CQC report explained · a residential care home
What the CQC found at Maria Residential Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found fire doors propped open, outdated food, an unsafe use of extension leads and fire evacuation plans needing updates. Medicines were given by trained staff, but some medicine procedures and records were not reliable.
- Effective?
- Good
- People's needs, risks, nutrition and hydration were assessed. Staff received training and supervision, and worked with health professionals. Mental capacity and best interest records were not always complete.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. Inspectors saw patient and gentle support, positive conversations and people being offered choices.
- Responsive?
- Good
- Care plans reflected people's needs and communication requirements. People had activities and outings, and complaints were investigated and resolved appropriately.
- Well-led?
- Requires improvement
- Management oversight had not identified or dealt with important safety and record-keeping problems. The registered manager was retiring and responsibilities were being handed to other family members.
What inspectors found, June 2019
Rated Requires Improvement; inspectors found kind and responsive care, but safety checks, records and management oversight needed improvement.
The inspection was unannounced and took place over three days. Inspectors spoke with people living in the home, staff and a relative. They observed care and checked medicines, care records, recruitment files, accidents, meetings, audits and safety records.
People were treated kindly and with dignity. Their care, food, activities and contact with health professionals were generally good. People said they felt safe and had positive relationships with staff.
Inspectors found fire doors propped open, food past its use-by date and some safety and care records that were not up to date. Most immediate problems were fixed, or plans were made, during the inspection. The home was rated Requires Improvement overall, with Safe and Well-led also rated Requires Improvement. Effective, Caring and Responsive were rated Good.
Kind and respectful care
Inspectors saw staff supporting people patiently and gently. People were treated with dignity and had positive relationships with staff.
“Staff were patient, kind and gentle with people when supporting them with care.” from the report
Good food support
People's nutritional needs were assessed. They were offered choices and received unhurried support with eating when needed.
“At lunchtime, we observed people were given one to one support if needed.” from the report
Activities and choice
People could take part in music, movement, games, colouring, shopping and café visits. Their preferences and communication needs were recorded.
“Activities were provided for people to participate in and enjoy.” from the report
Fire and building safety
seriousSome fire doors were held open with wedges. Earlier fire safety recommendations had not all been completed, evacuation plans needed updating and extension leads created a trip and fire risk.
“some fire doors were propped open using door wedges.” from the report
Management checks
seriousThe home's audits had not identified or addressed the safety and record problems found by inspectors. This led to a breach of Regulation 17.
“Although audits and quality assurance work had taken place they had not identified or addressed the issues we found.” from the report
Medicine records and procedures
needs fixingThere were no protocols for some as-needed medicines, and opening dates were not recorded. A discarded tablet was also not recorded, leaving no clear audit trail.
“When required" PRN protocols were not in place to guide the administration of 'as required' medicines.” from the report
Mental capacity records
needs fixingFor people who could not express themselves, records did not consistently show mental capacity assessments and best interest decisions.
“there was a lack of documentation around mental capacity assessments and the following of the best interest process.” from the report
- 01What has been done to keep fire doors safe and complete the fire authority's recommendations?
- 02How are medicines that are given only when needed recorded and checked now?
- 03How do you record mental capacity assessments and best interest decisions for people who cannot express their views?
- 04Who is now responsible for management checks, and how will you make sure safety problems are found promptly?
- 05Have the evacuation plans, asbestos check and night-time fire staffing arrangements now been completed?
This was an unannounced inspection covering all five CQC questions and the overall rating, following a previous Good rating published in November 2016. This explanation was written from the published report of 8 June 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2016
Rated Good; inspectors found safe, kind and personalised care, with improvements made after four breaches at the previous inspection.
This was an unannounced, comprehensive inspection on 18 October 2016. The inspector spoke with people living in the home, relatives, managers and care staff. They reviewed care records, medicine records, staff files and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicine arrangements, suitable training, good food and access to health professionals. They also found caring relationships, respect for people's choices and personalised care plans.
The provider had been in breach of four regulations at the April 2015 inspection. Inspectors found the required improvements had been completed. There were still some smaller record-keeping and audit issues, which managers agreed to address.
Safe staffing and care
Inspectors saw enough staff to support people safely. Staff understood safeguarding, risks and safe moving and handling.
“Throughout the inspection we saw there were enough staff to support people.” from the report
Kind and respectful staff
People received patient and compassionate support. Staff respected privacy, dignity, choices and independence.
“Staff were kind, compassionate and respectful and treated people with dignity and respect which promoted their wellbeing.” from the report
Personalised support
Care plans included people's histories, likes and dislikes. Staff used this information to shape daily care and activities.
“Care plans included detailed information relating to people's life histories, what and who was important to them, their likes and dislikes.” from the report
Good food and health support
People were offered choices and received help with eating and drinking when needed. Health concerns were followed up and relatives were informed.
“People had enough to eat and drink.” from the report
Improvements since the previous inspection
The provider completed the actions requested after the 2015 inspection. This included improvements to medicines, notifications, quality checks and fire safety arrangements.
“At this inspection we found improvements had been made and the provider had completed these actions.” from the report
Medicine audit gaps
needs fixingMedicine systems were generally safe, but inspectors found gaps in the monthly audits. Managers agreed to review this and produce an action schedule.
“However there were some gaps in the audits.” from the report
Mental capacity records
needs fixingSome assessments recognised that people had difficulty making decisions but did not say which decisions these were. Managers agreed to review the care plans.
“Some assessments had not identified which decisions the person had difficulty with.” from the report
Activities had reduced
minorSome relatives said activities were less frequent than before. The home said building work had affected access to reminiscence boxes and planned to reintroduce them.
“Some relatives made comments that the activities available for people were not as frequent as previously.” from the report
Previous rating was not displayed
minorThe ratings from the April 2015 inspection were not displayed on the website or in the office. The home acted immediately during this inspection and displayed the report in the home.
“Ratings of the April 2015 inspection were not displayed on the services website or in the office.” from the report
- 01How were the gaps found in the medicine audits reviewed and corrected?
- 02Have care plans been updated so they identify each decision a person may have difficulty making?
- 03How often are activities now offered, and have reminiscence boxes been reintroduced?
- 04What nursing care can the home provide, given that the report says it does not provide nursing care?
- 05What improvements or changes have been made since the October 2016 inspection?
This was an unannounced comprehensive inspection covering all five questions and the overall quality of the home. This explanation was written from the published report of 10 November 2016 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Maria Residential Home
3 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- June 2019Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 29 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
89 live-in carers within about an hour of Buckinghamshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,300 a week. 79 can care for a couple. 13 years' experience on average.
“We can all fully relax around Nyarai and she feels like part of our family, which is no mean feat!”
“She was v competent and confident and we felt our mum was safe in her care. She supported us through a difficult time.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.