The inspection was carried out by one adult social care CQC inspector. On the day of our inspection 47 people used the service. We spoke with four people who use the service and three people's relatives, three care workers and one nurse. In addition we spoke with the registered manager, the deputy manager, the maintenance manager and the activities co-ordinator. We observed how staff supported people, and looked at documents including care plans and management reports. People were provided with care appropriate to their needs, such as nursing or dementia care.
We considered information from a number of sources to decide on the focus of the inspection. All of the evidence we had gathered under the outcomes we inspected was used to answer the five questions we always ask;
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found.
Is the service caring?
We observed staff supported people with patience, respect and care. They treated people with dignity and promoted their independence. We saw people and staff smiling and enjoying the day. One person who usesthe service told us 'We do some lovely activities here sometimes with people from outside and that's always nice. We do get out quite a bit too, those that want to'.
Staff told us they considered people as members of their family, and enjoyed coming to work to spend time with them. The registered manager had commissioned specialist training for staff in dementia awareness, palliative and end of life care to improve the quality of life people experienced.
Care plans reflected people's needs and preferences. We saw staff followed guidance to ensure people were supported as they wished. They promoted people's independence and encouraged them to make choices, for example about meals, clothing and activities, and listened to their responses.
Is the service responsive?
The service responded promptly to ensure people were supported appropriately. People and their relatives were involved in setting up their plan of care, and reviewing this to ensure it remained up to date. Staff ensured care was provided as people wished. One person said 'I'm very happy with the way they look after my health. We have nurses all the time, the doctor and dentist when you need and they check our eyesight regularly too. I don't have to go anywhere. They all come here'.
We saw people had access to a range of activities, held in the home and local community. People were supported and encouraged to attend. Links with the local community were encouraged and supported.
As people's needs altered we saw that care plans were updated to reflect the changes in the care they required. For example, to support people with reduced mobility or to address nutritional concerns. The provider's complaints policy provided a formal opportunity for people to raise concerns.
A relative explained how the manager had quickly addressed a concern they had expressed. One person told us, 'I did have a problem once which my relative told the manager about and it was sorted out straight away. They are very 'no nonsense' here and get on with things. I'm very happy here'. A member of staff told us, 'Last year we had a bit of a problem with equipment, hoists and things. The manager got hold of it straight away and I think the equipment situation is better now than it's ever been'.
Is the service safe?
We found that although the building was not purpose built, the general security of the premises and gardens was appropriate and adequate to ensure that people lived in a safe environment.
We saw that in general, people were relaxed, and appeared to enjoy the company of staff. This indicated to us that people felt safe with staff. A relative of someone who used the service said 'When you know that your relative is in good hands and as happy as they can be, then you can stop worrying about it. I have complete confidence in the manager and staff here'. One of the people we spoke with told us, 'This is my home and I am very happy and settled here. The manager and staff are friends to me and I know they're watching out for us'.
Risks were identified, and actions put in place to reduce the risk of harm to people and others who use the service. For example, staff were trained to support people safely if they needed assistance to mobilise. Appropriate checks and equipment were in place to reduce the risk of pressure sores for those identified at risk of developing them. People's needs were regularly assessed to ensure changes were identified promptly. This meant the service was aware of appropriate actions to take to maintain people's health and wellbeing. Staff were appropriately trained and supported to provide person centred care in a safe way.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS). This applies to services such as Maple House. The registered manager was aware of the appropriate actions to complete to assess the need to apply for DoLS, and we saw that applications were made in accordance with the local authority procedure.
Is the service effective?
The service sought feedback from people, their relatives and staff. Regular meetings and comments books provided opportunities for raising concerns, sharing information and refining procedures to improve effectiveness.
Care plans detailed people's care needs and wishes. There were reviews and audits in place to ensure changes in people's care needs were identified and responded to appropriately.
We found evidence of good systems to monitor care standards and performance. Staff performance was monitored and supported through supervision, appraisal and practical assessment. New staff attended a thorough induction programme that included formal training and shadowing of experienced care workers. Staff were encouraged to develop their skills through specialist training and relevant further education.
Is the service well led?
We noted the registered manager operated an 'open door' policy and was very active in the service. People, visitors and staff readily sought reassurance guidance and support from the manager. A relative told us 'The manager doesn't let the grass grow and is very formidable. They run a tight ship and deal with any problems quickly so that my relative doesn't get anxious'.
We saw that the registered manager played a leading role in all aspects of care provision and administration of the service. They told us, 'I'm convinced that we provide person centred care to a high standard. I get feedback on this from relatives all the time'.