Archived: The Maple Care Home

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.

The Maple Care Home is a residential care home with nursing and can accommodate up to 63 people across three floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia and another provides nursing care. At the time of the inspection there were 47 people living in the home at the time of our inspection.

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

People felt safe living at the home and relatives we spoke with were happy with the care provided. One person told us, “I certainly do feel safe, it’s close knit. It’s just lovely.”

Not all risks were adequately addressed. Fire drills did not take place in line with the provider’s policy.A more robust system was required to investigate allegations of abuse. We have made a recommendation about this. Some staff told us they were concerned about staffing levels. Most people told us they were happy with how quickly staff attended to their needs, however, others described staff as ‘very busy’ and said at times they had to wait for assistance. Medicines were managed safely although some records could be improved. We were assured with the infection control measures in place. However, initial screening of visitors to the home needed to improve.

People and their relatives were happy with the management team. Relatives told us communication with the home had been good during the pandemic. We had mixed feedback from staff who did not all feel supported in their roles. Quality checks were carried out but did not highlight all of the issues we found. Some care records had not been updated on the electronic system and some staff found the system difficult to use. The provider was planning to replace the system to avoid these issues in future.

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 23 May 2018)

Why we inspected

We received concerns in relation to the management oversight and staffing levels at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report. The provider has already taken some action to mitigate the risks and we will continue to monitor to ensure they have been effective.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to risk management.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Maple is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Maple was registered for 63 beds and accommodated 47 people at the time of the inspection. 14 people lived on the ground floor, 11 people on the middle floor and 22 people lived on the top floor.

The service was last inspected January 2017 and we found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We found concerns relating records not being fully completed, audits were not effective and although feedback was sought no action was taken following the results. Following that inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the rating of the key questions to at least good. At this inspection we found the service had improved to good.

The provider had introduced electronic care plans. We found these easy to navigate and records were now fully complete. There were some care plans in place that were not relevant to the person, the registered manager was arranging for these to be removed. Care plans contained detailed information about people’s personal preferences and wishes as well as their life histories.

Audits took place and action plans were developed and addressed. Feedback was sought for different areas of the service, for example feedback on laundry, activities and the menu. We could see an action plan was produced and followed in response to people's comments.

Risks to people arising from their health and support needs as well as the premises were assessed, and plans were in place to minimise them.

People received their medicines safely, however work was needed to improve the application of topical medicines, this was addressed the day after the inspection.

People were supported to access the support of health care professionals when needed.

Safeguarding principles were well embedded and staff displayed a good understanding of what to do should they have any concerns.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role. Staff received effective supervision and a yearly appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received a varied and nutritional diet that met their preferences and dietary needs.

The interactions between people and staff showed that staff knew the people well.

The management team were approachable and they, and the staff team, worked in collaboration with external agencies to provide good outcomes for people. People, relatives and staff felt any concerns would be taken seriously and acted on.

Further information is in the detailed findings below.

The Maple is a purpose built care home. It provides residential care and accommodation for up to 63 people, including older people and people with dementia. Accommodation is provided over three floors, with each floor having private bedrooms with en-suite facilities, and communal bathrooms, lounge and dining areas. The home has a secure garden area and private parking facilities. At the time of inspection there were 57 people using the service.

There was a registered manager in place. 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.

Some care records were not fully completed or accurate. Checks undertaken by the registered manager and staff were not always documented.

Comprehensive audits of the service were undertaken and actions followed up, however they had not identified all of the issues we found. Feedback was sought from people and their relatives via surveys but no action plans were produced as a result of their findings.

Systems were in place for the management of medicines so that people received their medicines safely. Arrangements were in place for recording the administration of medicines however, some further improvements were needed in the guidance and records for topical medicines. We have made a recommendation about this.

Risks to people arising from their health and support needs or the premises were assessed, and in most instances plans were in place to minimise them. These were regularly reviewed to ensure they met people’s current needs. However, we found that risk assessments were not in place in every instance and the registered manager told us this would be addressed. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

During our inspection we observed there to be enough staff to meet people's needs. However, we received mixed feedback from people who used the service and staff who stated sometimes there were insufficient staff, particularly on a night. We discussed this with the registered manager who told us they were looking into it. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began working at The Maple Residential Care Home. Staff were given effective supervision and a yearly appraisal.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) and understood the requirements of the Act. This meant they were working within the law to support people who may have lacked capacity to make their own decisions. The registered manager understood their responsibilities in relation to DoLS.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. However, one person who was a vegetarian had not been appropriately catered for. The registered manager was taking action to address this. People told us they had a choice of food at the service, which they enjoyed. We saw no evidence of menus on the tables or pictorial menus, which would aid a person who may be living with dementia or have a memory impairment to make every day choices.

The registered manager worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, district nurses and other professionals. However, we found for one person medical advice was not sought in a timely manner.

We observed positive interactions between people and staff. Staff were patient, kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. People and their relatives spoke highly of the care they received. People had access to a wide range of activities, which they told us they enjoyed.

Procedures were in place to support people to access advocacy services should the need arise. The service had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any concerns.

Care plans required further work to ensure information was person centred and people’s life history and preferences were included. We have made a recommendation about this.

There was a clear complaints policy in place and we saw evidence of the correct procedures being followed to investigate complaints.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to record keeping, effective auditing and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.