Archived: The Maples Residential Care Home

Updated 9 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 over three days on 11, 14 and 20 August 2015. We told the registered provider the day before our visit that we would be coming so that a representative from the partnership would be present to answer any questions we had.

The inspection was carried out by two adult social care 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.

Before our inspection, we reviewed information we held about the service. This included correspondence we had received about the service and notifications required to be submitted by the service. We also gathered information from the local authority. This information was used to assist with the planning of our inspection and inform our judgements about the service.

We used a number of different methods to help us understand the experiences of people who lived in the home. We spent time observing the daily life in the home including the care and support being delivered. We spoke with seven people who used the service, two relatives, three staff and one of the registered providers. We looked round different areas of the home such as the communal areas and with their permission, some people’s rooms. We reviewed a range of records including five people’s care records, seven people’s medication administration records, two people’s personal financial transaction records, petty cash record and three staff files.

Updated 9 December 2015

This inspection took place over three days on 11, 14 and 20 August 2015 and was a short notice inspection, because the service were without a registered manager and we wanted a representative from the partnership to be present to answer any questions we had. A partnership is a legal relationship formed by the agreement between two or more individuals to carry on a business as co-owners.

Since 28 October 2013 Care Quality Commission inspectors have carried out six inspections and have found multiple areas of non-compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Whilst some improvements have been made the registered provider remains in breach of seven regulations.

The Maples Residential Care Home is a care home registered to provide personal care and accommodation for up to 15 older people. At the time of our inspection seven people were living at the home.

The service had been without a registered manager since June 2014. Since that time there had been four managers. The service were currently without a 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 and associated Regulations about how the service is run.

The registered provider had introduced some auditing systems and processes, but the audit process in place was not fully understood by the registered provider and was insufficient to assess, monitor and improve the service or manage risks to people.

The home had improved their systems and processes to manage medicines, which meant most people were protected from the risks associated with medicines, but we found one person who had not been administered one of their prescribed medicines for an infection they had.

Systems and processes had been improved to manage fire safety, but regular checks had not been maintained in terms of maintenance checks associated with fire extinguishers and emergency lighting.

Robust recruitment procedures continued not to be in place and staff were working without appropriate information and documents being obtained about them. Appropriate information was not available for agency staff who had worked at the home. This meant people may be cared for by staff who had not been appropriately assessed as safe to work with people.

Staff had still not received all the appropriate training relevant to their role and responsibilities. Staff had received supervisions, although this could be improved to cover a broader range of areas for staff to reflect and learn from practice.

In the main, people’s assessments, care plans and risk assessments contained up to date and accurate information about people, however, people had not always had an assessment of their needs carried out before admission to the service to ensure those needs could be met. Referrals were made to health professionals in relation to people’s health care needs, which included involvement from doctors and the community mental health team. One health professional confirmed a very caring staff team, but that the service lacked leadership and management for the staff and that this was reliant on support offered by them.

There was a lack of stimulating activities available for people to participate in or opportunities to maintain hobbies and interests.

When we spoke with people who used the service they all told us they felt ‘safe’. Relatives spoken with did not raise any concerns about mistreatment or inappropriate care provision of their relative. Staff had received safeguarding training, but were not confident the registered provider, without support, had the necessary knowledge to act on any concerns that were raised in an appropriate manner. We found an incident of potential theft that had not been reported to the appropriate authorities at the time the potential theft had been identified. This meant the registered provider continued not to inform the Commission about notifiable incidents in line with the Health and Social Care Act 2008.

The current staffing arrangements may not be safe and meet people’s needs as no dependency assessment had been undertaken to establish those staffing levels were sufficient to meet people’s needs, because five of the seven people who used the service needed two members of staff to assist them with moving and their personal care needs and at those times people in the lounge and dining areas were left unsupervised..

The MCA (Mental Capacity Act 2005) is legislation designed to protect people who are unable to make decisions for themselves and to ensure that any decisions are made in people’s best interests. Deprivation of Liberty Safeguards (DoLS) are part of this legislation and in place so that where someone is deprived of their liberty they are not subject to excessive restrictions. Some care staff we spoke with had not received training in MCA and DoLS and could not describe how these applied to their role and the registered provider had admitted a person to the service without the registered provider undertaking an appropriate assessment, which meant the person may have been admitted without lawful authority.

People were broadly positive about the food that they were served at mealtimes, but their responses indicated how choices were made could be improved.

The system and processes for identifying complaints had been improved. A complaints record was in place and the registered provider had taken action to resolve the complaint to the person’s satisfaction.

The registered provider had registered with the Information Commissioner’s Office, the office responsible for enforcing the Data Protection Act 1998 and where providers who hold personal data about people need to register.

The overall rating for this service is inadequate and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, the service will be inspected again in six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated up to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.