Maple Leaf Lodge Care Home

Maple Leaf Lodge is a residential care home providing accommodation for persons who require nursing or personal care to up to 67 people. The service provides support to older people living with a dementia and or a physical disability. At the time of our inspection there were 37 people using the service.

Maple Leaf Lodge accommodates up to 67 people in one adapted building, on three separate floors. One floor specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

Significant improvement had been made following the last inspection. The provider had reviewed and developed systems to monitor the quality and safety of the service. We found effective oversight and quality assurance processes in place which significantly reduced risk to people.

A variety of effective audit systems were demonstrated to monitor the quality of service people received. The provider had action plans in place demonstrating plans for continued improvement and how they could sustain this.

People received their prescribed medicines. Staff demonstrated understanding and knowledge of people’s healthcare needs.

There was significant improvement in Infection Prevention and Control (IPC) processes. The home was visibly clean, and areas had been renovated improving safety. The provider had systems in place to monitor IPC and COVID-19 measures in the home.

Staff were delivering person centred care, Interactions between people and staff were positive and engaging. People were receiving respectful and dignified care that met the needs of the person.

Staff spoke positively about the changes and improvement’s in the service. They felt supported by the management team. Relatives also felt the service had improved and their relatives continued to received good care.

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 the last comprehensive inspection on 23 June 2021 and update

The last rating for this service was inadequate (published 25 August 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 25 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from Inadequate to Good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maple Leaf Lodge Care Home on our website at www.cqc.org.uk.

There were significant shortfalls in Infection Prevention and Control (IPC) risks and environmental safety processes. Areas of the home and equipment were unclean.

Accessibility to Personal Protective Equipment (PPE) and clinical waste bins was not adequate.

The provider had systems in place to monitor the quality of the service. However, these needed to be embedded and further developed to show the planned improvements could be sustained.

We were not assured that this service met good infection prevention and control guidelines.

Maple Leaf Lodge Care Home is a residential care home providing accommodation for persons who require personal or nursing care to 52 people aged 65 and over at the time of the inspection. The service can support up to 67 people.

People’s experience of using this service and what we found

Organisational governance and quality assurance arrangements had not been effective in monitoring and improving the quality and safety of the service. We found systemic failures with oversight and quality assurances posing significant risk to service users.

The provider demonstrated a variety of systems to monitor the quality of the service. However, the processes in place needed to be embedded and further developed to show the planned improvements could be sustained.

People did not always receive their prescribed medicines. Alternative methods of administration and contact with healthcare professionals had not taken place, which put people at increased risk of health deterioration.

There were significant shortfalls in Infection Prevention and Control and environmental safety processes. Areas of the home were unclean and unsafe. The provider had systems in place to record COVID-19 testing however, ineffective monitoring meant people were at risk of infection.

People did not always receive person centred care. Their needs and preferences could not always be met. End of Life care was not always dignified.

Staff were negative about their experience of working in the service. People and their relatives provided mixed feedback, raising concerns with communication and staffing, but also highlighted they felt their relative received good care.

The provider did not always follow or act in accordance with the Mental Capacity Act (MCA). There were delays in applying for Deprivations of Liberty authorisations, meaning people were at risk of being deprived of their liberty without the legal authority.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 and update:

The last rating for the service under the previous provider was good, published on 07 March 2020.

Why we inspected

The inspection was prompted in part due to concerns received about medicines management, infection control, staffing etc. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maple Leaf Lodge Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person centred care, Governance and Deprivation of Liberty at this inspection.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Avery Lodge is a residential care home which provides accommodation and personal care for up to 64 older adults and people living with dementia. There were 59 people living at Avery Lodge on the day of our inspection.

People’s experience of using this service and what we found

People were protected from abuse. Staff were knowledgeable about how to recognise and report abuse. Systems were in place to ensure peoples safety, although these were not always effective in determining the level of risk associated with falls. The registered manager took immediate steps to ensure peoples falls risks were reviewed and the correct measures were in place. Risks associated with choking and skin integrity were managed appropriately and records were clear for staff to follow. Medicines were managed appropriately. Records of staffing levels showed the home was being staffed according to people's needs. Staff told us staffing levels were sufficient but said staff sickness sometimes affected this. Staff were recruited safely and in line with regulation.

People’s needs were assessed prior to moving into the home. Some people told us they were not satisfied with the quality of the food and told us the kitchen occasionally ran out of ingredients and condiments. We informed the registered manager who evidenced a plan to resolve the issues. Staff told us they received training they needed to do their job well. Staff told us they felt supported in their roles. People’s consent to care was sought. 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.

Staff were caring thoughtful and attentive. Staff seemed motivated and enthusiastic in their roles. People and relatives consistently told us staff were kind and caring and they were treated well. People were given the opportunity to express their views regularly and were involved in their care.

Staff were knowledgeable about how to maintain privacy and dignity.

Care planning captured people’s fundamental needs, but some development was required to capture more detail about people's likes and dislikes and what is important to them. The way people were involved in reviewing their care needed further development. We discussed this with the registered manager who developed a plan to address this. People knew how to complain and raise concerns and were listened to. Complaints were responded to appropriately and in line with policy. People were given the opportunity to take part in regular activities of their choosing. People took part in a variety of activities which they enjoyed.

There was a new registered manager who had plans to develop and improve the service. Staff were complimentary about the support they received from their managers. People and relatives were complimentary about the way the registered manager responded to issues and were happy with the support provided since in post. Processes were in place to ensure the delivery of care was monitored and checked regularly. Governance systems identified areas for improvement and plans were developed and actioned. The registered manager and the team built good working partnerships with other health and social care professionals and was developing and building links in the community.

Rating at last inspection

The last rating for this service was Good (published 02 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Avery Lodge is registered to provide accommodation and personal care for 67 people. It can accommodate older people, people who live with dementia and people who have a physical disability. The accommodation is provided on three floors. The ground floor is called Balmoral Suite where five older people can live. The first floor is called Kensington Suite where 31 people can live. The second floor is called Sandringham Suite where 31 people who live with dementia can be accommodated. At the time of our inspection visit there were 64 people living in the service. Nearly all of them were older people most of whom lived with dementia.

The service was run by a company that was the registered provider. There was a registered manager in post. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 19 January 2015 the service was rated Good.

At this inspection we found the service remained Good.

This inspection was unannounced and was carried out on 3 May 2017.

Care staff knew how to keep people safe from the risk of abuse. Although people had been helped to avoid preventable accidents some parts of Sandringham Suite had not been well cleaned and did not have a fresh atmosphere. Medicines were safely managed and there were enough staff on duty. Background checks had been completed before new care staff had been appointed.

Care staff knew how to support people in the right way. People enjoyed their meals and had been helped to eat and drink enough. They had also been supported to obtain all of the healthcare assistance they needed.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People were treated with compassion and respect. Care staff recognised people’s right to privacy and promoted their dignity. Confidential information was kept private.

People had been given all of the care they needed and they had been supported in innovative ways to pursue their hobbies and interests. There was a system for quickly and fairly resolving complaints.

People had been consulted about the development of their home. Quality checks had been completed to ensure that people received safe care. Care staff were supported to speak out if they had any concerns and good team work was promoted. People had benefited from care staff acting upon good practice guidance.

Further information is in the detailed findings below.

We found where people were able to they gave consent to their care and support. A person told us, 'I feel I more or less decide what I want. I get my breakfast early, which is the way I like it.'

We found people were provided with a varied and nutritional diet. We saw one relative had just been to ask for, and given, a 'goodie bag' of snacks as their relation was feeling a little under the weather.

We found that suitable arrangements were in place to manage people's medication and ensure they received any medication they needed. A person told us, 'I have two tablets every morning, they (staff) keep these and give them to me. I have a cream I put on every day, I keep that.'

We found there were sufficient staff to meet people's needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, 'There is always someone (staff member) around. If they can't see to you straight away they will come back to you.'