Archived: Maldon House

Updated 21 January 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by an inspector.

Service and service type

Maldon House 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced on the first day of inspection and the second day was announced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with everyone, but most people were not able to share their views of the service, due to complex communication and support needs. Therefore, we observed their experiences living at Maldon House and staff interactions with them. We spoke with two relatives, the registered manager, regional manager, deputy manager and three care staff. We also spoke with three visiting professionals. We reviewed a range of records. This included three people’s care records and medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed. We also pathway tracked three people. This is where we check that the records for people match the care and support they receive from staff.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at staff training, minutes of meetings and quality assurance records. We emailed three professionals who regularly visit the service and received two responses.

Updated 21 January 2020

About the service

Maldon House is a residential care home providing accommodation and personal care. People living at Maldon House had learning disabilities. Some had specialist needs related to Autism and behaviours that challenged. Others had needs related to down syndrome and epilepsy. People had different communication needs. Some people had limited verbal communication, and other people used gestures and body language to make their needs known.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Maldon House was a large house, bigger than most domestic style properties. It was registered for the support of up to 10 people. Nine people were using the service. This is larger than current best practice guidance. However, the size of the house having a negative impact on people was mitigated by the building design fitting into the residential area. Staff wore casual clothing and did not wear anything that suggested they were care staff when coming and going with people. There were several communal spaces to enable people to choose where to spend their time.

Since our last inspection there had been a change of management. Following a recent safeguarding investigation, a number of concerns were substantiated. Concerns related to people assessed as at risk of choking, some people whose behaviours challenged and one person at risk of leaving the property unescorted who had been assessed as unsafe to do so. Learning as a result of these incidents had been put into place but it was still too early to determine if they were fully embedded into everyday practise.

There had been a high level of sickness and this had an impact on the running of the service. In July 2019 the organisation carried out a full audit of the service and identified a number of shortfalls. A new manager was appointed and started in post in August 2019. She was registered with CQC in October 2019. Support systems were put in place to assist the registered manager in making improvements to the service. High levels of sickness continued to be a problem but at the time of inspection some improvement had been noted in this area.

Extensive work had been carried out to make improvements to the service and at the time of inspection the impact of the work carried out was significant. However, the improvements made, needed more time to be sustained, maintained and fully embedded into the culture of the service. We will not be able to confirm if enough action has been taken until we next inspect the service.

People received support from staff who knew them well as individuals. Where agency staff were used these were mainly staff who had worked at the service regularly and knew people well. People’s care and support needs were assessed and reviewed regularly. This meant people received care that was person-centred and reflected their needs and choices.

People were supported to maintain their own interests and friendships. Staff supported people to take part in activities of their choice to meet their individual needs and wishes. This included shopping trips, horse riding, swimming, trips to theatre and pubs, and trips to places of interest.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. The home was clean and tidy throughout. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

Extensive work had been carried out to ensure staff understood the risks associated with the people they supported. Risk assessments provided further guidance for staff about individual and environmental risks. People were supported to receive their medicines safely.

Staff received training that helped them to deliver the care and support people needed. This included specialist training in autism and positive behavioural support to meet people’s complex needs. Staff attended regular supervision meetings and told us they were very well supported by the registered manager. A staff member told us, “Supervisions are very helpful if you have a problem. We are given support to resolve issues and ideas to try.”

People's health and well-being needs were met. Where appropriate, staff supported people to attend health appointments, such as the GP, dentist or appointments for specialist advice and support. People's nutritional needs were assessed. They were supported to eat a wide range of healthy, freshly cooked meals, drinks and healthy snacks each day.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There was a detailed complaint procedure, and an easy read version to ensure anyone wanting to raise a concern could do so.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good. Published 17/01/2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.