37 people across two floors, each of which has separate adapted facilities. At the time of our inspection 14 people were living at the home.

We have summarised the paragraphs further to now read; At the last inspection on 21, 22 and 23 June 2017, Improvements were needed in relation to people’s care and treatment, medicines, staffing, people’s dignity and respect, care records and the governance of the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led. We found that during this inspection the action plan had been followed and improvements had been made.

The service had not had a registered manager in place for 537 days. 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. A new manager had been in post for eight weeks and was in the process of registering with us. The provider had employed an interim operations support manager, who had been in post since July 2017 and been based in the service supporting the home and staff team.

Fire procedures for visitors and signage was not clearly displayed in the home. The manager acknowledged this and told us they would address this as a priority. People had personal emergency evacuation plans in place and fire test took place regularly.

People and relatives fed back saying that laundry often went missing. The service told us that they would review the laundry system.

People were supported by staff who understood the risks they faced and valued their right to live full lives. Risk assessments in relation to people’s care and treatment were completed, regularly reviewed and up to date.

Improvements had been made to staffing levels within the home. Staff and people confirmed that they felt there were suitable numbers of staff to deliver care to people. Staff confirmed that improvements had been made around staff support. For example, better communication, supervision and organisation.

People, relatives, a health professionals and staff told us that the service was safe. Safeguarding alerts were being managed and lessons learnt by the home. Professionals confirmed that improvements had been made. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred.

Improvements had been made to ensure medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines.

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We undertook an unannounced inspection of Maumbury Care and Nursing Home on 21, 22 and 23 June 2017, because we had received concerns about people’s care.

The home is registered to provide accommodation and residential or nursing care for up to 37 people. At the time of our inspection there were 32 people living at the home, some of whom were living with a dementia. The home is set out over two floors.

When the service was last inspected in February 2017, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks were not consistently being managed sufficiently to ensure people always received safe care and treatment, and the systems in place to monitor the quality and safety of the care people received were not fully effective. As a result of the findings of the inspection in February 2017, we served a notice of decision to vary the conditions of the provider’s registration . We required the provider to report to the Care Quality Commission about the safety of people's care and how this was being monitored.

This inspection was brought forward because serious concerns had been raised by the local authority safeguarding team, health care proffessionals such as GP’s and people’s families. These included concerns about the safety and welfare of people. During this inspection, we found serious concerns about the care and treatment for some people living at the home consistent with the concerns raised by the local authority.

The home did not have a registered manager at the time of our 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. The previous registered manager left in June 2016. There was an acting manager in post who was also responsible for managing one of the provider’s other homes.

The systems in place to assess, manage and mitigate risk had not identified the concerns CQC identified during this inspection. The provider had identified some concerns relating to the service and they had put plans in place to mitigate risks. These included providing additional management support, However, these actions were not sufficient to ensure people received a safe, effective, caring, responsive and well led service.

People did not always receive their medicines when they needed them, risks to people were not always identified and where people had fallen staff did not always respond to ensure people’s safety. There were serious shortfalls in one person’s end of life care provision.

There were not enough staff or activities available to meet people’s social, emotional and wellbeing needs. Staff did not always follow health professional advice. Staff did not receive support and training required to support them in their role.

People’s rights were not protected because staff had not acted in accordance with the Mental Capacity Act 2005 (MCA). People’s mealtime experience was mixed. People generally commented positively about the food, and food was prepared to meet their individual needs.

People were not always treated with dignity and respect and their privacy was not always respected.

People’s care needs were not fully assessed and planned for. Care plans included contradictory and inaccurate information. Care records did not always reflect the care detailed within the care plan.

Quality assurance systems were ineffective at identifying and addressing shortfalls in the service provided. The provider had not always notified us of significant events which had occurred in line with their legal responsibilities.

Staff were aware of the procedures to follow if they suspected someone was being abused. The provider followed safe recruitment procedures.

People

The inspection took place on the 16 and 20 February 2017 and was unannounced.

The service is registered to provide accommodation and residential or nursing care for up to 37 people. At the time of our inspection the service was providing residential care to 35 older people some of whom were living with a dementia.

The service did not have a registered manager at the time of our inspection. The last registered manager of the service had left in May 2016 and the current manager had applied to take on this role. 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 inspected Maumbury Care and Nursing Home in November 2015 and there were breaches of regulation related to how people were supported in a personalised way and their dignity respected, how risks were managed and how the quality of care people received was monitored and improved. We rated the home as requires improvement in all areas we looked at. At our recent inspection we found that improvements had been made and people now received care that was personalised and upheld their dignity. There had also been improvements in how risks were managed but these were not sufficient to ensure people always received safe care and treatment. We also found that improvements to how the quality and safety of the care people received were monitored were not sufficient.

Staff understood the plans people had in place to eat and drink safely. The menu offered a variety of main meals and snacks and catered for individual likes, dislikes, allergies and special diets. However, the risks people faced related to eating and drinking enough had not been consistently managed or actions taken in order to minimise the risks. For example: referrals hadn’t been followed up, food and drink charts were not being completed consistently and people who had their food pureed did not consistently receive snacks between meals. Staff did not always have accurate information about changes to people’s risks.

Auditing systems were in place but they had not always recognised areas that needed improvement. When areas had been identified actions had been taken to improve outcomes for people.

People were supported by staff who felt supported in their roles. Staff received an induction and on-going training that enabled them to carry out their roles effectively. Some training was not current at the time of our inspection the manager shared plans about ensuring this was rectified.

People were supported by enough staff that had been recruited safely and understood their role in identifying and reporting unsafe practice or potential abuse.

People’s medicines were ordered, stored and administered safely. Peoples prescribed creams were being administered but not always recorded correctly. People had access to healthcare when it was needed.

People were supported to make choice and determine how they spent their days. Staff supported people to make choices about their day to day care and obtained consent in line with the principles of the Mental Capacity Act.

Care staff were kind, patient and friendly and respected people’s privacy and dignity. They had a good understanding of what mattered to people and used this information to support meaningful interactions.

People were supported by staff who understood the information held in their care plans. People and their families were involved in decisions related to their care.

People enjoyed the activities available to them. Some relatives felt that more activity was a priority and the manager told us that they were addressing how best to meet people’s needs for meaningful activity.

People, their families, staff and visiting professionals all described the manager

This was the first inspection of Maumbury care and nursing home

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.

Maumbury care and nursing home provides care and support for up to 37 older people. At the time of the inspection there were 21 people living at the home.

The leadership within the home needed to be improved. The provider did not have an effective system to check the quality of care people received at the home. Peoples individual care records were not always accurate and there no evidence that the systems in place to evaluate and improve the care being given were being implemented.

The systems and procedures for the safe handling of medicines were not safe and improvements were required. The system in place for the auditing of medication required improvement as it did not identify or plan for areas of improvement.

The risks people faced were not consistently acknowledged in people’s care records. When people were at risk of falls these were not acknowledged in their care records. Whilst staff were aware of the risks there was insufficient guidance to meet individual needs consistently. Care records were not always accurate and reliable.

Staff had little time to sit and talk with people or to meet their social and emotional needs. This also had an impact on the staff’s ability to meet people’s individual needs in a dignified and respectful manner. People could not be confident of receiving care at the time they wished because there was not always enough staff available to meet people’s needs. The language, both written and verbalised, that staff used to describe the people they cared for, was not always respectful.

Most staff had received induction training either prior or when they started work at the home. The provider had a plan in place to ensure all staff received the training required for them to meet people’s individual needs. We observed a number of care practices that demonstrated staff required more training in order to support people in a dignified and individual way.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.