About the service: Maycroft is a residential care home providing accommodation and personal care to up to six younger adults that live with learning disabilities. At the time of the inspection five people lived at the home.

People’s experience of using this service:

We found improvements had been made in the areas we rated as requires improvement following our previous inspection in March 2017. We also found the breaches of regulations that were issued had been met. However, we found improvements were required to ensure best interest decisions were recorded to ensure the records reflected the rationale for the decisions made on behalf of people.

People were supported by staff who were aware of the risks to them and knew how to keep them safe from harm. People appeared comfortable in staff presence and sought staff out by going over to them and holding their hand. People received their medicines as needed.

Recruitment processes were in place to ensure staff were safely recruited. Staff wore aprons and gloves to prevent the spread of infections. Systems were in place to analyse any accidents or incidents for patterns and trends, and to enable measures to be put in place to mitigate any identified risks.

Staff knew people well and had received training which provided them with the skills to support people safely and effectively. Staff felt supported in their role and were kept up to date with changes in people’s care needs. People were supported to choose what they had to eat and drink and to make healthy choices where appropriate in order to maintain a balanced diet. Staff were aware of people’s healthcare needs and how to support them to maintain good health.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. We saw staff routinely obtained people’s consent before providing support. An accessible safeguarding and complaints procedure was in place for people and their visitors to refer to if needed.

Relatives described staff as ‘caring, friendly, and dedicated’. We saw support was led by people and not by the staff, and people were encouraged to be as independent as possible.

People were supported to participate in activities that were of particular interest to them, as well as trying new opportunities.

Staff were confident the improvements made to the culture and the new training they had received had made a positive difference to the support provided to people. Staff felt the registered manager was approachable and provided good leadership and direction. Audits were completed to ensure the registered manager and provider had oversight of the service.

Quality audits were in place to ensure the registered manager and provider had oversight of the service and to ensure the service provided was meeting people’s needs. Records were not in place to support all of the best interests decisions made for people to clearly reflect the rationale for the decisions made for people. Staff were motivated and committed to ensuring people received support that met their needs and aspirations.

Rating at last inspection: At the last inspection the service was rated as ‘Requires Improvement. (Report published 16 June 2017).

Why we inspected: This was a planned inspection.

Follow up: We will monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

This inspection took place on 15 and 16 March 2017and was unannounced. We last inspected this service in July 2014 and we found the registered provider was meeting people’s needs and the requirements of the law at this time.

Maycroft is a care home for up to six people with learning disabilities or autism. There were five people living at the home at the time of our inspection. There was a registered manager in place who had worked at the home for several years. 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 not always supported to feel safe at the service. Risk management at the home failed to promote people’s independence and safety. Staff were due to receive refresher safeguarding training to ensure that they remained aware of their responsibilities to protect people. We observed that there were enough staff to meet people’s needs and saw that staff had been recruited following the registered provider’s suitable recruitment processes. People were often supported through safe medicines management, although further areas of improvement were identified.

People did not experience a consistent approach from staff which was informed through effective, person-centred care planning. People were supported by staff who received relevant training for their roles and who were kept informed of plans and changes at the home during handover sessions. The same team of staff had supported people over a long period of time at the home and we saw that they were familiar with people. People were not supported in line with the Mental Capacity Act (2005) and staff did not always support people to express or make their own decisions.

People had been referred to community health teams and for additional support on occasions during their time at the home. We could not be confident however that healthcare guidance was always sought and recommendations followed to promote people’s health over time.

People were not always addressed and supported by staff in a way that was respectful and promoted their dignity. People were not always encouraged to make decisions about their care and day-to-day routines. People’s care records did not always demonstrated a person-centred approach which met their needs. Relatives told us that they were involved in regular care plan reviews.

There was a registered manager in place who had not identified concerns relating to the culture of the service including where people were not supported to become involved in their care and the approach of some staff. Records were not always robust, and systems were not effective for ensuring the quality and safety of the service despite the registered provider’s active role in overseeing aspects of the service.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We did not give the provider notice that we were going to inspect Maycroft.  We call this an unannounced inspection. 

Maycroft is an adapted residential bungalow. It provides ground floor accommodation for up to six adults who have a learning disability and who may also have a physical disability. The home had been fitted with hoisting facilities in some bedrooms and the bathroom. There were special bathing facilities for people who were unable to stand and who needed staff support to stay clean and healthy. The home was run by a registered manager who had the support of a deputy manager and a team of seniors.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that the home was supporting people well, and during our visit we observed people and staff enjoying each other’s company. There was a happy and relaxed atmosphere in the home. We found people were being supported to access activities that they enjoyed and were of interest to them. Only one of the six people could verbally tell us how they found living at the home, and their feedback was entirely positive. We spoke to three relatives and four health care professionals. They told us the home was good and meeting the needs of the six people.

People lived in an environment that was clean, comfortable and well maintained. We found that each person had been supported to decorate and furnish their room in a colour and style that suited their age, personality and interests. We found that people’s rooms contained the equipment they needed for their care and a wide range of personal items.

Five of the six people we met were unable to verbally communicate what they needed or would like. We found information had been recorded in people’s care plans and advice had been sought from professionals with specialist knowledge about communication when this was required. Staff we spoke with were able to explain to us what they believed people’s sounds and facial expressions meant. Staff who had worked at the service for a long time told us how they shared their experience and knowledge about how people communicated, with new staff during induction to ensure new staff learnt about people’s communication as quickly as possible.

We found that each person’s care had been tailored to their needs and wishes. The care plans were all individual and reflected the preferences and needs of each person. We also found that the registered provider had a clear strategy about how the service should be developed to be as person centred and individual as possible. Training and new care plan documents were being provided to ensure this approach continued and would be applied and developed within the home. Three of the five staff we spoke with told us that in their opinion the best aspect of the service was the quality of care and individual care people received.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because both were still named as registered managers on our register at the time of our visit.

Although this was a scheduled visit, we took the opportunity to follow up on the action taken to make improvements after the previous visit had been made. These related to the arrangements for monitoring the performance of the home. The manager had implemented their action plan and the home was now compliant.

We met five people who lived in this home. One person told us how they were supported by staff to live their lives in the way they preferred. Other people were not able to talk with us but indicated that they were happy.

We spoke with four members of the staff team. All demonstrated a good level of knowledge of the needs and preferences of the people who lived in the home.

People were supported to be part of the community. They went out on a regular basis to places of interest and shops in addition to taking holidays.

Staff made sure that people received appropriate nutrition and hydration. One person told us that the food was good and said, ‘you always get a choice’.

There were good arrangements for the storage and administration of medication.

There were systems for making sure the high standards in this home were maintained, including using feedback from people in the home, their relatives and professional visitors.

We inspected Maycroft on May 24 2012, and we identified minor concerns in the area of quality monitoring. We reported these concerns in our review of our compliance, and we received an action plan from TRACS informing us of the action they would take. We were informed this work had been completed. We returned to the home on September 6 2012. We found that some progress had been made to improve the quality and risk monitoring systems, but this had not been completed.

On September 6 2012 we met one person who lived at Maycroft. They were very positive about their home, and the activities they were able to do each day. We talked with the person about the opportunities they had to make suggestions about their care or lifestyle choices. The person shared with us two examples of requests they had made, which staff had supported them with.

We used a number of different methods to help us understand the experiences of people using this service. People had complex needs which meant they were not able to tell us their experiences. We looked at the feedback relatives of people living in the home had given. This feedback was all positive and included, "Overall I feel the quality of care is high" and "I am very happy with the care(my relative) receives."

We spent time sitting in the areas of the home where people using the service were. This helped us to see how staff worked with people to meet their care and support needs. We saw that people were supported in a kind and friendly way by staff. We saw staff knocking before they entered people's bedrooms, and explaining to people what they were going to do. There was a lively atmosphere in the home we saw staff chatting with people and having a joke together.

We found that people had been supported with their personal care. People all looked clean and comfortable, and we saw staff help people with their personal care throughout the day. Records and talking with staff confirmed that people were supported to see a wide range of healthcare professionals.

We found there were plans in place and that staff had been trained in ways that reduced the risk of abuse in the home as far as possible.

We looked at records and spoke with staff and the registered manager about the checks made on staff before they start work at the home. We found these made sure only people suitable to work with vulnerable adults were recruited.

We looked at the ways the manager and provider check that the home is providing good quality and safe care. We found there were checks being completed by people working in the home, the organisation, and external agencies. We found these were effective at picking up ideas and issues, but they did not always ensure that the action needed was taken, or taken promptly.