Mapleton

Mapleton is a residential care home providing personal care for to up to 20 people. The service provides support to older people, including people living with a diagnosis of dementia and people with a learning disability. At the time of our inspection there were 15 people using the service. Mapleton has secure accommodation over two floors. People living at the service long term live on the ground floor. The first floor has been developed to be used as a short stay assessment unit to support people, who may have complex needs, moving from hospital to a longer-term setting. Both floors have kitchen, lounge and dining space and access to outside space. Peoples' bedrooms are en-suite and all rooms have ceiling track hoists.

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

The management team had addressed the concerns identified at the last inspection and were continuing to drive service improvement. They had created a culture which was person-centred, open, inclusive and empowering. A relative told us, “There were a few issues previously, but the management has changed completely since [family member] has been there and it seems well managed now. The staff seem happy. The home feels nice, homely and comfortable.”

There was a robust and effective quality assurance programme in place. People, relatives and staff were consulted and asked for their views. This enabled the provider and registered manager to identify issues and take prompt action to address them.

People felt safe living at Mapleton. They were supported by a stable and consistent staff team who knew them well. We saw kind and caring interactions during the inspection.

The provider and registered manager used a dependency tool to ensure there were sufficient numbers of staff deployed to meet the needs of the people at the service. Staff were recruited and selected safely.

New staff completed a thorough induction and received the training and supervision necessary to carry out their roles. There was a culture of continued learning and reflection. Staff told us, “If you make mistakes, they don’t come down on you like a ton of bricks. They ask what support you need to move forward. To reflect and learn from it.”

Risks to people's health and well-being were assessed and reviewed appropriately. There was clear guidance in place for staff to follow. Staff worked closely with a range of external health and social care professionals to meet people’s needs and help them work towards their goals.

Measures were in place to prevent the spread of infection, and safety checks on the environment were in place and robust. Medicines were safely managed. Incidents and accidents were appropriately recorded and analysed for patterns and trends. Safeguarding processes were in place to help protect people from abuse.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 this service was requires improvement (published 27 June 2022) 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.

At our last inspection we recommended the provider consider using a dependency tool to ensure staffing levels reflect peoples' level of care and support needs. At this inspection we found the provider had acted on this recommendation and made improvements to how staff were deployed.

Why we inspected

We carried out an unannounced focused inspection of this service on 19 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their support of people in line with The Mental Capacity Act 2005, and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mapleton is a residential care home providing personal care to up to 20 people. The service provides support to older people, including people living with a diagnosis of dementia. At the time of our inspection there were 19 people using the service. Mapleton has secure accommodation over two floors. People living at the service long term live on the ground floor, where as the first floor has been developed to be used as a short stay assessment unit to support people, who may have complex needs, moving from hospital to a longer term setting. Both floors have kitchen, lounge and dining space and access to outside space. Peoples’ bedrooms are en-suite and all rooms have ceiling track hoists.

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

Shortly before this inspection commenced, the registered manager had resigned and deregistered with the Care Quality Commission. The deputy manager was appointed as the new manager during this inspection. The new manager had identified concerns relating to induction, training, supervisions and appraisals, communication and record keeping, consent, medicines management, equality and consistency of care in the weeks prior to this inspection commencing. They had not yet had time to address all of these concerns. The previous manager had failed to complete a monthly audit tool required by the provider, and the provider had failed to address this. The provider had ‘stood down’ the requirement for the resource manager to complete three monthly quality checks, due to other business pressures caused by the Covid-19 pandemic. This meant there had been no effective manager or provider oversight of the service since August 2021. Notifications were not always made in line with legal requirements.

Staff told us that the previous manager’s approach had created conflict between the staff team, one said, “There’s been a lack of consistency and I hope that’s going to change.”

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.

Two people were being deprived of their liberty without the legal authorisation to do so. They had both been assessed as lacking capacity to consent to care, however, the service had failed to make DoLS applications in respect of these two people. One person told us they were not allowed to leave the building alone, despite being assessed as having capacity to consent to care and not being subject to a DoLS application.

There were enough staff to meet peoples’ needs safely, however, some staff and family members told us there were times when it was very busy. One staff member said, “It can be quite challenging with the level of care people need at the moment.”

We recommended the provider consider using a dependency tool to ensure staffing levels reflect peoples’ level of care and support needs. Staff training was not always kept up to date and new staff had not always been well supported through their induction.

The new manager had made immediate changes and held staff meetings in the weeks leading up to this inspection. Expectations were made clear and staff told us they felt confident in their ability. One staff member said, “I can see improvements already.” Another staff member told us the new manager had “been very supportive” and a third said, “I would say it feels a lot calmer.” A robust quality assurance structure had been created. Time was needed for team leaders and the acting deputy manager to complete these audits and for the systems to embed.

Peoples’ individual health needs were assessed prior to them moving to Mapleton, and a comprehensive initial assessment completed shortly after they arrived. Where people had identified risks, their care plans contained the information staff needed to minimise the risk to the person. For example, where people needed re-positioning regularly. Staff worked closely with other health professionals to ensure people received appropriate care and, where appropriate, were able to move onto another service which suited their long-term needs or to return home. People were well supported to maintain a balanced diet. Catering staff had a good knowledge of peoples’ likes and dislikes and people could choose from a variety of meals. One person told us the food was “wonderful”.

Systems were in place to protect people from abuse and appropriate referrals had been made to the local authority. People received their medicines safely and accidents and incidents were recorded and reviewed to identify any action that could be taken to mitigate the risk. We were assured that the provider had sufficient infection prevention and control measures in place and there were no limitations in place to people receiving visits.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (10 April 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to address the concerns identified, including appointing a new manager who will apply to register with the Care Quality Commission. A range of audits have been put in place and provider three monthly quality checks have been reinstated.

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

Enforcement and Recommendations

We have identified breaches in relation to the need for consent, notifications of incidents and good governance at this inspection.

We recommended the provider consider using a dependency tool to ensure staffing levels reflect peoples’ level of need.

Please see the action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

People were not all able to tell us verbally about their experience of living there. Therefore, we observed the interactions between people and the staff supporting them.

The management team and staff knew people well and understood their likes and preferences and health needs. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were welcome at any time and any concerns were listened and responded to.

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

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. People were observed to have good relationships with the staff team. Staff actively encouraged people to maintain links with the local community, their friends and family.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for social interaction and activity with staff. Staff knew how to keep people safe from harm.

People's care was individualised and focused on promoting their independence as well as their physical and mental well-being. Care was planned to meet people’s needs and preferences. The registered manager supported people as much as they were able to be involved in the development of care plans and any reviews.

The environment was safe and people had access to equipment where needed. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

People were involved in meal planning as much as they were able to. Staff encouraged people to eat a well-balanced diet and make healthy eating choices.

The registered manager and management team worked well to lead the staff team in their roles and ensure people received a good service. People, their relatives and staff told us they were approachable and that they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.

Rating at last inspection:

Good (report was published 22 September 2016)

Why we inspected:

This inspection was a scheduled comprehensive inspection based on the previous rating.

Follow up: ongoing monitoring; possibly more about how we will follow up.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Mapleton is a care home without nursing, registered to provide accommodation and care for up to 20 people. At the time of the inspection there were 16 people living at the home. The service provides some respite care as well as a permanent home for people, and was a specialist home catering for the needs of people living with dementia. Some also had physical care needs or were living with long term health conditions. This was the third rated inspection of the home.

The home comprised two separate units, one on the ground and first floor. Each unit had its own kitchen, dining area and lounges, and had been designed in partnership with the University of Stirling Dementia centre to reflect best practice standards in dementia friendly buildings. People had access to safe outdoor space and were able to be active around the building. All bedrooms were en-suite and for one person use. There was also a large communal room on the ground floor, and a hairdressing salon and activities room on the first floor.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there was good management and leadership at the home. Staff, visitors and people were positive and enthusiastic about their experiences of living, visiting or working there. Staff regularly referred to being “proud” of the support they gave people, and contrasted this with other places they had worked. There was a clear vision and ethos about the type of care being delivered that was understood by staff, people using the service and their families. This was aimed at enabling people to receive care and support that was individualised, respectful and in line with the person’s wishes and best practice. It meant that people received consistent care from people who had time to get to know them well. The manager had made themselves more accessible to people by moving their office nearer to where people spent their time. We saw this had been successful and people and visitors came in to speak with them throughout the day.

People were encouraged to be as independent and active as they wished, and we saw people’s special events and achievements were celebrated with them. This helped people feel valued and respected. Care files and plans reflected people’s needs or wishes about their care and how this was to be delivered. Plans were clear about the impact of living with dementia on every aspect of each person’s life. They reflected how people could be supported positively in ways that recognised the skills and independence they retained rather than focussing on areas of loss. Activities provided met people’s individual needs and wishes, and were based on replicating ordinary daily life and people’s previous lifestyle choices.

We saw much positive practice and evidence of caring relationships in place. We found good consistent practice across the staff team, which meant people’s needs could be met in a calm way. Staff and people respected the registered manager and management team, and staff understood their roles. People’s dignity was respected, and staff demonstrated respect for people’s individuality, for example, people’s wishes regarding their style of dress were respected. Staff took time to understand people’s wishes and spoke with them discreetly about their care. Information was given in ways people could understand, and care was delivered in private.

Visitors were encouraged to visit at any time, and enabled to continue to have positive relationships, including taking an active role with people’s support if they wished. For example, one relative told us they regularly came in to have breakfast with their relation on their way to work. This helped to maintain a normal family relationship, and the visitor helped prepare their relation’s breakfast for them. Visitors who were actively involved in their relation’s care spoke positively about this and the relationships at the home. One told us “I don’t just come to visit my Mum, I feel like I am coming to see everyone”.

People were supported to make choices about meals. Staff prepared some meals individually for people when they wanted them. People told us they enjoyed their meals, and gave feedback to the chef about likes and dislikes. Information was available for the catering team about different dietary needs and preferences. Staff sat and shared meals with people which encouraged a homely and comfortable feel to the mealtime, as well as ensuring people received discreet monitoring and support.

People received support from community healthcare services such as GPs and community nurses where this was needed. We saw people had been assessed for specialist seating and were supported to attend hospital appointments if needed. Staff had acted promptly to ensure people received medical care in an emergency.

Risks to people’s health and welfare were being assessed and mitigated. People were protected from the risks associated with medicines and from infections. Audits were in place to assess the quality of the services provided and practices were well understood by staff we spoke with or observed. The environment was well maintained and any issues or risks that arose were mitigated wherever possible. The environment was supportive to people living with dementia, with use of signage, colours, lighting and furnishings based on best practice advice.

Staff understood how to safeguard people from abuse. Staff told us they would report any concerns about people’s well being. There were enough staff on duty, and a full staff recruitment process had been followed to ensure any staff were safe to work with people. The home had effective complaints policies and procedures for people to use to raise any concerns.

Staff had the skills and training they needed for their job role and were knowledgeable about people’s care needs. Systems were in place to ensure their competency and to ensure they received the support they needed in their job role.

The service was supporting people in line with the Mental Capacity Act, and protecting their rights. Assessments of people’s best interests were being carried out where they lacked the capacity to make a decision. Applications had been made for authorisations under the Deprivation of Liberty Safeguards (DoLS) to deprive some people of their liberty at Mapleton. These had been made following individual risk assessments relating to the person and their living with dementia.

Regular audits ensured people had a chance to share their views and experiences. This was both through questionnaires and immediate feedback on a computer screen in the entrance area. There was a clear management structure at the home. The registered manager received support from the wider provider organisation, for example with regard to health and safety issues. Where any concerns had been identified there were clear action plans in place to address them. The governance systems at the home had improved, with increased oversight and regular management meetings to ensure improvements were sustained. Learning took place from incidents or accidents to help prevent a re-occurrence.

Records were well maintained. Staff recording in the plans was respectful and positive. Records were stored securely. The registered manager was planning to develop electronic records systems for people. Policies and procedures seen were up to date.

At the time of our inspection the home was about to undergo major redevelopment to become a dementia centre of excellence. Work was to start on the first floor and was not accessible. All the people were living on the ground floor.

All the people and relatives we spoke with were complimentary about the care provided. One person said 'Everything is good about this place I promise you.' One relative said 'The staff are lovely, genuinely caring. They keep you informed.'

All the people and staff we spoke with were very complimentary about the food. One person described the food as 'to die for'. A member of staff said the food was better than that in a four star hotel they had worked in.

All the people and relatives we spoke with were complimentary about the quality of the service. One person said 'It's lovely. I like it here. Everything is as it should be.' Another person said 'I don't complain about anything because I haven't got anything to complain about.'

Medicines were managed safely and records were fit for purpose.