Maple Manor

Maple Manor is a residential care home providing the regulated activity of accommodation and personal care to up to 5 people. The service provides support to people who have a learning disability and autistic people. At the time of our inspection there were 5 people using the service.

People’s experience of the 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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

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 polices and systems in the service supported this practice. Staff did everything they could to avoid restraining people. People were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines to achieve the best possible health outcome.

Right Care

Some systems were not as robust as they could be to manage and mitigate risks relating to the service's fire arrangements. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. Staff had training on how to recognise and report abuse and they knew how to apply this to their day-to-day work. The service had enough staff to meet people’s needs and to keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and the risks posed.

Right Culture

Governance arrangements were effective at service level but not at provider level. The provider's arrangements and lack of oversight did not effectively monitor the quality of care provided to drive improvements. The registered manager had the skills, knowledge, and experience to perform their role and a clear understanding of people’s needs but this oversight was lacking at provider level. The provider did not invest in staff by providing them with appropriate training to meet the needs of all people using the service.

Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity. The registered manager and team leader were visible in the service, approachable and took a genuine interest in what people, staff, family, and other professionals had to say. Staff felt respected, supported, and valued by the registered manager and team leader.

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 September 2018].

Why we inspected

The inspection was prompted in part due to concerns received about the use of unauthorised restraint used at one of the provider’s other services. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement [and Recommendations]

We have identified breaches in relation to the management of risks, including those related to the service’s fire arrangements, and the provider’s governance arrangements. We have made a recommendation about staff training.

Please see the action we have told the provider to take at the end of this report.

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 also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the Local Authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were protected from abuse. Staff understood how to recognise and report any concerns they had about people's safety and well-being. There was enough staff to keep people safe and provide them with one to one support. Risks to people health and wellbeing were assessed and mitigated. People's medicines were managed safely.

Staff had access to relevant face to face training and regular supervision to equip them with the knowledge and skills they needed to fulfil their roles and meet people’s needs.

Nutritional needs were met, and people were supported to access healthcare services if they needed them. People's health care needs were closely monitored and any changes to their health and wellbeing was responded to in a timely manner. Specialist advice and support was sought in planning to meet the needs of people who presented in a distressed manner which presented a risk to themselves and others.

Staff knew people well, passionate about providing personalised care and treated people with dignity and respect. 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.

Staff demonstrated a good understanding of the people living at the service and created opportunities for maximising their independence and life skills. Staff worked in partnership with other social care and health care professionals to ensure people received the support they needed.

The service consistently applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

We recommended further work be carried out to ascertain people’s needs and wishes in the event of sudden death or should there be a need for palliative care support.

The registered manager had a range of systems in place to monitor the quality and safety of the service and these were reviewed on a regular basis.

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 26 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service had a registered manager. 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. The manager is registered for this service and one other service other local, nearby care service.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risks to people’s health, welfare and safety had been assessed and guidance provided for staff with recorded action they should take to mitigate these risks.

People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff were provided with training in Safeguarding Adults from abuse. However, policies which guided staff in how to report poor practice had not been reviewed since 2009 and safeguarding people from abuse policy since 2011. These policies contained out of date information and did not provide up to date, relevant guidance in line with local safeguarding protocols and current regulatory requirements.

Staff were provided with training in understanding their roles and responsibilities with regards to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People’s capacity to make decisions about their everyday lives had been assessed and their consent was considered in the planning and provision of their care and support.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including GPs and dentists.

Staff were attentive to people's needs. Staff were able to demonstrate that they knew people well and treated people with dignity and respect.

People were provided with the opportunity to participate in personalised, meaningful activities according to their assessed needs, wishes and preferences. People were encouraged to develop as much independence as possible and learn new life skills.

The provider had a system in place to respond to suggestions, concerns and complaints. However, it was not always evident how complaints had been investigated and with the outcome recorded. The service had a number of ways of gathering people’s views including; one to one monthly meetings and satisfaction surveys. The provider and registered manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to plan for improvement of the service.

We saw that care plans and risk assessments were regularly reviewed with people who used the service or relatives if they were unable to fully participate.

We saw that staff were knowledgeable about people's needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people's care needs and preferences.

There were policies and procedures, records and monitoring systems in place to ensure that staff had received training to enable them to carry out their roles. Staff told us they felt supported by senior staff. One person told us 'I couldn't ask for a better manager, very supportive.'

We saw that there was a complaints policy and procedure in place. The staff were able to explain the complaints procedure. The service had not received any complaints since the last inspection. We saw recordings of telephone conversations with relatives that reflected their satisfaction with the service.

Maple Manor was very homely and the people who used the service had full access to all areas and were supported to pursue their various interests in the home and externally at day centres, clubs and colleges.

We saw that people's care records contained detailed information to show how they were to be cared for. The people using the service, or a person on their behalf had been involved in the planning of the care and support needed and decision processes were clearly recorded.

Staff had been provided with a range of training opportunities to keep their knowledge updated and ensure they were prepared to carry out their role and responsibilities in keeping people safe and well cared for.