Maplehurst Nursing Home

Updated 25 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 7 November 2017 and was unannounced. The inspection team consisted of two inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience for this inspection was an expert in care for older people.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what they do well and improvements they plan to make. We looked at this and other information we held about the service. This included previous inspection reports and notifications. Notifications are changes, events or incidents that the service must inform us about. We contacted stakeholders, including health and social care professionals involved in the service for their feedback. Two health and social care professionals gave feedback regarding the service.

During the inspection we observed the support that people received in the communal areas. We were also invited in to people’s individual rooms. We spoke with nine people, three relatives, five care staff, a housekeeper, the chef, a nurse, the registered manager and the provider. We spent time observing how people were cared for and their interactions with staff and visitors in order to understand their experience. We also took time to observe how people and staff interacted at lunch time.

We reviewed five staff files, medication records, staff rotas, policies and procedures, health and safety files, compliments and complaints recording, incident and accident records, meeting minutes, training records and surveys undertaken by the service. We also looked at the menus and activity plans. We looked at six people’s individual records, these included care plans, risk assessments and daily notes. We pathway tracked some of these individual records. This is when we looked at people's care documentation in depth; obtained their views on their experience of living at the home and made observations of the support they were given. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

The service was last inspected on 1 July 2015 and was awarded an Outstanding rating.

Updated 25 January 2018

The inspection took place on the 7 November 2017 and was unannounced.

Maplehurst Nursing Home is a nursing home. People in nursing homes receive accommodation for nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Maplehurst Nursing Home is registered to accommodate up to 38 people in one adapted building. The service currently operates from 29 rooms. On the day of our inspection there were 26 people using the service with a range of support and nursing needs including older people and older people living with dementia. The home is a large detached property spread over three floors.

The home had a registered manager. 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. People were safe because a safety culture was embedded at the service.

Staff had exceptional skills in managing and reducing risk and keeping people safe whilst promoting people to lead fulfilling lives and minimise restrictions on their freedom. People’s comments included “I feel much safer since coming to live at the home, particularly at night, the amount of staff on duty is unbelievable”.

People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely. Staff were trained to be aware of signs of abuse and were encouraged to report concerns, which were investigated. A robust recruitment process was in place to make sure people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns would be listened and responded to. The service had a written complaints process. Any concerns or complaints were investigated with actions identified to make improvements.

The service was inspirational in the approach to ensure that staff put their learning into practice to deliver care that meets people’s individual needs. This was around consistent mind-sets and behaviours. On an annual basis each staff member was asked to provide quantitative feedback on each of their peers on five criteria's. These five criteria's were aligned to the CQC’s five key questions. Is the service safe, effective, caring, responsive and well led?

People received exceptionally effective care, based on best practice by staff with an in-depth knowledge of their care and treatment needs, who were skilled and confident in their practice. Staff worked with people, other professionals and continually developed their skills. The service used innovative and creative ways to train and develop staff to put their learning into practice to provide outstanding care that met people's individual needs.

People mattered and the care was exceptionally personalised. Staff paid attention to detail and demonstrated pride, passion and enthusiasm for the people they supported. Each person had a trusted member of staff, known as a keyworker, who took a lead role in each person's care and wellbeing. They continuously looked for ways to ensure people had positive experiences and led fulfilling lives. Staff knew about people's lives, their interests and talents and encouraged them to share them with others.

Staff sought people's consent for their care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, capacity relatives, friends and relevant professionals were involved in best interest decision making.

There was a strong emphasis on the importance of eating and drinking well for people living with dementia. The provider was creative in looking at ways people were supported to eat and drink, sufficient to their needs. People had access to relevant health care professionals and received appropriate assessments and interventions in order to maintain good health.

The service was very caring. Without exception, people and their relatives told us the staff were extremely caring, kind, attentive and dedicated in their approach, which was evident throughout the inspection. They commended the exceptional quality of the care they received. One person told us “They are angels I would say, all of them. They care for me and look after me wonderfully”.

Staff were highly motivated, encouraged and supported to develop in their roles. The service had a very strong, person centred culture and the ethos was that of an extended family. Staff spoke positively and passionately, without exception, about working at the service. Staff had developed exceptionally kind, positive and compassionate relationships with people.

Care planning was focussed upon a person's whole life. People and relatives were asked to complete a comprehensive 'life book /social profile' upon admission to the home. Through people's detailed care plans the staff were able to demonstrate how much people had been supported to achieve what they wanted, improving their well-being and becoming mobile again.

People were encouraged to socialise, pursue their hobbies and interests and try new things in a variety of inspiring and innovative ways. The service found innovative and creative ways to enable people to live life to the full and continued do things they enjoyed. The service was currently a pilot site for a United States based charity ‘Music & Memory’. Music & Memory brings personalised music into the lives of older people and people living with dementia through digital music technology.

The culture of the service was open and inclusive and encouraged staff to see beyond each person's support needs. The provider had clear values which the registered manager promoted to staff. The provider and registered manager showed an outstanding drive and passion to ensure the service was under a continuous improvement plan and working to be an outstanding service, ensuring people were at the heart of the service

The provider and registered manager had robust and embedded quality monitoring arrangements through which they continually reviewed, evaluated and improved people's care. These showed the service was consistently high performing and surpassed expectations. People received a consistently high standard of care because staff and management put people first and at the heart of the service, using innovation and continuously looking for new ways to improve their care and quality of life. People, relatives and professionals spoke highly around the exceptional quality of care provided at Maplehurst Nursing Home.