Maple House

About the service

Maple House is a residential care home providing personal care and accommodation to 5 people at the time of the inspection. The service can support up to 5 people.

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

Right Support: The model of care and setting did not maximise people’s choice, control, and independence. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff were not adequately trained and did not always have the skills, knowledge and competence required. This included the routine and disproportionate use of non-recognised and unsafe physical restraint.

Right Care: Care was not consistently person-centred, or always provided in a way which promotes people’s dignity, privacy, and human rights. People were at avoidable risk of harm, through poor management of incidents and safeguarding concerns. Staff did not recognise or act appropriately on poor practice. There were safety issues relating to medicines management, fire, and infection prevention control. Suitable risk assessments were not always in place, and some care records were out of date.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive, and empowered lives. Governance and oversight measures were either not in place or ineffective to ensure the safety and quality of the service. There were multiple indicators of a closed staff culture, which included leaders, placing people at the ongoing risk of receiving poor care.

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 2 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the unsafe use of physical restraint. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to person-centred care, dignity and respect, the need for consent, safe care and treatment, safeguarding, governance, staffing and recruitment. Please see the action we have told the provider to take at the end of this report.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

We found the following examples of good practice.

Whole home testing for people and staff, including weekly testing and rapid testing was undertaken. Consent was gained from people each time prior to testing. Best interest decisions were taken on an individual basis for people who did not understand. Tests were not undertaken when people declined despite best efforts to support or were likely to be distressed by the process.

The service adhered to government guidance and arrangements were in place for the safe facilitation of visiting by two named family members. This was within an individualised risk assessment framework and enabled people’s right to meaningful family relationships be re-established following lockdown. The service was looking to provide seven day lateral flow tests (LFT) for named visitors to test before departure to visit the service. This would help with the 30 minute wait for a result as this caused people unnecessary anxiety and agitation prior to seeing their family member.

Contingency plans were in place to ensure effective management of an outbreak, including staff working in teams and changed shift patterns; limiting staff movement and reduce footfall.

Staff had received training on the use of personal protective equipment (PPE) and infection control practices and processes were in place to minimise the spread of infection. There was an adequate supply of PPE.

Cleaning regimes had been increased including regular hard surface contact cleaning.

Staff promoted people’s wellbeing during lockdown by supporting them to go out for walks or car drives every day. Alternative activities at home were introduced which included a lot of art and crafts and baking. A basket ball hoop and a hot tub was purchased for outside activity during the warm months.

This unannounced comprehensive inspection took place on the 5 and 12 June 2018.

At the last inspection in April 2017, the service was rated as requires improvement. We had concerns people were not always safe as staff did not have correct advice about how to safeguard people from abuse and there were gaps in the recording of some medication. We also found staff did not always keep people’s information confidential. At this inspection we found the provider had addressed our concerns and we rated the service as good.

At the time of our inspection there was 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 could live as ordinary a life as any citizen.

The registered manager was an effective leader and ran the service in an organised manner. There was a well-established and committed staff team well together n the registered manager’s absence. There were structured systems in place to check on the quality of the care being provided. When these checks found there were gaps or mistakes, senior staff ensured these were resolved. There was an open culture where the whole service learnt lessons and drove improvements.

Staff minimised the risks to people’s safety and knew what to do if they were concerned a person was at risk of abuse. Measures to reduce the spread of infection were extremely effective. There was enough safely recruited staff to meet people’s needs. People received their medicines safely and as prescribed.

Staff had the necessary skills to meet the complex needs of people at the service. The staff team felt well supported and communicated effectively to ensure support to people was consistent. People’s physical and mental wellbeing was promoted and they received support to access health and social care professionals when required.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. We found the registered manager and staff met their responsibility under the MCA. Where people were being restricted of their freedom, decisions were made in their best interest.

Staff were caring and treated people with dignity. They communicated with people in a variety of ways to ensure their views were central to the care provided. People lived full lives and were supported by staff to develop their independence. Care plans were extremely person centred and provided staff with the necessary information to meet people’s needs and keep them safe. People and families were able to provide feedback and know they would be listened to and any concerns addressed.

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 manager is registered for this service and one other service other local, nearby care service and is also one of the organisation’s directors.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risks to people’s health, welfare and safety had been assessed and guidance provided for staff with recorded action they should take to mitigate these risks.

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.

There were systems in place to ensure that staff were trained and people received their medicines as prescribed. However, gaps in medication administration records for the application of creams and lotions did not assure us that people always received these medicines as prescribed.

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. However the current practice of holding staff handover meetings in people’s communal lounge did not fully protect the confidentiality of their information and consider their rights to have their communal space protected without intrusion.

Staff were provided with training in Safeguarding Adults from abuse. However, policies which guided staff in how to report poor practice had not been reviewed since 2009 and safeguarding people from abuse policy since 2011. These policies contained out of date information and did not provide up to date, relevant guidance in line with local safeguarding protocols and current regulatory requirements.

Staff were provided with training in understanding their roles and responsibilities with regards to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People’s capacity to make decisions about their everyday lives had been assessed and their consent was considered in the planning and provision of their care and support

Staff were able to demonstrate that they knew people well and we observed treated people with dignity and respect. However, we recommend that the current practice of holding staff handover meetings in people’s communal lounge be reconsidered as this did not fully protect the confidentiality of their information and consider their rights to have their communal space protected without intrusion.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including GPs and dentists.

People were provided with the opportunity to participate in personalised, meaningful activities according to their assessed needs, wishes and preferences. People were encouraged to develop as much independence as possible and learn new life skills. People had access to annual holidays and opportunities to be integrated into the local community.

The provider had a system in place to respond to suggestions, concerns and complaints. The service had a number of ways of gathering people’s views including; one to one monthly meetings and satisfaction surveys. The provider and registered manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to plan for improvement of the service.

We saw that care plans and risk assessments were regularly reviewed with people who used the service or relatives if they were unable to fully participate.

We saw that staff were knowledgeable about people's needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people's care needs and preferences. One person who used the service told us: 'I like living here, the staff talk to me and take me to play football."

There were policies and procedures, records and monitoring systems in place for the protection of people who used the service. Staff told us about the training they had received to enable them to carry out their roles in supporting people. Staff told us they felt supported by the manager.

We saw that there was a complaints policy and procedure in place which was in an easy read format. The staff were able to explain the complaints procedure. People who used the service told us they were aware of how and who to complain to.

We spoke with two people who told us they liked living at Maple House and liked the staff who cared for them. One person said, "It is all very good here." Another person said, "The staff know what I need if I am anxious about things."

The people we observed during our visit were relaxed in the company of the staff and were able to pursue interests of their choice within the home. There was sufficient space within the home for people to go to an area away from others if they felt they needed privacy. We saw one person playing computer games with staff in his bedroom and another in the communal area watching the TV. Another person was out in the community, supported by a member of the staff team, at an educational establishment.

We saw that people's care records contained detailed information to show how they were to be cared for. The people using the service were familiar with these records and had signed them to confirm their agreement with the proposed care and support.