Maplin House

About the service

Maplin House is a residential care home and was providing accommodation and personal care to eight people at the time of the inspection. The service can support up to 16 people living with a learning disability and/or autism.

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

Not all risks to people's safety were assessed, mitigated and up to date to ensure they were kept safe. Improvements were required to ensure the security of medicines. Though there were the required numbers of staff on duty, one of these was undertaking training which meant there were not enough numbers of staff deployed to meet people’s care and support needs. People were not always supported to be independent and make decisions.

Quality assurance arrangements were in place to monitor the quality of the service provided. Whilst there was evidence available to demonstrate improvements had been made since our last inspection to the service in September 2021, The quality assurance system had not identified issues found during our inspection. This needed to be embedded into the service’s day to day ongoing monitoring.

Suitable arrangements were in place to ensure the right staff were employed at the service. People told us they had no concerns and that the service was a safe place to live. Interactions between people using the service and staff were relaxed and comfortable. The service was clean and odour free. This inspection highlighted lessons had been learned and improvements made since our last inspection in September 2021.

The service was not able to fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

• The service was a large residential property that comprised of 12 bedrooms within the local residential area. There were no visible signs to reflect from the outside, to show Maplin House was a care home. Most people had lived together at Maplin House for many years.

• People had their own rooms which had been personalised. People were able to use communal areas as they wished and to have privacy for themselves. However, the décor of the service required significant improvement.

• Improvements were needed to promote and develop some people’s independence and to support them to be better involved in making choices and decisions about the running of the home.

Right Care:

• Staff were caring and treated people as individuals. Better support was required to enable and facilitate people using the service to access the local community.

• Staff knew people well and understood how to communicate with each person.

Right culture:

• The ethos of the service was family orientated and we saw that people were comfortable and liked where they lived.

• There was a stable team of staff at Maplin House, of whom various staff members had worked at the service for a significant period of time. This meant people using the service received consistent care from staff who knew them well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate [published 12 October 2021].

The service has been in Special Measures since March 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

We have found evidence that the provider needs to continue to make improvements and to imbed continued learning.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture and to check compliance with the Warning Notices issued in September 2021.

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.

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.

Maplin House is a residential care home and was providing care to eight people who have a learning disability, physical disability and/or living with dementia. The care home can accommodate up to 16 people in one adapted building.

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

There was a lack of understanding and familiarisation with the COVID-19 national testing guidance as set out by the Department of Health and Social Care to keep service users and staff safe. The arrangements to prevent visitors from catching and spreading infections were not being followed. Recruitment practices continued to not be safe and operated in line with regulatory requirements. Staff rosters were not accurately maintained to determine the numbers of staff on duty on any given day or the hours worked. Some aspects of fire safety remained outstanding from our previous inspection to the service in February 2021. Although some improvements were noted since our last inspection in February 2021, quality assurance arrangements remain unreliable as the above shortfalls were not identified.

Information relating to people's individual risks were now recorded and mitigated for the safety of people using the service. Suitable arrangements were in place to ensure the safe management of medicines. People told us they felt safe and interactions between staff and people using the service were relaxed and comfortable. The service was clean, and staff wore appropriate Personal Protective Equipment [PPE].

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate [published 10 March 2021] and there were three breaches of regulation. 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 not all of the improvements had been made and the provider remained in breach of these regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 17 [Good governance] and Regulation 19 [Fit and proper persons employed] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also reviewed concerns raised by the Local Authority following an announced quality monitoring visit to Maplin House in July 2021. The overall rating for the service has remained Inadequate.

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 breaches in relation to COVID-19 testing for staff employed at the service at this inspection and continued breaches relating to the provider’s governance arrangements and recruitment practices.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Maplin House is a residential care home providing personal care to eight people who have a learning disability, physical disability and/or living with dementia. The care home can accommodate up to 16 people in one adapted building.

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

The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements were not reliable or effective in identifying shortfalls in the service and to meet regulatory requirements.

Information relating to people's individual risks were not always recorded or mitigated for the safety of people using the service. Risks relating to how Control of Substances Hazardous to Health (COSHH) items were stored, and the service’s fire arrangements, did not provide enough assurance that people were safe. Suitable arrangements were not in place to ensure the safe management of medicines and this placed people at risk of harm.

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 28 November 2018).

Why we inspected

We inspected the service because there had been a recent COVID-19 outbreak at Maplin House.

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 coronavirus and other infection outbreaks effectively.

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.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Maplin House is a residential care home for up to 16 older persons who have some degree of learning disability. They may also have a physical disability and/or dementia. There are currently 12 people using the service. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was administered by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for the needs of people.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed choices.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner.

The service was well-led. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Maplin House is registered to provide accommodation and personal care without nursing for up to 16 older persons who have a mild degree of learning disability. They may also be living with a physical disability and/or dementia. There were eight people living in the service on both of the inspection visits.

There was a registered manager 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.

Staff demonstrated a good knowledge of how to protect people from the risk of harm. They had been trained in safeguarding people and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had up to date care plans and risk assessments in place to ensure people were cared for safely. Staff had been safely recruited in sufficient numbers to meet people’s assessed needs. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines.

Staff had been well trained and supported to carry out their role. The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People had enough to eat and drink to meet their individual needs and preferences. People’s care needs had been assessed and their care plans provided staff with the information needed to meet people’s needs and to care for them safely. People’s healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed.

Staff knew the people they cared for well and they were kind, caring and respectful. They ensured that people’s privacy and dignity was maintained at all times. People expressed their views and opinions and they participated in activities of their choosing. People were able to receive their visitors at any time and their families and friends were made to feel welcome. People had access to advocacy services when needed. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People’s care and support was provided in a way that ensured their safety and welfare. They received a full assessment of their needs before using the service and care and support plans had been developed using the assessment process. People were confident that their concerns or complaints would be listened to and dealt with appropriately.

There was an effective system in place to assess and monitor the quality of the service and to drive improvements.

We found that people lived in a comfortable homely environment. People told us that they were happy with their rooms. One person said, 'I have lots of my own things in my room and that is how I like it.' Another person said, 'I can have what I like in my room and that is good because it is my room.' Another person said, 'I feel safe living here.'

People received their care and treatment from staff that had been properly trained, supported and supervised. They received safe quality care because the provider had an effective quality assurance system in place. People received safe, effective and compassionate care from a well led service that responds quickly to their changing needs.

During our visit in January 2013 we looked at a sample of recruitment and supervision records and found that there was an improvement in both recruitment and supervision. Staff told us that they felt well supported and people either told us or indicated that they were happy. Some of the people who live in Maplin House had limited communication but others were quite clear about how they felt. One person said, 'I am very happy, the staff are lovely.'