Archived: Maldon House

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.

The previous registered manager had left the service. A new manager had been appointed and was currently in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the CQC managed 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 met and spoke to all nine people during our visit. People were not all able to fully verbalise their views and used other methods of communication, for example pictures and electronic equipment. We therefore spent time observing people. One person when asked if they were happy at Maldon House responded; “Yes it’s nice.” A staff member said; “It’s a lovely place to work in.”

Surveys returned to the service recorded; “Many thanks for helping us get […] through the recent worrying times we have had. It’s really appreciated - you’re all fabulous.” Another said; “A big thank you for looking after […] for the past 10 years.”

People’s medicines were mostly managed safely. One person had their medicine crushed and administered through a tube in their stomach. We found this had not been authorised by their new GP. However after the inspection the manager contacted us to confirm this authorisation had taken place. Other peoples medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as speech and language therapists.

People were engaged in different activities and enjoyed the company of the staff. People were busy; however there was a calm and relaxed atmosphere within the service.

People’s care records were very detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review people’s support plans. People’s preferences were sought and respected.

People’s individual risks were documented, monitored and managed well to ensure they remained safe. People lived full and active lives and were supported to access local areas and a wide range of activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed whilst maintaining a healthy diet. People, when possible, were encouraged to help prepare meals and drinks.

Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the manager. They knew how to make sure people who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations of abuse would be fully investigated.

Staff described the new manager as being very approachable and supportive. Staff talked positively about their roles.

The manager and registered provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People who required it had additional staffing particularly if they were accessing the community. Staff confirmed there were sufficient staff to meet these requirements. People were protected by safe recruitment procedures. Staff were supported with an induction and ongoing training programme to develop their skills, and staff competency was assessed.

All significant events and incidents were documented and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from people living in the home, professionals and staff.

People's needs were assessed and care and treatment was planned and delivered in accordance with their individual care plan. Two people who live at the home told us they were happy with the support they received. The relatives of another two people told us they had no concerns and were every happy with the care provided. It was clear from our observations that people's independence was promoted and that staff supported people effectively. People's health care needs had been monitored and that specialist advice and support had been sought when needed.

A relative told us 'I have no concerns what so ever, I'm completely satisfied with the care here'. Another visitor told us told us 'If we ever had the slightest concern we would say something'.

Recruitment procedures were robust. Staff told us they were happy working in the home and they had received the training they needed to meet diverse needs of the people who lived there.

The staff at the home worked in co-operation with others. We saw that each person's care had been reviewed annually and that relevant health care and social care professionals had been involved in this process.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The equipment provided at the home promoted peoples comfort, safety and independence. It was safe to use and had been well maintained.