Maple View

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We reviewed 6 quality statements under this key question: assessing needs, delivering evidence-based care and treatment, how staff teams and services worked together, supporting people to live healthier lives, monitoring and improving outcomes and consent to care and treatment. At the last inspection, the provider was in breach of the regulations because the service was not working within the principles of the Mental Capacity Act, and people were not always supported to eat a healthy and balanced diet. Enough improvement had been made at this inspection and the provider was no longer in breach of the regulations. Before providing care staff sought people’s consent. Mental Capacity Assessments relating to people’s level of supervision and control had been completed and appropriate legal authorisations were in place to deprive a person of their liberty. Before using the service, people's needs were assessed to ensure staff would be able to support them effectively. People and their relatives were involved in planning how their care would be delivered. Systems were in place to assess and continually review people’s individual needs and preferences. This information was used to develop each person’s care plan and ensure it reflected their current care and support needs.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they had been involved in the assessment process prior to their loved one being admitted to Maple View. A relative told us, “The transition to an adult placement was detailed and exceptionally well executed, staff would listen and pay attention to whatever I said, they did observations for long time. [Persons] support plan was done in cooperation with me and other professionals.”

People had been comprehensively assessed to ensure the service could meet their needs. Information about people’s likes and dislikes and how staff should support them were in place. The registered manager told us, “On receiving a referral, I would arrange a home visit. I need to see if the person would fit in with the people living in the service. I assess what their needs are to determine if staff have the correct skills to support them and ask myself will staff need to undertake any further training to meet the person’s support needs. I would then arrange for them to visit the service with their relative. It has to be the correct placement for both us and them.”

Before people started using the service their care and support needs were discussed with them and their relatives. Each person then had their own personalised support plan which was reviewed monthly or sooner if their care and support needs changed. People had key workers who involved them in monthly reviews and feedback of the care and support they received. This included pictorial images to aid understanding of what was being asked/discussed.

Relatives we spoke to raised no concerns around their loved one’s nutrition. Where possible people were supported to be involved in menu planning and the weekly shopping. We saw for 1 person; staff had created a menu with nutritionally balance foods using a pictorial image of an eat well plate to help support them in understanding the importance of eating a well-balanced diet. Staff supported the person to prepare their own breakfast, lunch and hot beverages.

People's care plans detailed the support they required to eat and drink safely and their preferences in snacks, meals and drinks. People were supported to get involved in the weekly shopping if they wished to, and menu choices were discussed and agreed. People were provided with options at mealtimes and could choose what they wanted to eat and when, mealtimes were flexible according to the person’s wishes.

People’s health needs and dietary requirements were clearly outlined in their support plans. People were given the opportunity to live as healthily as possible, including being offered healthy snacks throughout the day and daily exercise. People’s nutrition and hydration needs were supported in line with current standards and the service monitored people’s weight regularly. Where required the service worked with speech and language therapists (SALT) to ensure people were receiving the correct support with their food and nutrition.

Everyone we spoke with told us they had been fully involved in the planning of people's care delivery and reviewing their care needs. Relatives overall were complimentary about the staffing team and the support provided to their loved ones. Comments included, “They (staff) battled my corner when we had to talk with the continence service to increase their number of continence products,” and “due to [persons] diagnosis they have regular check-ups with external health professionals. Staff always put forward a valuable point and I feel confident they are supporting [person] well at those visits.”

Staff had access to clear information about people's personal risks and how they should be supported. Guidance on the actions staff should take when there were changes in people's behaviours or physical needs were in place. Staff worked closely with health care professionals for the benefit of people in the service and kept them informed about people's progress and any changes in their well-being.

Feedback from health and social care professionals who worked closely with the service was positive. One healthcare professional told us, “I have been in regular contact with one of the team leader’s, who has attended all review meetings and given helpful feedback and updates with regards to the persons presentation within the home. From my observations of the carers that support the person to these sessions, they have a positive relationship with the person and support and encourage them appropriately.”

Processes were in place to ensure all relevant staff, teams and services were involved in assessing, planning and delivering people's care and treatment. Staff work collaboratively to understand and meet people's needs. This included, comprehensive daily handovers, staff meetings, debrief meetings, multi-disciplinary team meetings and supervisions to ensure staff had up to date information to support and promote people’s wellbeing.

People were encouraged and supported to make healthier choices to help promote and maintain their health and well being.

Staff told us they understood the importance of supporting people to live healthier lives and to engage in decision making about their care.

People and/or their legal representative were involved in regularly monitoring their health, including health assessments and checks where appropriate. People had hospital passports containing detailed information about their care needs should they go into hospital. They contained information such as ‘things I like to do/ things I don’t like and things which are important to me’. Staff supported people to attend healthcare appointments as and when required.

Although people were unable to tell us how staff supported them with their day to day living, we observed people going out to attend appointments or for walks throughout the day of our visit. A relative told us, “In the beginning [person] was scared to go out, the GP had to come for visits, gradually staff helped [person] overcome their fear. There was no medication used, and all I know now is [person] is going out, I have photos of them in different places. I just could not believe how [person] has changed for the better.”

The registered manager told us, “We have reviews with people’s relatives, their social workers. Most people have the support of a whole Multi-Disciplinary Team. We include people by use of signing, pictures cards, observation of any facial expressions and body language to enable people to tell us what they like. The team leader reviews people’s care plans monthly or sooner if any changes need to be made. People have a monthly meeting with their keyworker who then establishes if they want anything about their care changed if they need anything and want to go anywhere. We also capture different themes within their meetings, by way of pictorial images, use of sign language and do our best to enable the person to understand.”

Systems were in place to continuously monitor people’s care, treatment and outcomes. People’s care plans were up to date and reflected their current needs.

People living at Maple View were not all able to consent to their care. Staff supported people wherever possible to make day to day decisions such as what to wear, eat, drink and where they would like to do. This enabled people to have some autonomy over their day to day lives. Some people’s relative or representative were legally responsible for decision making on their behalf for more complex decisions, such as health, welfare, and finances.

Staff had received Mental Capacity Act (MCA) training and understood the principles of the MCA. They gave examples of how they applied the principles when supporting people and understood their responsibility to report if they had any concerns a person may be lacking capacity.

Where required people’s capacity had been assessed the outcome was clearly documented in their care plans. Where a person was assessed as lacking capacity, their care plans were clear on who the decision maker(s) were to act in their best interests. The service had applied for Deprivation of Liberty (DoLS) applications in line with best practice.