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Inspection carried out on 22 September 2017

During a routine inspection

The inspection took place on 22 September 2017. The inspection was unannounced but we telephoned the service before we left to ensure people were in. The service was last inspected on 25 July 2016 and was rated requires improvement with two breaches for regulation 12: Safe care and treatment and regulation 11, Consent. We had concerns about the safe administration of medication and poor documentation for people who lacked capacity to make their own decisions. At this inspection we found the necessary improvements had been made.

The service was registered in April 2013 and this was only the second inspection. It was registered for five people who had a learning disability. At the time of our inspection there were four people using the service. There was a registered manager, who was also one of the five directors. The directors had known each other for many years and set up the service together. All took an active role in managing and developing the service and this was their only care home.

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.

This was a highly individualised service where the needs of people using it were paramount. The staff knew people really well and people had continuity of care and support. People had previously lived at home with parents and this was their first home since reaching adult hood. Each person had their own room and an individual activity programme around their needs. Staff recognised people’s anxieties and behaviours and supported people accordingly.

There were systems in place to reduce risks people faced from day to day tasks and from people’s associated learning difficulty. Risks were well managed but without stifling people’s opportunity or lessoning people’s independence. The environment was well maintained and risks from potential hazards such as fire were well controlled.

Medicines were administered to people as and when required and there were safe systems to do this. Staff were well trained and audits were in place designed to ensure people received their medicines as intended.

Staff received training necessary for their role and continued professional development. Staff understood different types of abuse and said they would raise any concerns if they suspected a person to be at risk from harm or actual abuse. There were clear policies for staff to follow. Robust staff recruitment processes helped ensure that only suitable staff were employed and did not have a criminal past which might make them unsuitable.

Staff were supported in their role and although the directors were always available staff had both informal and formal support.

People were supported to stay healthy and had adequate diet and fluids for their needs. Staff monitored people’s health and there was a plan in place to ensure people received regular health care as needed. People had support around their needs in association with their mental health and associated behaviours.

Staff understood mental capacity and supported people to make day to day decisions and where people were unable to make more complex decisions staff acted in their best interest and followed due processes. This meant staff acted lawfully in terms of supporting people who lacked capacity. Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process.

Staff had sufficient

Inspection carried out on 25 July 2016

During a routine inspection

This inspection took place on 25 July 2016 and was announced. Maple Tree Care Ltd is registered to provide accommodation and personal care for up to four people who have a learning disability. We gave the service 48 hours’ notice of the inspection because it is small and we needed to be sure that people would be in.

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. The registered manager, who was also a director of the company, was away on holiday at the time of our visit. We met with three of the company directors during this visit.

The service had sufficient staff to meet the needs of the people living there. Staff were recruited safely and subject to the completion of appropriate checks. Staff had received training in how to recognise and report abuse. The registered manager and other directors of the service knew how to report any safeguarding concerns to the appropriate local authority if necessary.

Staff were not always well supported. They did not receive any formal supervision or appraisal and some training courses for staff were not undertaken at the recommended intervals.

Staff knew people well and were aware of their history, preferences and likes. People’s privacy and dignity were upheld.

All medicines were administered by staff who were trained to do so but some aspects of medicines

management needed improvement.

Where possible people or their relatives had been involved in the assessment and planning of their care. Care records were detailed and gave staff the information they required so that they were aware of how to meet people’s needs. There was a good level of detail for staff to reference if they needed to know what support was required.

There was a complaints procedure in place although this was not written in a format that people living in the home would find it easy to understand.

The Care Quality Commission is required to monitor the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had limited knowledge of the MCA and DoLS. The principles of the MCA had not always been followed when decisions had been made on behalf of people who could not make them for themselves.

We found the home was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.