Maple View

About the service

Maple View is a residential care home providing personal care to people who have a learning disability and/or autistic spectrum disorder. The service can support up to 5 people. Maple View is a detached bungalow located in a residential cul-de-sac in Colchester and is 1 of a group of 5 similar properties in the same cul-de-sac and owned by the same provider.

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

Right Support: 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. Staff had not always received adequate training to support people safely and this included in the use of physical and chemical restraint. People were not always supported with their medicines in a way that promoted their independence and achieved the best possible outcomes.

Right Care: People were not always protected from the risk of harm. People's care and support plans did not consistently reflect their current needs as accident and incident forms were not reviewed or followed up. The registered manager or staff were not aware how to apply national best practice supporting people with a learning disability and autistic people.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive, and empowered lives. People experienced or were at risk of harm because of a lack of protection they experienced or were at risk of abusive incidents, including unnecessary restraint. Staff have poor relationships with each other and there was minimal remedial action in relation to staff conduct or competency. The governance systems used were not effective and did not identify concerns related to quality and safety, restraint, medicine administration, risk, food intake or MCA processes.

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 (published 14 February 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the use of unauthorised restraint used at one of the provider’s ‘sister’ services. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only.

For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate 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 View on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, meeting nutritional needs, consent, and governance.

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

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

The overall rating for this service is ‘Inadequate’ and the service is 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.

We found the following examples of good practice.

All staff had completed training in British sign language (BSL). They used this communication method together with pictures and symbols to communicate with people who were deaf.

Whole home testing for people and staff, including weekly testing and rapid testing was undertaken. Consent was gained from people each time prior to testing. Best interest decisions were taken on an individual basis for people who did not understand. Tests were not undertaken when people declined despite best efforts to support or were likely to be distressed by the process.

The service adhered to government guidance and arrangements were in place for the safe facilitation of visiting by two named family members. This was within an individualised risk assessment framework and enabled people’s right to meaningful family relationships be re-established following lockdown.

Everybody using the service has now received both Covid-19 vaccines.

Contingency plans were in place to ensure effective management of an outbreak, including staff working in teams and changed shift patterns; limiting staff movement and reduce footfall. Everyone using the service had one to one staff support.

Staff had received training on the use of personal protective equipment (PPE) and infection control practices and processes were in place to minimise the spread of infection. There was an adequate supply of PPE.

Cleaning regimes had been increased including regular hard surface contact cleaning.

Staff promoted people’s wellbeing during lockdown by supporting them to go out for walks in open spaces or car drives every day. Alternative activities at home were introduced which included a lot of quiz's, art and crafts and baking.

Maple View is a residential care home that provides personal care and support registered for up to five people with a sensory impairment, learning disability and/or autistic spectrum disorder. People using the service live in a purpose built bungalow, located within a residential community setting alongside four other individually registered services run by the same provider. On the day of our inspection there were five people living in the service.

Rating at last inspection:

At our last inspection, the service was rated ‘Requires Improvement’. Our last report was published on 9 January 2018.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

People’s experience of using this service:

We previously inspected Maple View in November 2017 where the service was rated ‘Requires Improvement’. This was because we found that since our inspection in June 2015 where the service was rated ‘Good’ there had been a deterioration in the quality of care. There was a breach of Regulations 9, 12, 17, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection the provider had made good improvements to the service since our last inspection on 8 and 22 November 2017.

• Staff received better training, induction, supervision and support so they could effectively perform their roles.

• The registered manager had resolved issues surrounding the recording, investigation and analysis of incidents and accidents.

• Governance of the service had improved. Systems had been put in place for auditing the quality and safety of the service with action plans produced.

• People and relatives told us the staff were kind, friendly and supportive of their needs. Staff knew people's needs well.

• People’s safety had been considered and risks had been reduced by improved risk management systems.

• Medicines were managed safely.

• Care plans had been reviewed and systems put in place to enable ongoing review with people’s changing needs updated in a timely manner.

• People told us they were satisfied with the quality and variety of food they were provided with. People were supported to develop skills in food preparation and cooking.

• Referral for specialist support was accessed when needed. For example, in relation to management of behaviours that may present a risk, continence needs and support for people with sight and hearing impairment.

• The outcomes for people using the service reflected the principles and values of Registering the Right Support. People were provided with choice and control with opportunities to gain new skills and become more independent.

• The service met the characteristics for a rating of ‘Good’ in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was ‘Good’.

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

Maple View is a residential care home that provides personal care and support registered for up to five people with a sensory impairment, learning disability and/or autistic spectrum disorder. People using the service live in a purpose built bungalow, located within a residential community setting alongside four other individually registered services run by the same provider. On the day of our inspection there were five people living in the service

At the last inspection, the service was rated Good. At this inspection, we found deterioration in the overall governance of the service and so the overall rating is Requires Improvement.

The registered manager was also one of the organisation’s directors and managed another nearby residential care service. A team leader supported them with the day to day management of the service. 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.

There were sufficient staff on duty at the time of our inspection. A safe recruitment process was followed to ensure that staff employed were suitable for the work they were employed to perform. However, training for permanently employed staff was not effective. The registered manager provided the majority of training but was not accredited to provide training in British Sign Language to Level one. We identified concerns about staff understanding of current good practice. Staff did not demonstrate knowledge of safe care and best practice in caring for people with sensory needs and those who may present with behaviour that may pose a risk to themselves and others.

Staff did not all receive appropriate training to understand the complex needs of people using the service. Behaviour, which may have impacted on others, was not always managed correctly with clear guidance for staff in responding safely and appropriately. The management of behaviours, which had a negative impact on others, was inadequate and placed people at risk of harm.

There was a lack of learning from incidents and events with action taken to improve safety as the provider’s system for incident reporting and further analysis was ineffective.

Agency staff employed did not always have the skills, knowledge and relevant training to meet people's needs. We found that no check had been carried out which would assure the provider that staff employed from agencies had the skills, knowledge and experience to meet the needs of people who lived at Maple View.

Whilst we found there were safe systems for the management of people’s medicines and prevention and control of infection, further work was needed to ensure robust fire evacuation procedures were in place. Fire safety checks had not been carried out at the regularity as required. We recommend the service follow good practice in the carrying out of fire drills so that these are used as a learning opportunity and to mitigate risks to people’s safety and welfare.

People’s care was not always planned in a manner that was responsive to their needs. People had care and support plans in place but these were not always updated, reviewed or reflective of their current needs. People were supported to access health services but staff had not always been provided with up to date relevant information for people living with complex, medical health care needs. Improvement was required to ensure that the full range of people’s needs were being met.

The views of people were surveyed through monthly, through monthly one to one meetings with their keyworker. Relative and staff satisfaction surveys had been carried out. However, there was little evidence of any learning from this feedback or how responses received initiated any action plans for the continuous improvement of the service.

The registered manager did not operate effectively an accessible system for receiving and responding to complaints. People did not always have their complaints responded to in accordance with the provider’s policy with any audit trail of actions in response. This meant people’s concerns and complaints were not effectively listened to and used to improve the quality of care.

People were not supported by a service that had a good record management system. We found records management to be chaotic and poorly maintained.

People had enough to eat and drink with access to drinks and snacks. However, for people diagnosed with diabetes there was insufficient information to guide staff with and planning to meet their needs.

The governance framework for the service did not ensure that responsibilities were clear and that risks and regulatory requirements were understood and managed.

There were ineffective quality assurance mechanisms in place, with overall governance of the service, which would have identified the shortfalls we found at this inspection. There was a lack of learning from incidents and events with action taken to improve safety as the provider’s system for incident reporting and further analysis was ineffective. This meant that risks to people and staff safety and welfare were on going. The failure to develop effective systems for management and governance of the service had left people at the potential risk of harm.

This inspection identified a number of breaches of the health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.