Maple Leaf House

Maple Leaf House is a nursing home providing personal and nursing care to up to 48 people. The service provides support to older people and those with dementia. At the time of our inspection there were 45 people using the service. The home is purpose built to support people with living with dementia. It accommodates people on one floor with three wings, with a number of communal lounges, dining areas and quiet spaces. People have access to a secure outdoor space.

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

Records in relation to medicines were not always completed and best practice guidance in relation to medicine disposal was not always followed. People's risk assessments were not always reviewed following changes in their needs, such as after an incident. There were enough staff to meet the needs of the people using the service, however increased use of agency staff had impacted on the service providing person centred care and support. The home was clean and well maintained. Safeguarding processes were robust and ensured people were protected from the potential risk of abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Actions to improve the service or mitigate risk were not always effective. People's care records were not always kept up to date. The provider had not managed the impact of increased use of agency staff on the people’s care and support. The culture within the service was not always positive; staff and relatives did not always feel communication with management was effective. The registered manager was open and transparent, understood their regulatory responsibilities and engaged with the inspection process. The service demonstrated joined up working with a range of professionals.

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 8 October 2019).

Why we inspected

We received concerns in relation to the management of medicines, staffing and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maple Leaf House on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safety and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

We found the following examples of good practice.

¿ The home has had an outbreak of COVID-19 and had been supported by health care professionals to review their infection control practices. These were being following to drive improvements and to reduce the risk in relation to the spread of the infection.

¿ Staff had received training in the use of personal protective equipment (PPE) and ensured these measures were followed putting on, taking off and disposing of PPE.

¿ There was a good supply of PPE, which was monitored by the registered manager.

¿ There were enough staff to support the needs of the people, when required consistent agency staff were used, this reduced the risk of transition between homes.

¿ The cleaning within the home had been increased to cover high touch areas and the cleaning products reviewed to ensure they had the required properties to eliminate the virus.

¿ The provider had an infection control policy which had been reviewed in relation to COVID-19, and a contingency plan had been used to consider areas of learning and improvements.

¿The registered manager kept relatives and family informed about the relevant guidance in relation to visiting. When visitors were able to attend safety, measures were implemented to reduce the risk of the infection, including temperature checks and a health check questionnaire.

¿ Staff were supported to access a wellbeing application which offered health care advise and discount opportunities.

¿ Testing was completed within the home for staff and people using the service, this ensured swift action could be taken to isolate and to reduce any further risks to others.

Further information is in the detailed findings below.

Maple Leaf House is a nursing home providing personal and nursing care to 27 older people who may be living with dementia. The service can support up to 48 people.

The home is situated in a residential area of Ripley. The home has three lounge areas, a sensory room and reminiscence room. All areas of the home are on the ground floor and people have individual bedrooms which they can personalise. There is a garden in the centre of the building which people can use.

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

People were happy and relaxed with staff and there was enough staff to support them. Staff were safely recruited to ensure they were suitable to work with people. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Medicines were managed safely in accordance with current regulations and guidance and people received their medicines as prescribed. Accidents and incidents were recorded, and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were being supported to make decisions and where people lacked capacity decisions were made in their best interests.

Staff had received the training they needed to know how to support people and had supervision from nursing staff and managers. People were encouraged and supported to eat and drink well and there was a varied daily choice of meals; special dietary requirements were met. Health care was accessible for people and appointments were made for regular check-ups as needed. Oral hygiene checks were completed in the home and referrals made where additional dental care was needed.

People chose how to spend their day and they took part in activities they enjoyed. Family members were able to join in any activity and people were supported to stay in touch with their families and receive visitors. A resident chaplain conducted services in the home and provided people with opportunities to reflect. Friendly relationships had been developed between people and staff. Care plans described people’s needs and preferences and these were reviewed. People were encouraged to be as independent as possible.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. People were encouraged to express their views and were invited to complete surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People felt listened to and any concerns or issues they raised were addressed.

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 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Maple Leaf Care Home provides nursing and personal care for up to 48 older people living with dementia. At the time of our inspection, there were 45 people receiving care at the service. There was a registered manager for the service at the time of this inspection. This is a person who has registered with the Care Quality Commission. They are responsible for the day to day management of the regulated activity of personal care at the service. Like providers, as a registered person they have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in June 2014 the provider was meeting the requirements of the Health and Social Care Act 2008 and related care standards.

People and relatives were confident of people’s safe care at the service. The provider’s staffing, emergency and contingency planning arrangements helped to ensure that people received safe care. Recognised incident reporting and safeguarding procedures were understood and followed when required to protect people from the risk of harm or abuse.

Risks to people’s safety from their health conditions or environment were assessed before they received care. Identified risks were regularly reviewed and managed by staff who understood and followed the care actions required for their mitigation. People medicines were safely managed.

People were provided with the equipment they needed for their safe support. The environment and equipment used for people’s care was regularly checked and maintained to ensure safe use.

People and relatives were happy with their care, often describing this as good or excellent. Staff understood people’s health conditions and related care requirements, which their care plans showed.

People were supported to eat and drink sufficient amounts, maintain a well-balanced diet and access external health professionals when they needed to. Staff followed any related instructions for people’s care when required.

Staff training arrangements were comprehensive to ensure safe, effective care delivery and related staff competency. Arrangements for individual staff supervisions were not being consistently maintained. Management improvements were assured to rectify this.

People were provided with personal care in line with legislation and guidance in relation to consent. Staff understood and followed the Mental Capacity Act 2005 to obtain people’s consent or appropriate authorisation for their care when required. Care plan record keeping improvements were assured to consistently account for decision specific care in people’s best interests.

People received care from staff who knew them well and were kind, caring and respectful. Staff understood and promoted people’s choices, rights and comfort in their care. People and relatives were made to feel at ease and welcome by staff and they were involved, informed and consulted to help agree people’s care.

People’s care was individualised but not always timely. Staff were visible but sometimes did not observe or respond in a timely manner when people needed assistance.

Staff were usually mindful of people’s needs. They supported people in a way that was meaningful and helped to reassure them when required. People were regularly supported to engage in social and recreational activities and practice their religious faith in a way they chose.

Environmental adaptations and equipment often helped to enable people’s freedom of movement environmental engagement, orientation and recognition. Relevant specialist advice was secured to help inform service improvements to fully ensure this.

People and their families were confident and informed to raise any concerns or make a complaint. Their views about the service and those of staff were regularly sought and used to help improve people’s care experience.

The service was generally well managed with a strong culture of ‘staff teamwork.’ People, relatives, staff and external stakeholders were confident in the registered manager.

Staff understood their roles and responsibilities for people’s care and were informed and supported to raise any concerns about people’s care or make improvements when required.

Regular checks were made of the quality and safety of people’s care. Findings from this were used to inform, assure and make service improvements when required.

There were clear management arrangements and lines of reporting and decision making for the operation and direction of the service. The provider had sent us written notifications when required, telling us about important events that occurred at the service, in accordance with their legal obligations to us.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

All of the relatives we spoke with told us that the provider's staff cared for people in a safe and effective way.

People's capacity to understand had been appropriately assessed and decisions made in their best interests.

The provider had effective systems to identify and manage risks to people's health, safety and welfare and to make improvements where required.

Appropriate infection control arrangements were in place.

People were cared for by enough appropriately skilled and experienced staff.

Is the service effective?

People's care needs were properly assessed before they received care, which was delivered in line with their individual care plan. People's care plans were regularly reviewed to ensure their needs were being met.

People's relatives were happy with the standard of care provided and they told us that care was designed and delivered to meet people's individual needs.

Is the service caring?

The three people's relatives we spoke with were positive about the care provided. Their comments included, 'I am fully involved in deciding on the best care and support. It's a fantastic place with a great ethos.' And, 'There is a good standard of care here. I am happy my relative is at this home.'

Staff understood people's needs and we saw they interacted with people in a caring and respectful manner.

Is the service responsive?

The provider informed people about how to complain and people's relatives we spoke with said they knew how to do this. They also told us they were happy with people's care and had not needed to complain.

The service had recorded the details of accidents and incidents that had occurred. These had been investigated and the cause of the issues identified. Service improvement actions plans had been put in place.

People's relatives told us that they thought the provider was responsive.

Is the service well-led?

A registered manager was in place.

The provider had an effective system in place to check the quality of care provided. Records showed that regular checks were carried out to identify and manage risks to people's health, safety and welfare. Where improvements were needed, action plans had been put in place to deal with them.

Relatives we spoke with told us that they were satisfied with the care provided. Two told us they would not want their relative to be anywhere else and one said 'The dignity here is top class'. Other relatives described the service as friendly and approachable and they confirmed call bells were answered promptly.

We received mixed feedback about staffing levels. Three relatives we spoke with told us that they thought there were insufficient staff. One said 'Staffing is inadequate' and another said there was no time for staff to speak to people and that mealtimes were an issue. Three other relatives did not raise any issues about staffing and one told us 'Staffing is pretty constant'. Staff also gave us mixed feedback about staffing with one stating the provider's staffing standards were high and another saying insufficient staff was an issue for mealtimes. Our observation noted people receiving their breakfast late. This meant that there had been little improvement to staffing since our previous visit in February 2013.

Our observation showed us that staff showed warmth and encouragement towards people and maintained their dignity. Relatives we spoke with confirmed that staff showed respect to the person they were involved with.

We saw that the service used the correct legal processes when decisions needed to be made where people lacked capacity and that best interests assessments were completed where necessary. We saw that proper authorisations were in place where a person's liberty was being restricted.

All relatives we spoke with confirmed that appropriate advice and guidance was sought from health professionals and that they were kept informed of any health issues. One relative told us "Health issues are picked up very quickly" and another said they were very pleased with the efforts made to ensure their relative did not develop a pressure ulcer. One relative described the staff as wonderful.

We saw that there were occasions when there were insufficient staff and that this meant there were delays in people receiving assistance at key times, such as meal times.

We saw the provider had a system for assessing and monitoring the quality of the service and responded to complaints appropriately.