We carried out a review of the data available to us about Maltreath Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Maltreath Residential Care Home, you can give feedback on this service.
Maltreath is a residential care home providing personal care to up to 12 people. It specifically provides a service for people with mental health needs and some who are living with dementia. At the time of our inspection there were 7 people using the service. Maltreath accommodates people in one building.
People’s experience of using this service and what we found
There had been a change management of the service since our last inspection. People, staff and relatives spoke positively about changes that were taking place at the service.
People's records did not always contain the guidance and information needed to give people the care and support they needed in the way that suited them best. Detailed guidance was not always available to staff about how to mitigate risks to people and provide their care in the way they wanted. Staff were knowledgeable about people’s needs and know what action to take if risks occurred.
The registered manager had not always informed the Care Quality Commission (CQC) of notifiable events that happened at service in a timely way. They had realised this shortfall by the time we inspected and informed CQC retrospectively.
The provider and manager had a vision of how the service needed to develop and was striving to develop and improve the service offered to people. A governance framework was in place which covered all aspects of the service and the care delivered. Numerous quality assurance audits had been completed. When shortfalls had been identified, action had been taken and plans were in place to continue with the improvements.
People lived in an environment that needed upgrading and refurbishment. The management team had a renovation action plan in place. Significant works had been completed and there were on-going improvements throughout the service.
People told us they felt safe at the service. Staff had completed training in safeguarding and knew how to recognise and report abuse or neglect. Accident and incidents were recorded and analysed to look for trends and themes. Lessons had been learnt when things had gone wrong, and the management were open and honest about mistakes they had made. Action had been taken to reduce the risk of them from happening again.
The service had a safe recruitment process which ensured only suitable staff were employed. There were enough staff on duty to make sure people received the personal care and support they needed when they needed it. Staff had the appropriate training to enable them to carry out their roles effectively.
Staff had been trained in the administration of medicines. People received their medicines as prescribed, and the administration records were well kept. When people needed ‘as and when’ medicines there was guidance in place, so people were given there medicines consistently and safely. Staff had positive links with social and healthcare professionals which promoted people's wellbeing. Visiting professionals told us, "Maltreath has been very responsive and will not only follow professionals' advice but actively seek it in order to ensure they are following the right procedures and advice."
People were involved in planning changes at the service and the registered manager acted on feedback received from people and staff. Staff offered people choices in areas of their life and staff respected decisions they made. People told us they were supported to remain independent as possible.
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.
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 14 December 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this 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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.
Recommendations
We have made a recommendation regarding improving records.
The overall rating for the service remains good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maltreath on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Maltreath 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. Maltreath provides accommodation and personal care for up to 12 people. It specifically provides a service for people with mental health needs and some who are living with dementia. At the time of inspection, there were 12 people living at Maltreath.
There was a registered manager in place who was unavailable on 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 2008 and associated Regulations about how the service is run.
At this inspection we found the service remains good.
The atmosphere at Maltreath was relaxed and friendly. People and staff interacted with kindness and respect. There was an inclusive, supportive and homely culture that reflected the provider’s visions and values. People living at Maltreath were supported to live full and enriching lives. Staff knew people well and had the appropriate knowledge and training to keep people safe. Positive risk taking was encouraged to ensure people could maintain skills and experience new things.
There were enough staff to support people and staff continued to have the training and support to provide people with high quality care that responded and adapted to people's changing needs. Staff had a good working relationship with associated professionals, so people received care and support from professionals as and when they required it. Relatives told us that they were kept informed of changes in people's physical and emotional health.
Medicines were stored safely. However, there was not guidance for each person's use of 'as needed' (PRN) psychoactive medicine. Although staff knew people well, there was no guidance to tell new staff what triggers and signs to look out for. In addition, when psychoactive PRN's were given a sufficient explanation was not given. This was an area for improvement.
Daily checks ensured that if there were any shortfalls, these were quickly identified and resolved. The clean and well-maintained premises continued to meet the needs of people and staff knew how to protect people against the spread of infection.
Care continued to be developed in line with developments in the latest and best practice. The provider and manager attended a variety of forums and developments were discussed in team meetings and through training sessions. Care plans were person centred and thorough and were written in a way that was meaningful to people. Peoples communication needs were assessed and staff used different methods to enable people to communicate their views and choices in their own way, through discussions, reviews and resident’s meetings.
People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff worked with people and their relatives to ensure that care plans and support reflected their care needs. People discussed what they would like to happen if they were to pass away. However, the registered manager did not discuss with people what they would like to happen at the end of their lives, this was an area for improvement.
The manager sought feedback from people using the service, staff, relatives and health professionals and an accessible complaints procedure was available. Complaints, compliments, accidents and incidents were recorded, and these were collected and analysed by both the manager and the provider to identify patterns and if lessons could be learnt. Regular checks and audits were carried out to ensure issues were identified and resolved.
People's information was kept securely in the office and staff respected people's privacy, dignity and confidentiality. The previous CQC rating of 'Good' was displayed in the hallway for people to see.
There are two registered managers who both work with the staff each day. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 carried out an unannounced comprehensive inspection of this service in April 2015. Six breaches of legal requirements were found. We issued requirement notices relating to safeguarding people from abuse, lack of guidance to minimise risks, the maintenance of the premises, staffing and person centred care. We served a warning notice relating to good governance. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. At this inspection we checked that they had followed their plan and to confirm that they now met legal requirements. We found those breaches in the regulations had been met. We found one new breach of regulation.
Risks to people’s safety were identified, assessed and managed. Assessments identified people’s specific needs, and showed how risks could be minimised. However, staff did not consistently follow guidance to record behavioural events.
The registered manager and staff carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. Some audits needed further development to record actions taken and this was an area for improvement. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. There were regular fire drills and people told us how to leave the building safely and where to meet if the fire alarm sounded.
People were encouraged to be as independent as possible and were supported to take reasonable risks to maintain their independence. Some people were able to go out daily and do what they wanted in the local area. People met friends and visited local cafes. People were involved in activities, when they wanted to be, which they said they enjoyed.
People, their relatives and staff were encouraged to provide feedback to the registered manager about the quality of the service. This was had not yet been extended to health professionals, to continuously improve the quality of the service, and was an area for improvement.
People said they felt safe living at the service. Staff understood how to protect people from the risk of abuse and the action they needed to take keep people safe. Staff were confident to whistle blow to the registered manager or other organisations if they had any concerns and were confident that the appropriate action would be taken.
People received their medicines safely and when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. Accidents and incidents were recorded, analysed and discussed with staff to reduce the risks of them happening again.
Recruitment processes were in place to check that staff were of good character and safe to work with people. Information had been requested about staff’s employment history, including gaps in employment. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People were consistently supported by sufficient numbers of staff who knew them well.
People were happy with the care and support they received. People received their care in the way that they preferred. Care plans contained information and guidance so staff knew how to provide people’s care and support. Staff were familiar with people’s life stories and were knowledgeable about people’s likes, dislikes and preferences.
People and their relatives were involved with the planning of their care. Care and support was planned and given in line with people’s individual care needs. People spoke positively about staff and told us they were supportive and caring. Privacy was respected and people were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people.
The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. There were no people subject to an authorised DoLS.
People were supported to maintain good physical and mental health and had access to health care professionals when needed. People told us the staff supported them to attend appointments when they wanted them to. People were provided with a choice of healthy food that they liked. People told us they met each week to decide what they wanted to have on the menu the following week and that they made suggestions for different foods. When people were not eating enough they were seen by a dietician or their doctor. Staff followed the guidance given when fortified drinks and diets were required.
People and staff told us the service was well-led and that the registered managers were “always available” and “Here every day”. Staff said they felt supported, that the registered managers were approachable and that they worked closely as a team.
The registered manager and management team coached and mentored staff through regular one to one supervision. Staff were clear about what was expected of them and their roles and responsibilities and felt supported by the management team.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.
People said their views were taken seriously and any issues they raised were dealt with quickly. People told us they did not have any complaints about the service or the support they received from the staff.
This was an unannounced inspection carried out on 10 April 2015. Maltreath Residential Care Home is in a residential area in Cliftonville. The service provides care and support for a maximum of 12 persons with mental health conditions, including, schizophrenia, bipolar and psychosis. On the day of the inspection there were 12 people living at the service.
There are two registered managers who both work with the staff each day. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People told us that they felt safe living at the service and were well supported by staff. Staff understood the importance of keeping people safe and knew how to recognise signs of abuse. The provider did not have up to date policies and procedures in place for staff to follow to ensure that any concerns about people’s safety were reported properly. When there had been incidents between two people these had not been reported to CQC or the local safeguarding authority.
People were supported to have their medicines at the right time. Medicines were stored securely and safely. People’s medicines were regularly reviewed. There were no documented medicine audits to ensure people received their medicines safely.
There was a lack of guidance for staff to minimise the potential risks to people’s safety. Accidents and incidents were recorded and monitored by the registered managers; however, there was no information to show what positive action had been taken to support people and to keep them safe.
There were enough skilled and experienced staff on duty to make sure people received the care and support they needed. The provider had recruitment and selection processes in place to make sure that staff employed at the service were of good character.
The premises were not adequately maintained. There were no audits in place to monitor and identify shortfalls in the level of cleanliness and to take the appropriate action.
People were generally relaxed in each other’s company and with staff. Staff knew people and their individual preferences and routines well. Staff received regular training. The provider did not support staff by consistently holding one to one supervision meeting and appraisals with them.
There was a risk that people’s rights may not be protected because assessments were not carried out to check whether people were being deprived of their liberty and whether or not it was done so lawfully.
The provider worked closely with health and social care professionals to make sure people’s care needs were met. People’s nutritional needs were met by a range of nutritious foods and drinks.
Staff were kind and caring. Staff encouraged people to maintain their independence. People were treated with dignity and respect. Staff involved people in making decisions around their care and support. People’s records were stored securely to protect their confidentiality.
Care plans reflected people’s individual needs and choices. Care plans were up to date and regularly reviewed. People received personalised care and support and were involved with the planning of their care but were not always written in a respectful way by staff.
Some people had behaviours which may challenge others. There was no guidance for staff on what triggers a person may have and how to de-escalate behaviours quickly and to ensure people were supported in a consistent manner.
People told us that there was very little to do in the service. Some people were able to go out on their own while others needed the support of staff. Some people chose to stay in their rooms. There was a lack of activities in the service and some people may be at risk of social isolation.
The notices about making complaints contained out of date information. People told us that if they had any concerns that they would speak to the staff and that they would be listened to.
Care plans were kept securely to protect confidentiality. The records in the office were disorganised and not easily locate. Policies were out of date and had not been reviewed.
There were no systems in place to regularly monitor the quality of the service that people received.
We found a number of breaches 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 this report.
We saw that people were offered choices and their decisions and independence was respected.
People we spoke with told us that they liked living in the home and that staff were friendly and caring. We saw that people looked relaxed and calm.
People told us that they were satisfied with the care and support they received. One person said "The food is good, there is a good choice or I can ask for something different". Another said "I sometimes get on well with the people living here; I can go to my room when I don't".
We saw positive interactions between staff and the people who lived at the service. Staff spoke with people in a calm professional manner and explained what they were doing when they supported them.
There were effective recruitment and selection procedures in place. The service had processes in place for the recruitment and management of staff, and the staff working there had had the necessary recruitment checks.
We observed four people in the main lounge and found that they had positive interactions with each other and with the two carers on duty. We saw that all the people who use the service moved freely around the home, and were dressed in clean and season-appropriate clothing.
We observed 4 people in the main lounge and also observed other people in other parts of the home, and noted that they had positive interactions with each other and with support staff.
We found that people engaged positively with staff at the home. We noted that people at the home were comfortable, dressed appropriately and able to move freely about the home.
A visitor told us that the home was 'vey reasonable', and that his wife 'was very happy there and would not want to move'. He also told the inspectors that the staff at the home kept him updated on any changes to his wife's care.