Archived: The Maples

Updated 14 October 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Four inspectors and an Expert by Experience visited the service on the first day of the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the second visit three inspectors attended the site and the Expert by Experience made telephone calls to relatives.

Service and service type

The Maples is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission although they were not in day-to-day control of the home at the time of this inspection. This means that they and the registered provider are legally responsible for how the service is run and for the quality and safety of the care provided. A manager was newly in post. We refer to them as the 'manager' in this report.

Notice of inspection

The inspection on both days was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We observed care and support throughout the inspection visits to help us understand the experience of people who could not talk with us. We spoke with five people who used the service. Other people were not able to verbally communicate with us, so we observed their interactions with staff members throughout the inspection. A member of the inspection team was able to assist people’s communication with some use of Makaton. Makaton is a communication method that uses symbols, signs and speech to enable people to communicate. We spoke with 18 members of staff including the regional project manager, quality assurance business partner, business administrator, service manager, assistant manager, two team leaders, 11 support workers including one bank and two agency staff members.

We reviewed a range of records. This included 10 people’s care records including six people’s medicines records and five medicine related care plans. We looked at two staff files in relation to recruitment and staff supervision and agency staff files and processes. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We spoke with nine relatives by telephone to seek their opinion about their experience of the care provided. We sought feedback from local authorities who commissioned people’s support at The Maples. We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Following the inspection, we discussed our initial findings with the management team at The Maples including the Nominated individual. The nominated individual is responsible for supervising the management of

Updated 14 October 2021

About the service

The Maples is a care home without nursing for up to 15 people aged 18-65 years of age living with a range of complex conditions, including autism with associated sensory and communication difficulties, and complex behavioural needs. There were 13 people being supported in three different bungalows on one site at the time of the inspection.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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

The service could not show how they met the principles of Right support, right care, right culture.

Right support:

¿ The model of care and setting did not maximise people’s choice, control and independence. The remote rural location of the campus meant people had to use a car or public transport to access local amenities. Due to vehicle sharing and 13 staff out of 76 who were authorised to drive, people could not always enjoy unplanned outings unless they utilised public transport. We received feedback that some staff did not feel confident to support people in the community, which also limited the use of public transport as an option for some people. One person told us, “We have no activity room now as they have turned it into a meeting room.”. The provider told us there were plans to build a bespoke activity centre on site this year.

Right care:

¿ The care people received was not always person-centred and did not always promote people’s dignity, privacy and human rights. People were not always supported by trained, skilled staff who were familiar with people’s needs and agreed care plans. Agency staff, who were frequently allocated as people’s one to one support, had not always received training such as, epilepsy or certified restrictive practice training. The provider had not reviewed the compatibility of people using the service or the impact of people’s needs upon others’ rights. A person told us they were frightened by one of the people they shared a house with.

Right culture:

¿ During our inspection the management team were open about the need to make improvements and had started to invest to develop the service. However, at the time of our inspection, this had not made enough impact to enable people to live full, inclusive or empowered lives. Staff told us they felt there was a lack of visible leadership, and management failed to act on known issues. For example, alarm technology to manage risk was not being implemented by staff due to lost equipment. The management team had not acted to replace equipment or seek suitable alternatives.

People¿were not¿supported to have maximum choice and control of their lives and staff did not always support¿them in the least restrictive way possible¿and in their best interests; the policies and systems in the service¿did not¿support¿this practice.¿

¿ People’s care and support was not provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs. People’s homes were in a state of disrepair and did not provide a good standard of comfort or therapeutic surroundings for people with different sensory needs. We were not assured that the provider had consistently implemented effective infection control systems to ensure people and others were protected from the risks associated with COVID-19.

¿ People were not protected from abuse and poor care. Staff were not always able to recognise or respond appropriately to abuse. For example, staff did not recognise the unauthorised use of restrictive physical interventions were a potential form of abuse. The service relied on a significant amount of agency staff which impacted on people's care. Care staff, both permanent and temporary, had not always been provided with training or had their competency assessed to ensure they had the skills to safely manage behaviours that could challenge the person and others.

¿ People did not receive care, support and treatment from trained staff and specialists able to meet their needs and wishes. The provider had not ensured that staff had relevant training, regular supervision and appraisal.

¿ People were not always supported to be independent and have control over their own lives. Their human rights were not always upheld. The provider had not ensured all staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

¿ People did not always have care from staff that protected and respected their privacy and dignity and understood each person’s individual needs. People’s communication needs were not always met, and information shared in a way that could be understood.

¿ People’s risks were not always assessed regularly in a person-centred way. People were not involved with managing their own risks whenever possible.

¿ People who had behaviours that could challenge themselves or others had proactive plans in place to reduce the need for restrictive practices. However, there was limited evidence of this guidance being followed by staff. Systems in place to report and learn from incidents where restrictive practices were used were not effective.

¿ People did not always make choices and take part in meaningful activities which were part of their planned care and support. People’s aspirations and goals were not fully explored so staff could support them to achieve these. Support did not focus on people’s quality of life and follow best practice.

¿ People’s care, treatment and support plans, did not fully reflect all of their sensory, cognitive and functioning needs. People and those important to them, were not actively involved in planning their care. Care plans were not always reviewed to ensure they were up to date and accurate.

¿ Systems were not fully embedded to ensure the safe management of medicines. The provider was working to their own medicines improvement plan. However, this had not identified or mitigated all the concerns we found during the inspection.

¿ Referrals to appropriate health professionals had not always taken place, and when they had, not all had been followed up to ensure actions were taken to improve people’s health and wellbeing.

¿ People were not always supported by staff who understand best practice in relation to learning disabilities and autism. The provider was aware of the shortfalls in staff knowledge and training and was taking steps to improve staff training and support in these areas. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, were not fully involved with leaders to develop and improve the service.

¿ Where people were supported by staff who knew them well, and understood the support they required, people experienced caring and positive relationships with staff.

The provider recognised improvements were required and had reacted with an action plan. However, there was not a clear understanding of risk-based priorities or vision shared by the whole team to drive improvements. We asked the provider for reassurance that they would take urgent action in response to our findings on the first day of the inspection. We checked that this had taken place on our second visit.

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 4 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safe management of medicines. A decision was made to undertake a comprehensive inspection to provide assurance that the service is applying the principles of Right support right care right culture.

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 changed from Good to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Maples 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 identified eight breaches at this inspection in relation to person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse, premises and equipment, receiving and acting on complaints and good governance and staffing.

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.

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 relevant local authorities to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.