Maple Cottage

Maple Cottage is a residential care home providing the regulated activity of accommodation and personal care to up to 5 people. The service provides support to people who have a learning disability and/or are autistic. At the time of our inspection there were 5 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

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 polices and systems in the service supported this practice. Staff did everything they could to avoid restraining people. People were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines to achieve the best possible health outcome.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. Staff had training on how to recognise and report abuse and they knew how to apply this to their day-to-day work. The service had enough appropriately skilled staff to meet people’s needs and to keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and the risks posed.

Right Culture

Governance arrangements were effective at service level but not at provider level. The registered manager had the skills, knowledge, and experience to perform their role and a clear understanding of people’s needs but this oversight was lacking at provider level. The provider did not invest in staff by providing them with appropriate training to meet the needs of all people using the service. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity. The registered manager and team leader were visible in the service, approachable and took a genuine interest in what people, staff, family, and other professionals had to say. Staff felt respected, supported, and valued by the registered manager and team leader.

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 January 2018]

Why we inspected

The inspection was prompted in part due to concerns received about the use of unauthorised restraint 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 questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement

We have identified breaches in relation to the management of risks, including those related to hot water outlets and the service’s fire arrangements, and the provider’s governance arrangements. We have made a recommendation about staff training.

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 also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

We found the following examples of good practice.

At the time of our visit the service was at the end of an outbreak which had been well managed and contained within the home to two out of five people. National guidance was followed on the use of personal protective equipment (PPE) and staff had received training in infection control and prevention. The service was working closely with the local authority, Public Health England and the Clinical Commissioning Group (CCG) infection control team to ensure their infection prevention and control (IPC) practice was safe and people’s needs were being met.

People had isolated within their bedrooms and were allocated own staff for continued one to one support for the duration of their isolation. Staff worked in teams and shift patterns were changed to limit staff movement and reduce footfall. Arrangements were in place to minimise the spread of infection such as the safe management of laundry, crockery and cutlery. Cleaning regimes had been increased including regular hard surface contact cleaning.

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 and Covid-19 outbreak.

Maple Cottage is a residential care home that provides personal care and support for up to five people who have a learning disability and/or autistic spectrum disorder. People using the service live in a single house located within a residential community setting. People living in care homes receive accommodation and personal care and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were four people living at the service.

At the last inspection, the service was rated Good. At this inspection, we found the service remained Good.

A Registered Manager was 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.

The registered manager had clear aims and objectives for the service. There was ongoing work to embed the values of providing personalised care, promoting independence, choice, rights and empowerment. We saw that the registered manager and staff put these values into practice.

This service was provided in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include supporting people with choice, promotion of independence and inclusion. People with learning disabilities and autism using the service are supported to live as ordinary a life as any other citizen.

People were treated with dignity and respect and staff interacted with people in a kind, caring and sensitive manner. Staff demonstrated a good knowledge of their roles and responsibilities in recognising abuse and safeguarding procedures with steps they should take to protect people.

The registered manager had a system in place to ensure appropriate recruitment checks had been carried out before staff started working at the service. There were sufficient numbers of skilled, trained and qualified staff on duty. Staff told us that they felt well supported in their role and we saw that staff had received regular supervision and training relevant to the roles they were employed to perform.

We found that detailed assessments had been carried out prior to admission to the service. Care plans had been developed around each individual’s needs and preferences. We saw that there were comprehensive risk assessments in place and plans to guide staff in how the risks identified were to be managed and mitigated. People were supported with taking informed, every day risks and encouraged to take part in daily activities and outings. We saw that appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves, to help ensure their rights were protected.

People’s medicines had been stored safely. There were clear personalised protocols in place to guide staff as to how people liked to take their medicines and identified allergies.

People were relaxed in the presence of staff. Where people lacked capacity to air their views verbally, staff supported people with opportunities to communicate through pictorial aids and visual prompts, appropriate for the individual. Relative’s told us they were happy with the service provided and were able to raise concerns and there were systems in place to ensure people could be confident they would be listened to and appropriate action taken.

People were supported to be able to eat and drink sufficient amounts to meet their needs and were offered choice. Where assessed as appropriate people were supported to develop their independence and gain life skills. People had access to a range of healthcare providers such as specialist learning disability support teams, speech and language therapists, their GP, dentists and opticians.

People had some opportunity to feedback on their experiences through monthly keyworker meetings and regular care reviews. Staff involved people in day to day decisions and the running of the service. Staff worked to create ways to involve people with limited verbal communication in day to day decisions and the running of the service.

Staff understood their roles and responsibilities and told us they were well supported by the management of the service. There was an open culture where people felt comfortable to air their views and, provide honest feedback. The registered manager was a visible presence in the service and carried out a number of quality and safety monitoring audits to help ensure the service was running effectively, keep people safe and to plan for improvement of the service.

Maple Cottage is registered to provide a residential care service with support for up to five people with a learning disability and/or autistic spectrum disorder. On the day of our inspection there were three people living at the service.

There was a registered manager who was on long term leave from the service. Another registered manager from another of the provider’s services who was also a director was covering during the registered manager’s absence. 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.

The safety of people who used the service was taken seriously. The registered manager and staff were aware of their responsibility to protect people’s health and wellbeing. There were processes in place to ensure people’s safety, including risk assessments with guidance for staff with actions to take to safeguard people from the risk of harm. These identified how the risks to people’s safety were minimised and ensured people’s human rights, to choice and freedom were safeguarded.

Medicines were stored in a safe place. Staff had been trained. Where people required assistance to take their medicines, there were arrangements in place to provide this support safely.

There were sufficient numbers of care staff available to provide one to one care and support according to people’s assessed needs. Care staff were trained and supported to meet people’s individual needs. There was a consistent team of skilled staff who had developed good relationships with the people they cared for.

There were systems in place to ensure that people’s rights to respect, privacy and dignity were promoted and respected.

People and or their representatives, where appropriate, were involved in making decisions about their care and support. Where people were not able to give informed consent, staff and the manager ensured their human rights were protected. Staff and the registered manager had a good understanding of the Mental Capacity Act (MCA) 2005 and associated Deprivation of Liberty Safeguards (DoLS). People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions.

The service was committed to providing personalised care and ensured that people using the service were consulted about how they lived their everyday lives. People were supported to access holidays and activities according to their personal choice and preferences.

The culture of the service was open, inclusive, empowering and enabled people to live as full a life as possible according to their choices, wishes and preferences. The management team provided effective leadership to the service and enabled people to air their views through care reviews, one to one meetings. The manager and the provider carried out regular quality and safety audits of the service. These identified any shortfalls in delivery of the quality or safety of the service, with actions planned including timescales to evidence planning for continuous improvement of the service.

The provider had a complaints policy which detailed the procedure for logging a complaint and was available in easy read format for people to view. Relative’s told us they knew who the manager was and would speak directly with them if they had any concerns.