Maple Manor Care Home

Maple Manor Care Home is a residential care home providing personal care to up to 16 people in one adapted building. The service provides support to people who require support with personal care and people with learning disabilities. At the time of our inspection there were seven people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support

The service provided people with care and support in a safe environment, however improvements were required to ensure the home was always clean and well-maintained. Further work was required to ensure people were supported to personalise their rooms.

Whilst the provider worked with people to plan for when they experienced periods of distress, the guidance was not always fully implemented by staff.

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 supported to engage in meaningful activities, including support to travel wherever they needed to go.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right care

People’s care, treatment and support plans did not always fully reflect their range of needs.

Staff understood how to protect people from poor care and abuse because they received and understood training on how to recognise and report abuse. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

The provider worked well with other agencies. People received kind and compassionate care.

Right culture

Whilst people received compassionate care, further improvements were required to ensure the staff always understood best practice in relation to specific needs people with a learning disability and/or autistic people may have.

The provider continued to work on reducing staff turnover which supported people to receive consistent care from staff who knew them well.

Where possible, people and those important to them, including advocates, were involved in planning their 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 requires improvement (published 3 November 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has remained 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 Manor Care Home on our website at www.cqc.org.uk.

Enforcement

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 safe care and treatment and good 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Maple Manor Nursing Home is registered to accommodate up to 16 people in one adapted building. People living at the service had a learning disability and or autism or mental health needs. At the time of our inspection, 13 people were living at the service. Accommodation is provided over two floors and a stair chair lift is available.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The service size and design were not in line with the best practise guidance and some people bedrooms were not personalised.

The atmosphere in the home was positive and people had opportunities of engaging in some meaningful activities in the community, however further improvements were required to increase in -house activities and positive interactions between the staff and people who used the service.

The provider's systems and processes used to monitor quality and safety had improved, however further work was required to ensure the care plan and risk assessments were always up to date.

People received person-centred care that promoted their dignity and human rights and were looked after by an appropriate number of staff. Staff understood their roles and responsibilities and how to meet people's individual care and treatment needs. However, the high turnover of staff impacted on the staff being able to form positive rapport with people.

Improvements were made in incident management including the recording, analysis and learning from incidents; medicines management and infection prevention and control.

The staff team worked well with external health and social professionals and followed recommendations made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 3 June 2021) and there were breaches in Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we issued warning notices.

We found improvements had been made and the provider was no longer in breach of regulations. The service remains rated Requires Improvement.

Why we inspected

We received ongoing concerns about the staffing levels and safe care and treatment of people. We also undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The provider completed an action plan after the last inspection, to show what they would do and by when to improve Regulation 12 Safe care and treatment and Regulation 17 Good governance.

This focused inspection checked they had followed their action plan and to confirm they now met legal requirements. We found the provider had met their action plan and was no longer in breach of the Regulations.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Maple Manor Nursing Home is registered to accommodate up to 16 people in one adapted building. People living at the service had a learning disability and or autism or mental health needs. At the time of our inspection, 15 people were living at the service. Accommodation is provided over two floors and a stair chair lift is available.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Improvements were required in how people were involved in their care and treatment that maximised their choice, control and independence. People did not receive consistent person-centred care that promoted their dignity and human rights. Whilst the atmosphere was more positive and opportunities of meaningful activities increased, further improvements were required. Action by the management team to further develop staff values, attitudes and behaviours were required. Staff also needed to take responsibility and be accountable for their roles and responsibilities.

Staff guidance, training and development in how to meet people's individual care and treatment needs were required. This included enhancing staff's skills and understanding in how to meet behaviours that could be challenging. Improvements were required to incident management including the recording, analysis and learning from incidents.

Reviews of people's support plans and risk assessments to ensure guidance for staff was up to date and reflective of current care needs needed further work.

Overall, improvements had been made to medicines management and infection prevention and control. Some ongoing improvements were required to ensure best practice guidance was followed.

The provider's systems and processes used to monitor quality and safety needed further review and improvements to ensure they were sufficiently robust and effective. New and improved communication systems were being developed.

The staff team worked with external health and social professionals and followed recommendations made.

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 requires improvement (published 1 December 2020). The service remains rated requires improvement. The last comprehensive inspection rating for this service under the provider’s previous name of the service (Sycamore Lodge) was Good (published 3 November 2017).

Why we inspected

We received ongoing concerns about the safe care and treatment of people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We carried out an unannounced focussed inspection of this service on 2 November 2020. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection, to show what they would do and by when to improve Regulation 12 Safe care and treatment and Regulation 17 Good governance.

This focused inspection checked they had followed their action plan and to confirm they now met legal requirements. We found the provider had not met their action plan and improvements were still ongoing.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to continue to make improvements. Please see the Safe and Well-led sections of this full report. Following feedback with the provider about the inspection findings, they took some action to mitigate risks.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to Regulation 12 Safe care and treatment and Regulation 17 Good governance. Continued improvements to people's care records, risk assessments and how behaviours that were challenging were managed. Staff required further support and training to develop their skills and knowledge. Improvements were required with communication systems and in the monitoring tools used to assess and review health and safety. Where improvements had been made these needed to become fully embedded.

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.

Since our last inspection there had been a change to the management team, a new manager and deputy commenced the week before our inspection.

Some actions were required to improve cleanliness and hygiene of the environment including equipment. Additional clinical waste bins were also required and hand hygiene posters, the management team agreed to make these improvements.

We found the following examples of good practice.

• Cleaning of frequent touch points had been increased and cleaning fluids had been changed in response to COVID-19.

• Action had been taken to reduce the risk of transmission of COVID -19 from visitors to the service. Visitors were required to have a COVID-19 lateral flow test, complete a COVID questionnaire and had their temperature taken before entering. Hand sanitiser and personal protective equipment (PPE) was available.

• The provider had ensured staff had an ongoing supply of PPE and the management team checked to ensure this was used correctly.

• Staff had received training in the prevention and control of infections (IPC). Additional COVID –19 and had recently been provided by the local IPC clinical commissioning group.

• At the time of the inspection the service was in the process of being redecorated and plans were in place to replace furnishings.

• The provider had a COVID-19 and business continuity plan, and associated risk assessments to mitigate risks.

• Both staff and people who used the service received regular COVID-19 testing. People living at the service had received their first dose of the COVID-19 vaccination and staff were in the process of receiving this.

• People were supported to maintain contact with family via telephone, zoom calls and socially distanced window / door visits.

• Relatives were kept informed about people’s health, care and welfare needs.

Maple Manor Nursing Home is registered to accommodate up to 16 people in one adapted building. People living at the service had a learning disability and or Autism or mental health needs. At the time of our inspection, 14 people were living at the service. Accommodation is provided over two floors and a stair chair lift is available.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Staff levels had not consistently enabled people to receive care and treatment that maximised their choice, control and independence. People did not receive consistent person-centred care that promoted their dignity and human rights. Staff were task focussed and did not consistently uphold people’s dignity. Improvements in communication and leadership was required to develop staff values, attitudes and behaviours.

Risks were not effectively or safely assessed, monitored or managed. Staff competency, understanding and skills in meeting people’s individual care and treatment needs in relation to their mental health needed improving. Support plans varied in the level of detail and quality of guidance provided to staff and had not been consistently updated when changes occurred.

Staffing levels did not consistently meet people’s individual assessed needs. Day time staffing levels fluctuated, meaning we were not sufficiently assured people were safe. Night staffing levels were not adequate to meet people’s individual needs in an event they required to be evacuated safely. The provider took action to make improvements. Safe staff recruitment processes were used to ensure staff appointed were suitable.

Staff understood their role and responsibilities to protect people from discrimination and abuse but had not always reported concerns. Incidents were reviewed and analysed, but it was not clear how this informed the management of risks.

Leadership and communication were not fully effective, impacting on staff morale, team work and people not receiving positive outcomes. Systems and processes were in place to monitor the quality and safety of the service, but these had not been fully effective in identifying all shortfalls and areas that needed improving.

People received their prescribed medicines when required and the storage, management and monitoring of medicines followed best practice guidance.

Infection, prevention and control guidance was being followed at the time of the inspection. Cleaning had increased and Covid -19 risk assessments and plans were in place to support staff.

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 under the provider’s previous name of the service (Sycamore Lodge) was Good (published 3 November 2017).

Why we inspected

We received concerns in relation to staffing levels, the leadership of the service and how behaviours described as challenging were being met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report. Following feedback with the provider about the inspection findings, they took some action to mitigate 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maple Manor Nursing Home / Sycamore Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12 Safe care and treatment and Regulation 17 Good governance.

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.

Sycamore Lodge Nursing Home provides accommodation for people who require nursing care. There were 16 people with learning disabilities receiving care at the time of our visit. This was the first rated inspection of Sycamore lodge Nursing Home since they registered with CQC in February 2016.

There was a manager registered with the Care Quality Commission (CQC). 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 were kept safe and people’s families felt they were safe when staff provided care. People were supported by staff who could identify the different types of abuse and who to report concerns to. Assessments of the risks to people’s safety were in place and regularly reviewed.

There were sufficient numbers of suitably qualified and experienced staff in place to keep people safe. Safe recruitment processes were in place.

People were protected from the risks associated with managing medicines. Processes in place ensured medicines were handled and administered safely.

People were supported by staff who received appropriate induction, training, supervision and a yearly appraisal. Staff were supported by management. People’s rights were protected under the Mental Capacity Act 2005. People received the assistance they required to have enough to eat and drink. External professionals were involved in people’s care as appropriate.

People were encouraged to have positive caring relationships with staff and other people living in the home. People were treated with respect and dignity. The service supports people to express their views and be actively involved in making decisions about their care, treatment and support. Information was available for people if they wished to speak with an independent advocate. People were supported to live as independently as possible.

People’s needs were assessed to determine if the service could meet their needs. People were encouraged to raise concerns or complaints if needed. The provider followed their procedures to ensure any complaints or concerns were dealt with in a timely manner.

The service promoted a positive culture. People appeared to be happy with the way the home was managed. Staff felt the registered manager was approachable and listened to their views or concerns. There were a number of quality assurance processes in place to assess the quality and effectiveness of the service, but not all the systems in place were robust or identified issues to ensure they would be addressed in a timely manner.

We have made a recommendation about the completion of robust action plans and systems to ensure the service follows up and checks issues have been resolved.