This inspection took place on 8 and 14 October 2015 and was unannounced. Maple Leaf House is a care home which provides care for up to 30 people. This includes older people, younger adults and people with mental health conditions including dementia. On the day of our inspection there were 16 people living at the home.
The home had a manager but they were not registered with us. 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.
People we spoke with told us they liked living at the home and felt safe. However, we found risks associated with their care were not being identified and effectively managed to keep them and staff safe from harm.
Medicines were not always managed effectively. Sometimes medicines prescribed for people had not been given and it was not clear from records why this was. In some cases people had not been given the medicine they needed to manage their health conditions because it was out of stock. Staff competencies in regards to medicine management were not routinely checked to ensure safe medicine management within the home.
There were sufficient numbers of staff to meet people's needs on the day of our visit, but we could not be confident this was always the case because duty rotas were not accurate. New staff went through recruitment checks to ensure their suitability prior to working with people in the home.
People were positive in their comments about living at the home but some people’s needs were not being met effectively. This particularly applied to those people who had behaviours that challenged themselves, staff and others. This was because many staff had not completed training linked to people’s needs to support them in their role.
People had a choice of meals and most comments were positive about the food provided. We saw people who needed assistance to eat were not rushed and were supported to eat at their own pace. Where people had additional needs associated with eating and drinking, advice had been sought from a health professional although this was not always followed.
The provider was not meeting their legal responsibilities under the Deprivation of Liberty Safeguards. There were people in the home who were subject to restrictions in regards to their care which had not been authorised by the local authority.
The service was not consistently responsive to people's needs. Although people's choices were mostly respected and listened to, people who had difficulties communicating had limited stimulation and opportunities for their social care needs to be met. A lack of background information about people’s interests and preferences meant there were people who did not experience person centred care.
There was a system to record complaints and people told us they felt able to approach the manager if they had any concerns. However, complaints had not always been recorded in a way that would enable the provider to monitor them and ensure people were satisfied with the responses made.
The provider and manager did not have sufficient systems and processes in place to assure themselves that the home was providing a quality service to people. People had limited opportunities to provide their opinions of the service and to be involved in decisions related to their care. Audit processes were not effective in ensuring sufficient improvements to the service were made in a timely manner.
We found a number of breaches 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.
The overall rating for this service is ‘Inadequate’ and the service will therefore be placed in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.