Archived: Mappleton House

The service did not have a registered manager in place at the time of our inspection and has not had one since June 2015. 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.

Although people were supported by staff who knew how to recognise abuse, action was not always taken to protect people from the risk of harm. People were at risk in relation to how they were supported and from risks from the environment. There were insufficient numbers of staff deployed in the service and medicines were not always managed safely.

People were supported by staff who did not have the knowledge and skills to provide safe and appropriate care and support. People who lacked the capacity to make certain decisions were not protected under the Mental Capacity Act 2005 and had unauthorised restrictions placed upon them. People were not supported to maintain their nutrition and hydration.

People lived in a service where staff were not always respectful of their privacy and didn’t treat them with dignity. People’s emotional needs were not always recognised and responded to and people were not supported to enjoy an active social life.People knew who to raise concerns with but concerns were not always responded to or acted on.

There was a lack of appropriate governance and risk management framework and this resulted in us finding multiple breaches in regulation and negative outcomes for people who used the service. There were no effective systems in place to develop and improve the service, based on the needs of the people who used it, their families and staff.

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, will be inspected again within 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 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.

We carried out an unannounced comprehensive inspection of this service on 10 and 12 May 2016 . After that inspection we received concerns in relation to the provider not taking action to protect people from harm and a lack of appropriate leadership, resulting in the service being unsafe. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mappleton House on our website at www.cqc.org.uk”

The service did not have a registered manager in place at the time of our inspection and has not had one since June 2015. 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.

Although people were supported by staff who knew how to recognise abuse, action was still not always taken to protect people from the risk of harm. People were still at risk in relation to how they were supported and from risks from the environment. Staff were not deployed appropriately in the service to ensure people were supported safely.

People were supported by staff who did not have the knowledge and skills to provide safe and appropriate care and support. People who lacked the capacity to make certain decisions were still. not protected under the Mental Capacity Act 2005.

There was still a lack of appropriate governance and risk management framework and this resulted in us finding ongoing breaches in regulation and negative outcomes for people who used the service.

The overall rating for this service is ‘Inadequate’ and therefore remains 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, will be inspected again within 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 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.

There were systems in place to protect people from abuse or the risk of abuse. Two relatives told us they felt their relative was safe in the home. However records showed one person had sustained bruising on four separate occasions where the causes were not known and these had not been referred to the safeguarding vulnerable adult's team in line with procedures.

Improvements had been made to the management of medicines and people were receiving their prescribed medication appropriately.

One relative told us they had attended meetings to discuss the care delivery and felt their views and input had been taken into consideration. They told us, 'I have discussed [my relatives] care with the manager and feel they have taken on board what I said. I feel confident things are improving.'

We saw there were appropriate records being kept of the care and support given to people.

We saw staff were kind and caring towards people and they maintained good relationships with them.

People were observed to join in activities as they wanted to and several people went out for lunch on the day of our visit.

All the relatives spoke positively about the care and support their relative received. One person said, 'The staff are very good with my family member. They know exactly what they want. They can communicate with them better then me.' Another relative said, 'The staff are absolutely wonderful and they are well looked after.'

One relative told us they were fully involved with the care planning and had regular informal updates each time they visited the home. They told us the staff promoted choices where possible and their relative would let them know if they didn't like something. We saw this during our visit.

We spoke with two relatives in respect of the medicines and neither of them had any concerns at that time.

Relatives also felt that staff were kind and caring and well trained to carry out their job role and that there were sufficient staff available to support their relative.