Background to this inspection
Updated
5 October 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
Two inspectors and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
The Maple Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Maple Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of the inspection, the service had a manager who was in the process of becoming registered with the CQC.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 31 August 2022 and ended on 9 September 2022. We visited the service on 31 August 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with five people who used the service and 12 relatives about their experience of the care provided. We spoke with 14 members of staff including the manager, a nurse, senior care workers, care workers, kitchen staff and the maintenance person. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included six people’s care records, three staff recruitment files and multiple medication records. A variety of documents relating to the management of the service, including policies, training records, maintenance records and quality assurance documents were also reviewed.
Updated
5 October 2022
About the service
The Maple Care Home is a residential care home with nursing, which can accommodate up to 63 people. At the time of our inspection there were 49 people using the service. The service supports people across three floors, one of which specialises in supporting people who are living with dementia, and one of which provides nursing care.
People’s experience of using this service and what we found
Robust systems were not fully in place to manage and mitigate risks to people. The manager was in the process of implementing processes and procedures, but they needed to become embedded and sustained.
Some key information was missing from some people’s care plans. We have made a recommendation around this. Some staff were not sure what to do in the event of a fire. We have made a recommendation around this. Some areas of the environment were not always safe for people. The manager addressed this immediately following our feedback.
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 policies and systems in the service supported this practice.
Staff helped to keep people safe from the risk of avoidable harm. There were enough staff on duty to provide safe care to people. There had been changes within the staff team which had made some people feel unsettled. The manager had safe recruitment procedures in place. People received their medicines as prescribed. Some areas of the service required maintenance work, and the manager had a home improvement plan in place.
Audits had identified some issues we found on inspection, but not all. We received positive feedback about the manager and the ongoing changes to the service. Relatives gave mixed feedback about the quality of communication with the home. The manager and provider were open and transparent and committed to continuous improvement.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 8 April 2021) and there was a breach of regulation 12 (safe care and treatment). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12. However, systems were not fully in place to manage risk which was a new breach of regulation 17 (good governance).
At our last inspection we recommended that the provider reviews their safeguarding procedures in line with best practice guidance. At this inspection we found the provider had made improvements.
The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.
The overall rating for the service has remained requires improvement based on the findings of this inspection.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Maple Care Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified a breach in relation to systems and processes to manage risk. Please see the action we have told the provider to take at the end of this report.
We have made recommendations around reviewing people’s care plans and reviewing staff knowledge and competency in the event of a fire.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.