Maynell House provides a residential care service for up to 25 older people, some living with dementia. At the time of this unannounced comprehensive inspection of 23 August 2017 there were 23 people who used the service.

At our last inspection of 6 July 2015 the service was rated Good overall, with a rating of Requires Improvement for Responsive. At this inspection we found the service remained Good overall. Improvements had been made in Responsive which is now rated as Good. However, we received mixed feedback from people about if they felt cared for and respected. Improvements were needed in how staff and the service demonstrated to people that they were cared for in a compassionate way. People were involved in making decisions about their care and support, not all people felt that they were always listened to. Therefore Caring is rated as Requires improvement.

There was not 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. The previous registered manager left the service July 2017. There was a new manager in post and their application for registration had been received.

The service continued to provide a safe service to people. This included systems designed to minimise the risks to people, including from abuse, in their daily living and with their medicines. Staff were available when people needed assistance, however, care provided was based on tasks required for people’s needs. The recruitment of staff was done safely.

People were supported by staff who were trained and supported to meet their needs. 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. Systems were in place to assess and meet people’s dietary and health needs and for people to maintain good health and have access to health professionals where needed.

People received care and support which was planned and delivered to meet their individual needs. People were supported to participate in meaningful activities. A complaints procedure was in place.

The service had a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to improve.

Further information is in the detailed findings below.

Maynell House provides accommodation and personal care for up to 25 older people, some living with dementia.

There were 22 people living in the service when we inspected on 6 July 2015. This was an unannounced inspection.

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.

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

Staff were trained and supported to meet the needs of the people who used the service. Staff were available when people needed assistance. However, improvements were needed to provide more social interactions to people.

People, or their representatives, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. However, improvements were needed in the ways that staff were provided with guidance in care records about people’s specific care needs and how staff were provided with up to date information about people’s changing needs. The service was up to date with changes to the law regarding the Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People’s nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake, or ability to swallow, appropriate referrals had been made for specialist advice and support.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed. As a result the quality of the service continued to improve.

Our previous inspection of 8 May 2014 found that service did not have suitable arrangements in place to gain people's consent and assess their mental capacity to make decisions before acting on their behalf. Staff did not always understand their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We had concerns about the staff employed to work at the service and the update of their skills to support the people who used the service. We had concerns about the information and subjects covered in a recent refresher course staff had undertaken. This meant that we could not be assured that staff had the necessary skills to support people effectively. During this inspection we checked that improvements had been made.

We spoke with four people who used the service. We also spoke with one person's relative and three staff members. We looked at five people's care records. Other records viewed included staff training records, health and safety checks, staff and resident meeting minutes and satisfaction questionnaires completed by the people who used the service and staff. We considered our inspection findings to answer five questions we always ask; is the service safe, effective, caring, responsive and well led? This is a summary of what we found:

Is the service safe?

When we arrived at the service the staff on duty asked to see our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure the safety of people using the service.

People who used the service told us that they felt safe using the service. One person told us, “Staff are polite and good. I feel safe here.”

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that the service had begun a programme of staff assessment of safeguarding knowledge through the supervision process. This would ensure that all staff were regularly assessed in this area as well as receiving their mandatory training. This meant that staff were provided with the information they needed to ensure that people were being protected from the risk of abuse.

We saw records which showed that the service responded appropriately to concerns or allegations of abuse.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "I get everything I need." Another person said, "I can't fault it here." Another person said, "I am very happy here." We also spoke with a person's relative who told us that they felt that their relative was well looked after. They said, "I have no problems at all with them (the service)."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "I get on well with all of them." Another person said, "They are all very kind and they work so hard."

People using the service, their relatives and other professionals involved with the service completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken into account and listened to.

People told us that they attended meetings to discuss the way in which the service operated.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had a system for regular auditing and monitoring of the quality of the care provided to people who used the service and records seen by us showed that identified shortfalls had been addressed. People who used the service had access to regular forums where they could discuss their care and staff were required to attend staff meetings on a regular basis. As a result the quality of the service was continuingly improving.

During our inspection we spoke with six people who used the service. We also spoke with the new manager, deputy manager, visiting quality manager for the provider and five staff. We inspected people's care records, staff training and supervision records and documents relating to the quality of the service and health and safety checks undertaken by the provider.

Below is a summary of what we found.

During our inspection we looked to see whether we could answer five key questions: is the service safe, effective, caring, responsive and well led?

Is the service safe?

The provider had effective safeguarding procedures in place to protect people from the risk of abuse or harm.

We looked to see whether there were the right levels of staff working at the service. There were sufficient staff to meet people's needs.

We found that the service did not have suitable arrangements in place to gain people’s consent and assess their mental capacity to make decisions before acting on their behalf. Staff did not always understand their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The service had a safe medication administration system in place. People received their medications on time and staff were trained to support people safely.

The service had a robust recruitment process in place which meant that they checked and ensured that staff were fit and safe to work with vulnerable people.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to improve.

Is the service effective?

People's health and care needs were assessed before they came to the home to determine their needs and make sure the service could meet them effectively. Care plans seen included information about the care and support provided to people such as support with their personal care needs, mobility, behaviour and medication.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate. There was no evidence that people had been involved in the review of their care.

We had concerns about the staff employed to work at the service and the update of their skills to support the people who used the service. We had concerns about the information and subjects covered in a recent refresher course staff had undertaken. This meant that we could not be assured that staff had the necessary skills to support people effectively.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and gave people time to respond. We found staff showed patience when communicating with people who used the service.

People told us that the staff were caring. One person said about the service, “I like it here, I don’t have to do anything, feel lazy sometimes.” Another said about staff, “The staff are always very busy, but they are all very kind.”

Is the service responsive?

We saw people were able to access help and support from other health and social care professionals when necessary.

Although some activities took place at the time of our inspection there were no evidence in any of the recent records we saw that showed how people were involved and engaged within the service or assisted to access the community.

The service responded well to concerns about the safety of people who used the service. A visiting relative told us that the service always responded to any issues and addressed these.

People told us that the service responded to their needs. One person told us, “They (staff) are very good too, very kind.” Another person told us, “I do most things myself but if I need help they (staff) help me.”

Is the service well-led?

The service had a quality assurance system in place to identify areas of improvement. There were regular audits on medication and the environment.

Records seen by us showed that identified repairs and maintenance were addressed promptly. As a result the quality of the service was continuously improving.

The staff members we spoke with told us that since the new manager had started things had improved and they felt well supported and able to access the manager for support. However there had been no recent formal arrangements in place for supervision or appraisal which meant that we could not be assured that staff were receiving appropriate professional development and support.

The majority of the people who used the service were living with dementia and had limited ability to verbally communicate with us. However, as part of our inspection we spoke with three people who used the service and a visiting relative of a person who used the service. We asked them to tell us how they felt they were being cared for. They told us, “It's alright,.” and, “A lot of people are very kind." We asked people how they felt the staff treated them. A relative of person told us, "Staff are very helpful."

Our observations indicated that staff asked the people who used the service if they wished to participate in activities and received support to meet their personal needs. We observed that staff gave people choices.

The service had good infection control procedures in place.

People were receiving nutritious meals of their choice.

We found that although the management team had current staff vacancies they were recruiting to fill these and maintain staffing levels.

The service had good quality monitoring processes in place to ensure the continued delivery of safe and effective care.

We spoke with eight people who used the service. They told us that the staff treated them respect and listened and acted on what they said. One person said that the staff were "Very kind." Another said "They (staff) treat me well I can only speak for myself."

People said that they were consulted about the care and support that they were provided with. They told us that they felt that their needs were met and they were cared for and supported in the ways that they expected. One person said "I am very happy here." Another person said "Very happy or I would leave."

People told us that they were provided with enough to eat and drink and the quality of the food was good. One person said "The food here is very good, it is all freshly cooked."