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Inspection carried out on 23 March 2019

During a routine inspection

About the service: We carried out an unannounced comprehensive inspection of Mapleton on 23 March 2019. Mapleton is a ‘care home’ that provides care for a maximum of 20 older people, all who are living with a diagnosis of dementia. At the time of the inspection 15 people were using the service.

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

Inspection carried out on 10 August 2016

During a routine inspection

This inspection took place on the 10 August 2016 and was unannounced. The inspection started at 07:25am to allow us to see how staff were deployed for the day.

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

Inspection carried out on 03 July 2015

During a routine inspection

This inspection took place on 03 July 2015 and was unannounced. It was undertaken to follow up the response by the home to the requirements made and enforcement action taken as a result of our inspection on 24 and 26 February 2015.

Mapleton is a care home without nursing, operated by Devon County Council (DCC). It is registered to provide care for up to 20 people. In 2014 the home was redeveloped as a “Centre of Excellence” for people with dementia. This included a re-design of the home, based on good practice advice with regard to the care of people with dementia. The home provides two units of 10 single bedrooms with en-suite facilities, each having their own dining and lounge areas. Communal areas in these units have been designed to be homely and domestic in feel, and support people with dementia to orientate themselves independently. In addition there is a landscaped garden with sensory areas and a large communal room on the ground floor.

At the time of the inspection there were 16 people living at the home.

The registered manager was not available during the inspection. 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. Management cover was being provided by two deputy managers: one employed at Mapleton and one from another home operated by Devon County Council which had recently closed, as well as Devon County Council’s Resource Manager.

At the previous inspection we identified concerns relating to the safety and welfare of the people living in the home, including the prevention of pressure ulcers, maintaining people’s nutrition and hydration and managing medicines safely. We found not all staff had an understanding of the care needs of people with dementia or the principles of the Mental Capacity Act 2005.

We took enforcement action against the home in response to breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Actions had been taken to address the shortcomings identified at our last inspection. However, we are unable to judge two of the key questions as ‘good’ because the actions taken to ensure people receive responsive and well led care have not been in place long enough to ensure they are applied consistently and over time.

Following the inspection in February 2015 the home provided us with a detailed action plan of how these issues of concern were to be addressed. The home has worked cooperatively with the Care Quality Commission and Devon County Council’s Safeguarding and Quality Assurance and Improvement Teams to identify how these issues arose, where and how improvements need to be made and how to ensure these issues do not reoccur.

At this inspection we found people’s care needs had been fully assessed. People told us they felt safe and were well cared for. Risks to their health and welfare had been identified and management plans provided clear instructions for staff about how to reduce risks and keep people safe. Where necessary advice had been sought from other care professionals such as the community nurses, dieticians, occupational therapist, and specialist nurses. Care plans were more detailed and provided information about people’s preferences and how they wished to be supported.

Communication between shifts had improved to ensure all staff were aware of people’s care needs and their responsibilities.

Medication practices had been reviewed and were safe. The way in which topical medicines were stored and recorded had changed to ensure people received these medicines as prescribed.

We found people’s nutrition and hydration needs were better identified, recorded and reviewed. Staff had clear guidance on what actions to take should they identify someone was not eating or drinking enough to maintain their health. The way in which people were supported to make choices about what they wished to eat had improved with the use of pictorial menus and meals being presented in serving dishes.

Staff had received comprehensive training in dementia care, the Mental capacity Act 2005 and Deprivation of Liberty Safeguards, some of which was provided in association with Plymouth University. They had a better understanding of the care needs of people with dementia and how to support people who became anxious due to their memory loss.

During our inspection in February 2015 we found people were supported by kind and caring staff and this continued to be the case at this inspection.

People’s care plans had been written with the person and their relatives, where appropriate, to enable staff to have a better understanding of their preferences, past history and social interests.

Staff recorded the care and support they provided to people in more detail than at the previous inspection. Should someone be reluctant to receive personal care, staff were guided with strategies that might overcome their hesitancy.

We saw people were encouraged to continue to live as ordinary a life as possible, to participate in everyday tasks around the home, to continue with their hobbies and to go out to the local town.

People and relatives told us the home was well managed. Since the previous inspection, the home has worked cooperatively with the local authority’s safeguarding team to identify risks to people’s health and wellbeing and to ensure people’s care needs have been thoroughly assessed. Devon County Council’s (DCC) senior managers, the home’s registered manager and the staff team have worked with DCC’s Quality Assurance and Improvement Team to identify the weaknesses in the previous quality assurance process and to produce a more robust plan of audit and review. Increased quality monitoring included a monthly check by the registered manager of issues such as care plan reviews and daily recording, medication practices, the safety of equipment, infection control and staff learning and development. A full health and safety audit had been undertaken in May 2015.

Inspection carried out on 24 and 26 February 2015

During a routine inspection

We inspected Mapleton on the 24 and 26 of February 2015. The inspection was unannounced and was undertaken as we had received information of concern in relation to care of people at the home as the result of an ongoing safeguarding process.

Mapleton is a care home without nursing, operated by Devon County Council (DCC). It is registered to provide care for up to 20 people. In 2014 the home was redeveloped as a “Centre of Excellence” for people with dementia. This included a re-design of the home, based on good practice advice with regard to the care of people with dementia. The home now provides two units of 10 single bedrooms with en-suite facilities, each having their own dining and lounge areas. Communal areas in these units have been designed to be homely and domestic in feel, and support people with dementia to orientate themselves independently. In addition there is a landscaped garden with sensory areas and a large communal room on the ground floor.

The registered manager was not available during the inspection. 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. Management cover was being provided by an interim manager from another home operated by Devon County Council which was in the process of a planned closure. The interim manager had only been at the home for just over a week when we began the inspection, but had already made an application to have this location added to their registration to ensure that they were legally responsible for the operation of the home in the absence of the registered manager. They were at the home for both days of the inspection.

People were not protected against the risks associated with their care. Risk assessments were not being completed properly and actions were not always taken to address risk when risks were identified. We found some people did not receive the safe care they needed as a result.

There was poor monitoring of people’s eating and drinking which put people who used the service at risk of inadequate hydration and nutrition. We found that people had been put at risk because action plans had not been put in place to assess weight loss or constipation.

The home did not always respond to people’s specific or individual care needs. We saw that some referrals to community healthcare or other services had not been made and that care recommended for individuals had not always been carried out. People who presented challenges to their care did not always have this reflected in their care planning. Staff did not have clear and consistent strategies for managing behaviours that presented challenges.

Medication systems were not being managed well enough or reviewed regularly to ensure that people received the medication they needed in a safe way.

Staff were not all working consistently to support people, did not all have the skills or knowledge to support people effectively. They did not understand people’s rights under the Deprivation of Liberty Safeguards. One person had not been properly assessed for their capacity to consent to a forthcoming medical procedure and no best interests decision had been undertaken. The CQC had not been informed about the authorisation of a Deprivation of Liberty Safeguard for a person who lived at the home.

Records were not well managed or used. Care files were overly large documents that contained out of date or inappropriate information, such as information on old hospital appointments. Information was difficult to locate and was in places contradictory. This left people at risk of unsafe or inappropriate care as staff could not easily locate information about people’s needs or trace through the care that they had received.

There was a lack of understanding and clarity over the ethos and philosophy of the service throughout the staff team. Although changes had been made to the building in line with best practice, changes in other areas such as care planning were not well developed. This led to conflict in how the unit was working.

Quality assurance systems and monitoring systems were not working well. This meant that learning did not take place over incidents and people were not being protected from inappropriate or unsafe care.

Staff had received training in care, and there were enough staff on duty to support people and meet their needs.

The home’s recruitment systems helped ensure people were cared for by staff who were suitable to be working with potentially vulnerable people, and staff had received training in how to protect people from abuse.

Staff had developed trusting and caring relationships with people at the service. We saw positive interactions between people with staff involving people in daily living tasks such as laying tables to help maintain their independence and self-esteem. Staff spoke about people affectionately and respectfully.

We found a number of breaches of regulations and you can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 22 July 2013

During a routine inspection

On the day of our inspection 17 people were living at the home and receiving care from the service. We, the Care Quality Commission (CQC), spoke with three people, three relatives the manager, deputy manager, three care workers and the cook. We looked at four care plans.

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.

Inspection carried out on 29 August 2012

During a routine inspection

We (the Care Quality Commission) carried out an unannounced inspection of the service on 29 August 2012. The home was last reviewed by the Commission for Social Care Inspection (the predecessor organisation of the Care Quality Commission) in November 2009 and awarded a three star excellent rating.

On the day of our inspection 21 people were living at the home and receiving care from the service. One person was receiving respite care.

We spoke with two people, three staff and two relatives. Some people, because of their complex needs, were not able to share their experiences and so we used the Short Observational Framework for Inspection (SOFI). This was a specific way of observing care to help us understand the experience of people who could not talk with us. We also spent time observing care and lunch time and looked at four care plans.

We spoke to visitors at the home who were relatives or friends of the people. One stated that “It is a great comfort to know they are so well cared for”. Another stated “The home is absolutely superb”. Relatives also told us that they were able to take part in events organised at the home such as outings, bingo and cream tea evenings.

People we spoke with stated they were happy and were always treated politely and courteously by care staff. They also said that the food was good.

All the staff we spoke with described the standard of care as good. However all commented on the decrease in staff numbers over time and how it had impacted on the ability to support activities. Staff also expressed frustration at the lack of time to sit and talk with people. However all the staff were clear that people’s essential care needs were met.