About the service: Mapleford (Nursing Home) Limited is a nursing and residential care home which provides nursing and personal care to up to 54 people, including older people, younger adults, people with mental ill health and people living with dementia. At the time of the inspection, 35 people were living at the home.
People’s experience of using this service:
People were happy with the care and support provided by the service. However, we found a number of areas that needed to be improved.
We have made recommendations about infection control practices, reviewing people's records, the management of complaints and the availability of activities at the home.
The provider had not ensured safety checks of the home environment were being completed regularly or that equipment had been inspected or serviced as often as necessary. Before the inspection we received concerns about levels of hygiene at the home and we found the home environment smelled stale and unclean. Staff had not reviewed people’s risk assessments in line with the provider’s timescales and people’s emergency evacuation plans did not reflect the support they would need from staff if they had to be evacuated from the home. People were happy with staffing levels at the home. However, the service was short of permanent staff and relied heavily on agency staff during the day and at night. This meant that people were not always supported by staff who knew them and were familiar with their needs. The registered manager followed safe processes when recruiting staff to ensure they were suitable to support adults at risk. The service managed people’s medicines in a safe way.
Staff did not always support people in a way which met their needs. Care documentation about people’s dietary needs was not always clear and consistent. People’s care plans and risk assessments were not always reviewed and updated regularly. This meant that staff did not always have access to accurate information about people’s needs and how to meet them. Some staff refresher training was overdue. Most people felt staff had the knowledge and skills to support them effectively. Staff completed mental capacity assessments in line with the Mental Capacity Act 2005 and consulted people’s relatives when people were unable to make decisions about their care. When people needed to be deprived of their liberty to keep them safe, the service applied to the local authority for authorisation to do this. Staff supported people with their healthcare needs and referred people to community professionals when they needed extra support.
People liked the staff who supported them. They told us staff were kind and treated them with respect. Staff considered people’s diversity and provided people with any support they needed with their communication needs. Staff respected people’s right to privacy and dignity and encouraged people to be independent when it was safe to do so. Some people and relatives told us staff had discussed their care needs with them and they were involved in decisions about their care. The service provided people with information about local advocacy services, to ensure they received support to express their views if they needed to.
Staff did not always provide people with care that reflected their needs and preferences. Staff had not completed monthly reviews of people’s needs and risks, in line with the provider’s processes. Some had not been reviewed or updated for many months, which meant they may not have reflected people’s needs and risks. The service used a lot of agency staff, who were not always familiar with people’s needs and how they liked to be supported. Complaints had not always been managed in line with the complaints policy. One person told us they had raised concerns previously but had not felt listened to. The registered manager took action when we raised these concerns with her. Staff offered people choices and encouraged them to make decisions about their care when they could. Staff provided people with effective end of life care which involved their relatives.
The provider had failed to have effective oversight of the service and to ensure that improvements were made when needed. The provider and registered manager had completed a variety of audits, but necessary actions had not been completed in a timely way. This meant the audits had not been effective in ensuring appropriate levels of safety and quality were maintained at the home. The provider had failed to identify and address some of the issues we found during our inspection. The service worked in partnership with a variety of community agencies. Community professionals gave us mixed feedback about the home and the care staff provided. Some staff told us they would not be happy for a family member to live at the home, due to inconsistencies in the standards of care provided.
Rating at last inspection:
At the last inspection the service was rated good (published 10 August 2017).
Why we inspected:
This inspection was brought forward due to information of concern received about the home.
During this inspection we identified breaches in relation to the safety of the premises, the provider’s failure to ensure staff had the skills to provide people with safe care and the provider’s failure to monitor and improve the quality and safety of the service.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up:
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements, working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.