Hallmark Maycroft Manor Luxury Care Home

Maycroft Manor is a residential care home providing nursing care and support for up to 96 people. People were living with a range of needs associated with the frailties of old age and some people were living with dementia or other mental health needs. 87 people were living at the service on the day of our inspection.

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

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were enough staff to care for them. One person told us, “The carers and the care are very good. The help they provide to me is very good, that is what keeps me going, and until He up there takes me, I am happy to keep going.” Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “I had heard of this home’s reputation. Care homes had always been scary places for me. However, they have gone through the process so thoroughly and they have protected [my relative’s] dignity and independence as much as they could. [My relative] has settled in very quickly, I have been very impressed.”

People told us staff were kind and they had a good relationship with them. People received medicines safely. The service was clean, hygienic and a pleasant environment to spend time in. People’s care plans were up to date and accurately reflected their needs. People were able to receive visits from their relatives and there was a programme of activities to support their well-being.

Staff worked collaboratively with outside agencies such as the local authority and healthcare professionals. Complaints were handled appropriately, and people enjoyed the food and drinks on offer. People were protected from harm and abuse, as staff knew how to safeguard people and what procedures they should follow.

Staff had received relevant training to meet people’s needs. Complaints were responded to appropriately and people’s wishes at the end of their life were respected. People were able to express their views and had their dignity, independence and privacy promoted.

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.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this.

People received good care that met their needs and improved their wellbeing. The staff team were dedicated and enthusiastic.

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 21 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about care delivery. A decision was made for us to inspect and examine those risks. We inspected and found no concerns with the care delivery at the service.

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.

The overall rating for the service has remained as Good.

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.

Maycroft Manor is a care home registered to provide nursing and residential care and accommodation for 105 people with various health conditions, including dementia and sensory impairment. There were 97 people living at the service on the day of our inspection. Maycroft Manor is a large purpose built care home located in Brighton, East Sussex.

People’s experience of using this service:

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. One person told us, “You can only say great things here, they are wonderful. I have nothing to complain about”.

People enjoyed an independent lifestyle and told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. One person told us, “You can’t complain about the food”. A relative added, “When I’m older I want to live here. They are amazing. They really understand my [relative’s] dementia and what makes her happy”.

People felt the service was well presented and welcoming to them and their visitors. A relative told us, “We’re always made welcome and there is always so much going on. We sit in the bistro or in [my relative’s] room or the lounge”.

People told us they thought the service was well managed and they enjoyed living there. One person told us, “I’ll tell you how good it is, I came for six weeks and wanted to stay forever”.

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “Our training is good, and we’ve had a lot of training around dementia”.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received high quality care that met their needs and improved their wellbeing from dedicated and enthusiastic staff. A member of staff said, “I love working here. The residents are great and so are my colleagues. We are there for the residents and each other”.

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

Rating at last inspection: Requires Improvement (report published 30 October 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good. If we receive any concerning information we may inspect sooner.

Medicines were not managed safely, improvements were required in relation to recording and stock control. This was an area of practice that requires improvement.

The service had quality assurance systems and processes in place to assess, monitor and drive improvements in the quality of care people received. However, systems of audit for managing medicines were not robust. This was an area of practice that needs improvement.

The service had 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.

Staff had a good understanding of safeguarding and there were systems and process in place to keep people safe. The provider ensured staff were suitable to work at the service before they started. We observed people’s needs being responded to in a timely manner. The service was clean and infection control procedures followed.

People’s needs and choices were assessed prior to people moving into the service, and they were supported to have maximum choice and control of their lives. Staff continued to support people in the least restrictive way possible. People continued to enjoy a balanced diet and remained supported to access healthcare services as and when needed.

Care continued to be personalised to meet the needs of individuals including their care, social and wellbeing needs. The provider ensured there were systems in place to deal with concerns and complaints. End of life care was considered at the service and people’s wishes were documented in their care plans.

We observed positive interactions between people and staff, staff knew people well and had built trusting relationships. People’s independence continued to be promoted, staff supported people in a dignified manner and people’s privacy continued to be respected.

People, staff and relatives remained engaged and involved in the service provided. The culture of the home continued to be positive and respected people’s equality, diversity and human rights.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Maycroft Manor provides care and support to people with personal care and nursing needs, many of whom were living with dementia. The home was arranged over three floors and offered residential and nursing care based on people’s particular needs and requirements. Individual units were referred to as ‘communities’. One area was a specifically designed unit which provided an environment that supported people living with dementia. The home provided care and support for up to 99 people. There were 86 people living at the service on the day of our inspection. Maycroft Manor belongs to a large corporate organisation called Hallmark Care Homes. Hallmark Care Homes provide residential and nursing care across England.

A registered manager was not 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 and associated Regulations about how the service is run. The registered manager had left the service approximately two months previously, and day to day management of the service was carried out by a peripatetic manager and clinical care manager. The provider was in the process of recruiting another registered manager.

The service was clean and well maintained, with clear guidance displayed for people and staff in relation to the prevention and control of the serious infectious outbreak. People told us they understood that the service had a serious infectious outbreak and that they had been provided with information about this. They told us they understood that visiting was restricted and that there may be some temporary changes to the way their care was provided. One person told us, “They told us all about it (the outbreak), they’ve been wonderful. They have done everything they can to sort it out. It seems like they’ve gone over the top, but they have to”. The provider had also ensured that up to date and relevant information updates in relation to the outbreak were prepared and distributed to staff, visitors and people living at the service.

The provider had actively engaged with and followed guidance and protocols dictated by professional bodies such as Public Health England (PHE), Environmental Health (EH) and the local Clinical Commissioning Group (CCG) in order to contain the outbreak, and to obtain samples for screening people, staff and pets at the service.

The provider had sensitively and appropriately gathered stool samples for screening from everybody living and working at the service. Arrangements had also been made to provide specialist equipment and take isolation precautions for people who had been infected.

The provider had implemented appropriate refresher training for staff in relation to hand washing and infection control, and had also liaised with PHE to provide specific training around the effects of a serious infectious outbreak.

Effective management procedures had been put in place in light of the outbreak. A team of four managers had been put together to specifically deal with the issues in the service and to liaise with staff and external bodies. Staff told us that they felt well supported and listened to during the outbreak, and had clear lines of management and communication available to them. A member of staff told us, “Everything has been handled really well, especially around giving us good information about new guidance. I’ve been able to approach the manager about anything to do with it. It’s really great that we’ve got such a good manager”.

Changes had been made to the environment of the service and the way it was cleaned and maintained to limit the possibility of cross contamination. Staff practices and procedures had been amended in order to limit the risk of infection, and changes had been made in the way that waste was disposed of. The provider had relevant and up to date policies and procedures in relation to infection control and had updated them in light of this outbreak.

The provider undertook quality assurance reviews to measure and monitor the standard of infection control in the service and drive improvement. The provider was in the process of arranging meetings to establish learning and reflective practice, to put together protocols and tools to assist other services, both in the Hallmark Care group, and the local area that may be affected by an outbreak of this nature in the future.

As part of this inspection we spoke with eight people who used the service and four visiting friends or relatives. We also spoke with the managing director, the regional manager, the clinical care manager, the hospitality services manager, two registered nurses, a kitchen assistant, a chef and seven care workers.

Is the service safe?

People indicated to us that they felt safe living at the home and that they were treated with dignity and respect. Risk assessments were in place for people and were regularly reviewed.

The service had a system in place to set the staff rotas, which took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required.

Medicines were stored appropriately, however associated records showed that medicines were not ordered, administered and recorded in line with regulations.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to medicines.

Is the service effective?

People's health and care needs were assessed with them, and they or their relatives had been involved in writing their care plans. Their current health needs were reviewed and monitored regularly.

People had a choice of food at mealtimes. However, their food and fluid intake was not recorded and managed robustly. Some of the food and fluid recording had not been completed thoroughly and contained gaps. It was therefore not possible to confirm that all people's needs were being met.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to meeting nutritional needs.

Is the service caring?

People were cared for by staff with kindness and compassion, and they were treated with respect and dignity. People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff knew people well and linked with professionals, families and friends to undertake reviews of people's care.

People's preferences, interests, aspirations and diverse needs had been recorded.

Is the service responsive?

People were assessed prior to admission so that staff could have a comprehensive picture of their health and care needs, likes and dislikes and cultural needs.

Care plans reflected people's needs, choices and preferences and had been reviewed.

Is the service well-led?

The service had a registered manager in post at the time of our inspection. Staff we spoke with told us they were clear about their roles and responsibilities, and had a good understanding of the ethos of the home.

People were involved in developing the service and were supported to do so.

The service worked with other agencies and services to make sure people received their care in a joined up way.

As part of this inspection we spoke with four people who used the service and ten visiting friends or relatives. We also spoke with a manager, the acting regional director, a maintenance worker, two kitchen staff, eight care workers, a domestic worker, a team leader, two nurses, a hairdresser, a laundry worker and two speech and language therapists.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were being safeguarded as required.

The service was safe, clean and hygienic. Equipment had been well maintained and serviced regularly therefore did not put people at unnecessary risk. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Some staff did not know about the risk management plans that had been written for some people with particular needs. This was putting these people at unnecessary risk of harm.

The service had a system to set the staff rotas, which took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This system was not robust, there were regularly not enough care staff on duty, and the service was not managing levels of sickness and absence appropriately. This meant that people's needs were not always met.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staffing.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

We saw that visitors were able to see people in private and that visiting times were flexible.

People's health and care needs were assessed, but they were not always involved in writing their care plans. Some of the care plans had not been updated thoroughly and contained gaps. It was therefore not possible to confirm that all people's needs were being met.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning and recording of care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'The staff listen to me and accept my choices'. Another person told us, 'The staff are wonderful, they are all well-chosen. I think the care here is excellent'.

People who used the service, their relatives or friends involved with the service had been invited to complete a satisfaction survey, which was in the process of being analysed to identify any shortfalls or concerns.

On the whole people's preferences, interests, aspirations and diverse needs had been recorded. However we found that care and support had not always been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in and outside the service . The home had dedicated 'lifestyles' workers, and people told us that they had regular activities planned and trips out of the home, which helped to keep them involved with their local community.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open, thorough and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance systems, records seen by us showed that identified shortfalls were addressed promptly.

Staff we spoke with told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. However, we identified some shortfalls around communication between staff, which impacted on the care being provided to people.