Maple Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified a breach of the legal regulations for safe care and treatment. People did not always have accurate care plans to guide safe practice. Medicines were not always properly and safely managed. On the first day of our assessment, parts of the environment and some of the equipment were not clean. Actions were taken before our second visit. However, people told us they felt safe. The staff worked with other professionals in supporting people’s health. The provider used a tool to help determine staffing levels and staffed in accordance with this. Staff were recruited safely. People’s mental capacity was assessed and the service applied for Deprivation of Liberty Safeguards (DoLS) as required.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us that when they raised concerns or issues, communication could be slow and there was limited evidence of change or action. For example, a person told us, “It never seems to change anything when I say something.” There were concerns that information was not always effectively communicated within the staff team.

The management team explained how they reviewed accident and incidents and safeguarding incidents to identify any themes, trends or lessons learnt. However, these were not always effective when ensuring all necessary actions had been taken to respond to and mitigate risk and maximise learning opportunities.

Systems and processes had not helped to identify and ensure necessary actions and learning had taken place following accidents and incidents. For example, there had been a high number of falls but further training for staff had not been explored to ensure they had the required skills and knowledge. This was discussed with the registered manager during the assessment and was then introduced for staff to complete.

People told us they were supported to access a range of health care professionals including the GP, physiotherapists and district nurses.

Staff sought input from other professionals when required.

Professionals generally provided positive feedback about how the service worked with them. For example, a professional told us, “On the whole the care home work well with us; they attend the multi-disciplinary meetings and appear to gain good benefit from this. The staff are helpful and keen to share information or updates for people.”

Effective processes were in place to ensure the service worked well with partner agencies in supporting people. Prior to people moving into the service, pre-admission assessments were completed with them and their relatives to ensure they could be safely cared for and have the input of the right people.

Some relatives expressed concerns that issues or risks were not actively addressed, which could have compromised people’s safety. Most people did, however, tell us they felt safe living at the service. Comments included, “Yes, I feel safe, the staff are nice” and, “I do feel safe. They look after you.”

Some staff were not aware of how to access key policies to guide them in their knowledge and practice. Staff were not always clear about how to escalate unresolved concerns. Staff felt confident in raising any issues with the registered manager.

We observed staff supporting people safely. Staff responded to people in a friendly and approachable manner and sought consent before care or support was provided. Staff were patient and took time to explain what they were doing. People seemed relaxed and comfortable with staff.

The provider did not have an effective overview of all safeguarding incidents which had occurred in the service. This was discussed during the assessment. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments and relevant best interest decisions were in place and applications to deprive people of their liberty were submitted when required. However, conditions attached to the DoLS had not always been acted upon. The provider had the relevant policies and procedures in place to guide knowledge and practice.

People told us they were not involved in the creation of their documentation. When concerns or risks were raised, these were not always acknowledged, and sometimes went unresolved. Relatives told us they were informed when accidents happened.

We could not be fully assured of staff practice in relation to risk management due to the gaps and inconsistencies in documentation used to guide their practice.

We observed staff sensitively support people. This included providing reassurance to somebody who was upset. Staff understood the person’s non-verbal communication and knew what to say to calm them. Staff were observed using equipment safely.

People’s records were not always consistent, accurate or up-to-date. This meant we could not be assured care was provided in the safest way. Risk assessments did not consistently contain sufficient information to guide staff about the required actions to mitigate potential risks. Examples of this include conflicting information about a person’s nutritional needs or how to safely support somebody with their catheter. Staff had also not received training on catheter care.

People told us their bedrooms were kept clean and tidy. One person said, “[The service is] always clean. Cleaners are always in; they dust and everything.” People had the equipment they required to help keep them safe.

The registered manager understood their responsibilities to ensure the safety of the environment was maintained. Maintenance staff were employed to carry out checks of the service and equipment.

On our first day, we observed premises and equipment were not always clean and hygienic. For example, armchairs were dirty, as were some wheelchairs and slings. On our second day, there were noticeable improvements including the replacement of chairs in communal areas. We observed equipment and items which could be a hazard to people, such as chemicals for cleaning, were securely stored.

The checks of the environment had failed to identify some of the improvements needed. Actions were taken following our first day. Internal health and safety checks were completed and up-to-date to ensure the safety of the environment and equipment.

Some people recalled occasions where they had needed to wait a long time for carers to come to them. There were also concerns that staff were not always visible within communal areas. Some people felt there was a lack of continuity and retention of staff. For example, a person said, “They seem to have a problem with staff; they’re always changing them. There are always new faces.” Most people told us that staff responded to their requests for support, with one person stating, “The carers work so hard. They come when I need them.” We received feedback that staff may benefit from further training on certain topics, such as catheter care, noting, “A little bit of observation and training in that area would really help.”

We received mixed feedback from staff about staffing levels. For example, a staff member described staffing as, “a struggle” noting there was limited time to spend with people outside of delivery personal care. Some staff members commented that there could be more training in areas such as behaviour support to ensure they had the required knowledge and skills. Other staff did however tell us that staffing levels were sufficient. Our observations supported there was a process for determining staffing levels, and staff were available but there was limited interaction outside of planned care activities.

We noted for some people they had little direct interaction with staff. We did, however, observe staff were available and responded to people in a timely manner.

The provider had not ensured staff received training to meet people’s individual needs and in response to risk. This included staff having not received falls or catheter care training. The provider used a dependency tool to assess the required staffing levels. This was regularly reviewed and updated when there were changes in the service. Recruitment checks were carried out to ensure staff were of suitable character to work with people. Staff received supervision to provide support and help develop their skills and practice.

People told us they were happy with the cleanliness of the service.

The provider employed housekeeping staff to carry out cleaning duties. The management team understood what was needed to keep a service clean.

On the first day of our assessment, we observed multiple concerns regarding the cleanliness of the service and equipment including unclean furniture, a kitchenette with marks and stains on the walls and a dirty floor. Following feedback, the provider took the necessary actions and improvements had been made.

The provider’s processes to monitor the cleanliness of the environment did not highlight any of the issues we found during our first visit. The provider did however have an infection prevention and control policy and staff had completed training on this topic.

People did not raise any concerns with us about their medicines. However, elements of staff practice and record keeping required improvement. For example, medicines administration records were not always accurate and up-to-date. Guidance to support staff in the safe administration of ‘when required’ medicines was not always in place or lacked person specific information. Failure to have this information could place people at risk of not receiving their medicines as required.   

Staff didn’t have a consistent approach or process for the recording of medicines administration. The provider informed us they were aware of some of the issues and work had begun to improve these but had not been fully addressed by the time of our assessment. Staff did, however, undertake training and had their competency to administer medicines assessed.  

The audits and checks undertaken for medicines had not been effective in identifying the issues we found during this assessment. For example, processes were not always robust when supporting people that needed their medicines given covertly, (hidden in food or drink) or when thickener needed to be added to people’s food or drink. Actions had not always been taken to ensure some medicines were being stored within safe temperature ranges.