Maylands

Maylands is registered with the Care Quality Commission (CQC) to provide two services. Maylands is a residential care home providing personal and nursing care to 16 people who have a learning disability and some people are living with dementia at the time of the inspection. The residential care service can support up to 18 people.

Maylands is also registered to provide a supported living service which delivers personal care to people in their own homes. The service was supporting 17 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. One person was in receipt of personal care.

People’s experience of using this service and what we found

People and their relatives told us they were happy and safe living at Maylands residential home. However, we found that medicines were not always managed safely. When people were living with health conditions, there was not always guidance for staff when people became unwell, to keep them safe. Accident and incident oversight was not robust and did not consider factors such as time incidents took place. Information was not reviewed for the service as a whole to look for trends and patterns. We found that people had not been harmed, however management oversight in these areas had failed to identify these issues.

There were systems in place to protect people from abuse. The registered manager ensured there were sufficient numbers of staff to keep people safe. There had been amendments made to the environment to keep people safe. For example one person had a lower bed to allow them to get into and out of bed independently. The service was clean, and the risk of infection had been mitigated.

Staff had the training and skills to meet people’s needs. Staff told us they were well supported by the management team. People were supported to eat and drink enough to keep them healthy. When people’s needs changed they were reviewed by healthcare professionals such as speech and language therapists.

We observed staff to be kind and caring towards the people they supported. There was a clear mutual respect and fondness between people and staff. Staff advocated on behalf of people, but ensured people made the decisions they could for themselves. People were supported to as independent as possible.

People, relatives, staff and healthcare professionals had been asked to give feedback on the service. This feedback was used to improve the quality of the service. Feedback from all stakeholders was positive and we observed a positive culture within the service.

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 did this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Whilst the size of the service is not in line with best practice guidance would recommend for people with learning disabilities, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence. People had been encouraged and supported to maintain their independence.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. We observed staff to be kind and caring towards people.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. There was a positive culture within the service, which supported good outcomes for people.

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 Outstanding (published 31 March 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Maylands is registered to provide accommodation and personal care for up to 18 people who have a learning disability and who need support with their personal care. Maylands is in a residential area of Whitstable, within accessible distance of local amenities. Accommodation is provided over two levels, there were 17 people living at the service at the time of inspection and each had their own ensuite bedroom, all of which were personalised to suit each individuals tastes.

The service had a registered manager, who was present throughout the inspection. 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 and associated Regulations about how the service is run.

We received wholly positive feedback about Maylands from people, relatives and professionals. We heard about exceptional standards of care and support which improved the quality of people's lives and gave their families peace of mind. We observed warm, caring attitudes from staff and a real drive to provide the best possible service for people.

The registered manager, a deputy manager and senior staff, provided leadership to the staff and led by example. Staff were motivated and felt supported by the registered manager and management team. The staff team were committed to the mission of the organisation, ‘to offer people a home for life.’ Staff treated people as individuals and each person received person centred support. Staff told us the registered manager was very approachable and they were confident and were extremely positive about their style of management.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were plenty of staff on duty to make sure people were safe and people's needs were met promptly and effectively by staff who knew people and their preferences very well. Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. The registered manager carried out routine checks of staff knowledge and capability.

There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and support.

People were kept safe because staff knew how to recognise and report abuse. Staff had received safeguarding training; they knew the signs of abuse and were confident about how to raise a concern. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Medicines were stored and administered safely. People were supported in a safe environment and possible risks to people had been identified and were managed to keep people as safe as possible whilst enabling people to live as independent a life as possible. People's health was carefully monitored and professional advice sought quickly and efficiently as needed. Staff worked collaboratively with health professionals, especially from the local community teams, forming excellent working relationships which had led to good outcomes for people.

Equipment and premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Systems were in place to check if people were at risk of being deprived of their liberty. Systems were in operation to obtain consent from people and to comply with the MCA. People were supported to make decisions and choices about all aspects of their lives.

People received care that was tailored specifically to them, needs had been assessed to identify the care they required. Care and support was planned and reviewed with people to make sure they continued to have the support they needed. People were actively encouraged to be as independent as possible. Detailed, specific guidance was provided to staff about how to provide all areas of the care and support people needed.

There was notable affection between staff and people and this was evident in actions such as the registered manager visiting people in hospital in their own time. The care people had been given at the end of their life received much praise from relatives and professionals. The staff team demonstrated commitment and maturity in supporting people and their families at that time; ensuring people always received the care and support they needed at all times, often volunteering to stay after the end of their shift.

Staff listened to what people told them and responded appropriately. Staff knew people very well and responded to noises, gestures and body language. People were treated with respect and their privacy and dignity was maintained. People and their relatives told us that they had no complaints and if they did they would speak to the staff who would listen to them and take action.

Staff actively encouraged people to be involved and feel included in their environment. People were offered a huge variety of activities and participated in an array of social events of their choice. The staff team were fully committed to ensuring that activities were offered to meet the needs and interests of each individual living at Maylands. Activities and social events were praised by people, their families, community links and professionals; with relatives telling us they ‘go the extra mile’ for everyone. There were wholly positive and caring interactions between the staff and people, and people were comfortable and at ease with the staff. The atmosphere was relaxed, with lots of laughter, people told us about different events and their holidays that had been involved in planning and organising.

Where they wanted to be, people were involved in planning the menu and cooking meals and were supported to have a balanced diet; everyone said the food was tasty. Staff understood people’s likes and dislikes and dietary requirements and promoted eating a healthy diet. Picture cards were displayed in the dining room and in the kitchen to help people make specific choices about drinks, snacks and meals.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. People, their relatives and staff were asked about their experiences of the care. These were used to improve and develop the service.

The registered manager encouraged an open culture; and people, relatives, visitors and staff were all enabled to speak out with any concerns; so that they could be put right. Standards of care were continuously reviewed by the provider and registered manager to ensure they were maintained and to make improvements when necessary.

People, relatives and staff told us that the service was exceptionally well led and that they felt supported by the registered manager to make sure they could support and care for people safely and effectively. They told us the manager and staff provided outstanding care and support for their loved ones, treating everyone as extended family. Accurate records were kept about the care and support people received and about the day to day running of the service. This provided staff with the information they needed to provide safe and consistent care and support to people. The registered manager had exceptional management oversight and was able to fully assist us in all aspects of our inspection.

We found that overall people had positive experiences. The staff knew what support people needed and they respected their wishes if they wanted to manage on their own. We observed that the support offered to people corresponded with the needs highlighted in their care plans. Staff demonstrated a good understanding of the Mental Capacity act (2005) and were person focused in their delivery of care and support.

People, who could, told us that they were supported to engage in a variety of activities and we saw people participating in an exercise session with a personal trainer. One person told us, " we have lots to do and we have fun".

We saw that people received a balanced diet and were supported with their nutritional needs. We found evidence that the provider and their staff worked in collaboration with outside professionals such as speech and language therapists and dieticians, where necessary and we saw documentation that confirmed that staff worked in line with reccomendations made.