Maple View

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 6 quality statements under this key question: learning culture, safeguarding, involving people to manage risk, safe and effective staffing, infection prevention and control and medicines optimisation. At our last inspection we found the service to be in breach of regulation 12 of the Health and Social Care Act 2008 (Regulations). This was because people were not safe and were at risk of avoidable harm. At this assessment we found the provider had made enough improvement and was no longer in breach of the regulations. Staff had received up to date training on the use of physical intervention techniques and could demonstrate how they used them to avoid excessive use of medicines. This was confirmed by staff who told us medication was only used as a ‘last resort’. We saw evidence of lessons being shared and learned from, where staff had information had to minimise the risk of recurrence. We did identify a safeguarding concern which had not been referred to the relevant safeguarding authorities or CQC, however the registered manager responded and raised the concern retrospectively after our assessment visit. Staff had been safely recruited. Employment and criminal checks had been carried out to ensure staff were of good character to work with people. There were enough suitably trained staff available to meet people’s needs and staff had received training to administer medication. However, further improvements were needed to ensure effective monitoring of medication was in place. Care plans contained information about potential risks to people’s daily lives and guidance for staff about how to mitigate them. Effective infection prevention and control measures were in place.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Overall relatives were positive about the relationships staff had developed with their loved ones. If any concerns arose, they felt comfortable raising them with staff and were confident in the action they would take. A relative told us, “I am interested in what they do with [person] and how they treat [person], and I have no complaints whatsoever. No service is perfect, but what I like is their openness and candour if something goes wrong. There have been a few incidents which happened in the past, I was informed immediately, medical advice was sought and obtain, and staff learned lesson from them.”

The registered manager spoke of the improvements made within the service especially in relation to the investment around staff training and communication since our last inspection. Staff completed a comprehensive daily handover for people, recording everything about the person over a 24-hour period. The registered manager told us, “Complaints are dealt with straight away, we are open and honest, sorting out as soon as possible. We now send newsletters out, have more regular email contact with relatives. Information sharing is discussed in staff meetings and debriefs to ensure staff are all aware and kept informed.”

Systems were in place for recording and responding to accidents, incidents and complaints. The registered manager and team leader analysed the data from these to identify any themes and trends. Staff were able to raise and discuss any concerns during 1:2:1 supervision sessions and staff meetings. Debriefs were held for staff to discuss incidents and share ideas on how improvements could be made.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us they felt safe living at the service. One person signed to say they were okay with the support of a staff member. Relatives told us, “Maple View is a safe and welcoming place, I can visit anytime I want to. I trust staff, they will go above and beyond to keep [person] safe.” And “Maple View is far better than any before. It suits [person] well, we are very happy how safe [person] is, and how well [person] is cared for.”

Staff and managers had completed appropriate levels of safeguarding training for their roles and understood their responsibility to report any concerns. Staff told us, “Safeguarding would be completed online to the local authority, although I do not complete them now, I have experience in safeguarding and reporting due to my previous role.” And “If I see anything I do not agree with I am here to protect people, so if something wasn’t right, I would raise with the registered manager or go to the police.”

People had 1:1 support from staff throughout the day and evening. We observed staff supporting people in a kind and caring way. Staff spent time talking to people and supporting them with their individual needs. If people wanted their own private time, this was facilitated by staff ensuring they checked in with the person to see how they were.

The systems and policies in place to reduce the risk of people being abused or harmed had improved since our last inspection. Lessons learned had been implemented following the last reported safeguarding. Information was shared with staff through debriefs to mitigate future risk. However, we identified 1 incident where a person had sustained an injury resulting in hospital treatment. This had not been raised as a safeguarding to the local authority, nor had the CQC been notified. A similar concern was identified at our last inspection. Although improvements had been made the registered manager needed to ensure they are fully aware of the local authority criteria for safeguarding referrals. The registered manager raised a safeguarding after our assessment and sent the relevant statutory notification to CQC retrospectively.

Before using the service, people's needs were assessed to ensure staff would be able to support them effectively. People and relatives were involved in these initial assessments and any on-going review of their care needs. People had keyworkers allocated to them, who carried out monthly meetings covering a range of topics to discuss including people’s preferred method of communication such as British Sign Language, pictorial or both. A relative told us, “Every five weeks [person] goes to a proper barber shop, a risk assessment is completed for every situation and [person] goes with staff they know well.”

Staff knew people well; they were able to tell us about associated risks to people and how they managed those risks. The registered manager told us, “I complete the risk assessments. I look at what those risks are for example, if a person is deaf/ or has left sided weakness, how do we support them to take positive risks. Do they understand and staff and what the impact is for both the person and the staff member supporting them.”

Assessments had been completed to support people and minimise risk. Staff had access to clear information about people's personal risks and how to minimise them. We observed staff safely supporting people in line with their risk assessments. People were being supported to go out for walks or attend their chosen activity. There were minimal restrictions on people’s freedom to move around, people had access to a safe secure garden area and were free to access outside areas.

People’s support plans included detailed risk assessments which provided information about potential risks to their daily lives. Since our last inspection, detailed incident forms had been completed, they included evidence of de-escalation techniques and strategies and debriefs carried out with staff by team leaders. People’s Personal Emergency Evacuation Plans (PEEPS) were completed in detail to mitigate risk to the person and others in the event of evacuation. They included plans of the person’s bedroom and a step-by-step pictorial process of how to open the window if the person refused to evacuate.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff were always available when people needed them. This meant people had the opportunity to freely move around their home. People appeared comfortable and relaxed in the company of their allocated support workers. Relatives told us, “[Person] is always fully staffed and supported very well by staff at Maple View,” and “I do think there are enough staff, I visit once a month, but [person] has other family members who also visit, and we all think there are plenty of staff.”

Staff we spoke with did not raise any concerns around the staffing levels. One staff member told us, “There are always the required staffing levels since I have been here, we have 2 staff on at night. Occasionally people may go home to spend time with their families, staffing is then adjusted accordingly.”

During our visit, we observed there to be enough staff to provide people with the support they needed. Support was provided on a 1:1 or 2:1 basis. In line with people’s agreed core support hours, additional staff were available throughout the week to assist with activities. Staff were confident when talking about their role, safeguarding and risks, and knew the people they supported well.

Systems were in place to ensure there were suitably qualified, skilled and experienced staff and safe recruitment practices were followed. Appropriate checks were completed before a new member of staff started working at the service. This included an application form, written references, proof of identification and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment choices. Staff received a comprehensive training and induction programme over a period of 5 weeks and their competencies were signed off by a senior member of staff.

Relatives were positive about the cleanliness of the service and told us there were no restrictions on visiting. A relative told us, “The home is nice and clean without looking clinical.”

Staff had access to personal protective equipment (PPE) and confirmed they had received training around infection prevention and control.

The environment appeared clean and tidy with no odours detected. People using the service had equipment which we observed to be clean and used for its intended purpose and not shared. The service had a homely environment which staff maintained.

The provider had infection prevention and control policies and procedures in place. Regular audits were undertaken, and any shortfalls were addressed if required.

People’s medicines were held in secure locked cabinets in their bedrooms and all medicines we checked, counted, and reconciled on the day of our assessment. Whilst relatives did not raise any concerns about how their loved one’s medicines were administered, our assessment found elements of people’s medicine management did not meet the expected standards.

Staff told us they had received training and had their medicines competency checked to ensure the safe administration of medicines to people. A member of staff told us, “I administer medicines and record the count. We use a pain scoring chart which will indicate if pain medicine is required.

Staff had received training and were assessed as competent to administer medication. However, the governance and oversight had not always identified the concerns. We found 1 person had ‘over the counter’ (homely) medicines in their medicine’s cabinet. The providers policy and procedure relating to homely medicines had not been followed and advice had not been sought from the GP/Pharmacy to ensure this medicine would not have any adverse reactions to the person if taken alongside their prescribed medicines. A person’s topical cream had not been applied as per the GP’s recommendations of twice daily. We found the cream was dated as opened on 9 August 2024 and was almost full, which indicated it had not been applied as per the GP’s instructions and subsequently had proved ineffective in its treatment. The registered manager and team leader addressed the concerns we raised after our assessment.