This unannounced inspection took place on 24 and 25 July 2017. Maybank Residential Care Home is registered with us to provide care and support for up to six adults with learning disabilities. At the time of the inspection there were five people living in the home.

As part of the requirements for registration with us it was necessary for a registered manager to be employed at the home. This requirement had been met. 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.

During our previous inspection in January 2016 we found breaches of Regulation 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not protected against the risks associated with unsafe or unsuitable premises and equipment because of inadequate maintenance checks and audits. Appropriate training and

competency checks had not taken place for staff. The provider had failed to assess, monitor and

mitigate the risks relating to the health, safety and welfare of people. The provider had also failed to implement the Mental Capacity Act 2005 codes of practice.

During this inspection we found there had been improvements in most areas. We had some concerns about the storage and administration of medicines. Following this inspection we were sent an action plan that addressed our concerns and systems had been put in place to ensure people’s safety was maintained. We found these concerns had occurred partly by a lack of oversight from the registered manager. As a result we have made a recommendation about best practice in relation to quality audits.

Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. Staff were trained and knowledgeable about how to protect people from abuse.

Where the provider had to impose restrictions on people’s freedom, appropriate mental capacity assessments had been completed and a Deprivation of Liberty Safeguards (DoLS) had been authorised by the local authority. 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. Records showed best interest meetings had taken place to ensure decisions made on behalf of a person were made with their best interest in mind. People were supported with food and drinks to ensure they remained hydrated and their health was maintained. When people became unwell, the provider ensured appropriate medical and psychological help was sought. Advice given by specialist health professionals was followed by staff.

We observed staff to be kind and considerate in their support with people. People appeared happy and relaxed in the company of staff. We saw positive interactions between both parties. Where people were able to, they were involved in identifying their needs and planning their care. Where people required the assistance of an advocate or family member this was facilitated by the service.

We observed staff treating people in a respectful and dignified way.

People’s care was personalised to their individual needs. Records showed how staff were supported to assist people in their specific areas of need. Systems were being put in place to obtain feedback from people, their representatives and professionals to enable the provider to drive forward improvements to the service. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

Staff, people and their relatives spoke positively about the registered manager. Quality assurance audits

This inspection took place on the 5 and 7 January 2016 and was unannounced. The last inspection of this service took place in 2013. The service was found to be meeting the requirements of the regulations at that time.

Maybank Residential Care Home provides residential care to six adults with a learning disability. It is a requirement of the registration of Maybank that there is a registered manager in place. At the time of the inspection a registered manager was in place. 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's relatives told us the service was safe, it was well managed and people were well cared for.

Some areas of the running of the home required improvements, for example, we found audits had not been completed accurately and where actions were required these were not always acted upon in a timely way. We found some parts of the home required cleaning and that monitoring of the standards of cleaning had not always taken place. We have made a recommendation about the cleaning of the home. Other findings included hot water taps that delivered water that was above the recommended temperature and trip hazards outside the building. Audits had not identified the concerns we found.

Staff were supported to carry out their role through supervision, appraisals and team meetings.

Records showed staff received training both through e-learning and face to face training, however some training for staff was not up to date. This included areas of training such as moving and handling, first aid and safeguarding. Records showed only two staff had completed the practical moving and handling training. This meant the provider was unable to demonstrate that staff knew how to carry out moving and handling techniques safely.

The Mental Capacity Act 2005 code of practice had not been applied consistently in the home. People’s mental capacity had not always been assessed appropriately. Documents showed an attempt had been made to assess people’s mental capacity but the assessments were not decision or time specific. Where people’s liberty had been deprived a deprivation of liberty safeguard application had been made with the local authority to ensure it was lawful and in the person’s best interest.

People were supported with their nutritional needs, food and fluid were available to people, and where people needed additional support due to a risk of choking this was supplied by staff.

Staff treated people in a kind and dignified way. People appeared comfortable and relaxed in the home, there appeared to be a good rapport between staff and people. Staff understood people’s needs and responded appropriately to support people.

Each person had a care plan and risk assessments in place. This enabled staff to meet people’s needs and to know and understand each person’s likes and dislikes. We saw that the needs of one person in relation to their skin integrity were not recorded in their care plan, which placed them at risk of harm.

The provider had a complaints policy in place, but no complaints had been received in the last year. The provider also sought feedback from people, relatives, staff and visiting professionals on how the home provided care and what improvements could be made. Where points were raised that could lead to improvement an action plan was in place.

From our observations people appeared to be well cared for and happy living at Maybank Residential Care Home.

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

People had their privacy and dignity respected with personal care undertaken in the bathroom or people's bedroom. They had been involved in identifying what their care and support needs were and this was reflected in their care plans. Plans were in place for a new bath to be fitted and in recognition of what people said that their preferences would be for a bath or shower, consideration was given to having a bath or shower.

People could be supported in giving feedback or making complaints as staff were informed about the complaints procedure and how to support people in making a complaint.

The people using this service had complex needs and were unable to communicate their views directly to us. We saw that staff were responsive to people, showed a good understanding of people’s needs and treated people with respect. People and staff seemed at ease together.

All the people we spoke to told us that they liked living at Maybank. They liked their accommodation and said they thought it was a pleasant place to live. They told us that the staff supported them in doing what they were interested in. They said the staff were good. They felt that the routine of the home suited them. They went out with staff to local shops, used local services, and often went for a drive with staff.

They said they liked the food served in the home. People told us that staff did not put pressure on them to participate in activities if they did not feel up to it. One person who was managing their own medicines with help from staff told us that they were quite happy doing this. People said that they were in contact with their families.