The Care Quality Commission (CQC) has downgraded the rating for Maple House from good to inadequate following an inspection in September and October.
Maple House, run by Maple Health UK Limited, is a residential care home supporting up to five autistic people and people with a learning disability. This inspection was prompted in part by concerns CQC received about the use of unsafe physical restraint at the home.
In addition to dropping from good to inadequate overall, Maple House has also dropped from good to inadequate for how safe, effective, caring, and well-led it is. It dropped from good to requires improvement for being responsive.
The home has now been placed in special measures, meaning it must make rapid and widespread improvements and will be kept under close review by CQC and re-inspected to check on the progress of those improvements.
CQC are also taking further regulatory action to protect people and will report on this when legally able to do so.
Rebecca Bauers, CQC’s director for people with a learning disability and autistic people, said:
“When we inspected Maple House we were deeply concerned to find people being disproportionately and often unlawfully restrained because leaders didn’t ensure staff had the skills or training to care for people safely and compassionately. We saw leaders often ignored people’s needs when making decisions, and had created a closed culture which discouraged staff from raising concerns.
“We’ve raised urgent concerns around the unsafe use of physical restraint to the provider, local authority safeguarding team, and police to ensure people are kept safe. We stand by our public commitment to ensure that reducing restrictive practices, and promoting positive cultures, is everyone’s business.
“We also found people weren’t always given choices in their care and staff didn’t always record restrictions placed on people’s freedom, while managers didn’t always attempt to reduce these restrictions. This violates people’s human rights.
“When things went wrong, leaders didn’t always effectively investigate to learn from it, and protect people from repeated mistakes in future. We found a culture of blaming others instead of taking accountability among leaders, and staff told us they’d had their hours cut when they raised concerns. This deliberately created a closed culture where staff were scared to speak up. This is unacceptable as staff have important information to share with providers when things aren’t right and need to be improved.
“We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, and independence that most people take for granted and it’s unacceptable that the people they relied on were treating them this way.
“We’ve told the provider exactly where improvements are needed and will closely monitor the home to make sure people are being cared for safely during this time. We’re also taking further regulatory action which we’ll report on when we’re legally able to do so.”
Inspectors also found:
- Leaders told inspectors they hadn’t booked staff training on the use of physical restraint for financial reasons, despite the risks this posed to both the people living in the home and staff. This training was booked following this inspection
- The service had a very poor culture among both staff and leaders, with allegations of bullying, violence and sexual misconduct. Leaders hadn’t taken enough action to reduce this inappropriate staff behaviour, even when this was a known trigger for people’s anxiety and distress
- Leaders didn’t keep people safe by suspending staff promptly when investigating safeguarding concerns
- Staff didn’t always know how to meet people’s individual needs and preferences because care plans and risk assessments weren’t always good quality. One staff member who spoke to inspectors didn’t know the person they were supporting was autistic
- Staff hadn’t raised serious concerns about people’s care to external authorities. Leaders had failed to notify CQC of serious safety and safeguarding incidents, which is a legal requirement
- Leaders had poor oversight of people’s care. Audits were delegated to staff who didn’t have the skills to complete them, meaning concerns were missed or not acted on
- Some people enjoyed meaningful leisure time, but other people didn’t have choices and were subject to disproportionate restrictions. There weren’t enough staff to make sure people had access to leisure activities outside the home
- Staff spoke warmly about people they supported, but some people’s care plans contained demeaning and disrespectful language.
However:
- Some people’s relatives gave positive feedback on the home, although inspectors found people’s quality of life varied significantly depending on their needs
- The home met people’s communication needs well, such as through photographs to help people know what was likely to happen that day.