About the service: Maple Court is a residential care home that was providing personal and nursing care to 53 people at the time of the inspection, some of whom were living with dementia.

People’s experience of using this service:

Decisions about people’s care and treatment had not always been made in line with law and guidance. Care records did not always reflect people’s individual needs and some gave inconsistent information.

People felt safe and staff knew how to identify and report concerns for people’s safety. People were supported by a caring and compassionate staff team. People were supported to maintain their independence and their dignity was valued and respected.

People’s wishes about how they wanted to be supported at the end of their lives had not always been recorded, which meant their values and beliefs may not be respected. Activities were available for people to take part in; however, people felt more could be done to help them participate in hobbies and interests. People and their relatives knew how to raise a concern about the service and were confident these would be addressed.

People, relatives and staff found the registered manager approachable. Although the quality audits completed had not always identified the shortfalls found at the inspection; the registered manager had an improvement plan designed to identify and improve the quality of service people received.

Rating at last inspection: 09 April 2018, Requires Improvement, with a breach of Regulation 12, Safe Care and Treatment. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. At this inspection we found a number of improvements had been made, however some were still required.

Why we inspected: This was a planned inspection based on the rating from our last inspection.

Enforcement: No enforcement action was required.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

This inspection took place on 9 April 2018 and was unannounced. At the last inspection completed in October 2017 we rated the service as inadequate, as we identified a number of breaches of legal requirements. The provider was not meeting the regulations for safe care and treatment, staffing, safeguarding people from abuse, person-centred care, treating people with dignity and respect and good governance.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we asked the provider to send us an action plan to show what they would do and by when to make improvements to meet the regulations.

At this inspection we found improvements had been made however there was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for safe care and treatment. The provider was meeting all other regulations.

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

Maple Court Nursing Home accommodates up to 80 people in one adapted building. Care and support is provided over two floors and these floors are operated as two separate units. At the time of the inspection there were 50 people using the service.

There was a registered manager in post at the time of the inspection. 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’s medicines were not consistently managed safely. We found two prescribed medicines that were out of stock, so people had not received these medicines. The provider had a system in place to check medicines daily and this had not identified the low stock.

People’s risks were not always suitably managed in order to keep them safe, though we saw improvements in the management of some people’s risks. Further work was required to ensure that these were consistent for all people who used the service.

Improvements had been made to staffing within the home but further improvements were required to ensure that people had access to the support they required in a timely manner.

People were protected from avoidable harm and abuse by staff who were trained to recognise signs of abuse and knew how to report their concerns. Most risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were kept clean and tidy. Staff had their suitability to work in a care setting checked before they began working with people.

Improvements had been made to the mealtime experience though one person received fluids with the incorrect amount of thickener that had been prescribed by a professional.

People told us they were happy with the care they received. However, we observed that staff did not always protect people’s privacy and dignity.

People told us they had choices however we observed that people were not consistently offered choices.

People had been involved in developing their own plans of care. However, not all people’s care plans had been reviewed and updated which meant that some people’s plans did not accurately reflect their needs and preferences.

The systems in place to check the safety a

This inspection took place on 19, 20, and 23 October 2017 and was unannounced.

Maple Court Nursing Home is a care home providing accommodation, personal and nursing care for up to 80 people. The home was divided into two separate units. Elizabeth suite on the ground floor provides general nursing care and Saunders suite on the first floor provides nursing care for people who may be living with dementia or with more complex support needs. At the time of this inspection 72 people were using the service.

There was no registered manager in post. 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 provider told us that a new manager had been recruited and they were undertaking an induction with the provider before commencing in post at Maple Court Nursing Home. An acting site manager was responsible for managing the home until the new manager was in post.

At our previous inspection on 27 July 2016 the home was rated ‘Good’. At this inspection we found that there were breaches of Regulations and the home was rated ‘Inadequate’. The service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Risks to people's safety, health and wellbeing were not always suitably assessed and managed and plans in place to manage risks were not always followed by staff.

There was not always enough suitably skilled staff deployed effectively to keep people safe or to meet their needs. Staff were not always trained to provide safe and effective care.

People were not always protected from the risks of avoidable harm and abuse because incidents of possible abuse were not always identified and reported to the local authority as required. Action was not always taken to protect people from further occurrences.

We found that medicines were not managed safely and people were at risk of not receiving their medicines as directed by the prescriber.

Systems in place to consistently assess and monitor risks to people and the quality of care provided were not operated effectively. This meant that issues with the safety and quality of the care were not reliably identified and rectified.

People did not consistently have choices about food and drinks and improvements were ne

This inspection took place on 27 July 2016 and was unannounced. At our previous inspection on 9 and 10 February 2016 we found that people were not always protected from the risk of abuse. Incidents had not been identified as potential abuse; they had not been reported or investigated. There were insufficient staff to keep people safe and people did not receive care in a person centred or safe way. The service was not well led. We issued the provider with two warning notices and three requirement actions and told them they needed to make improvements. We had rated the service as 'Inadequate' and placed it into special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection we found improvements had been made to protecting and safeguarding people from abuse, people were provided with a more person centred care approach and suitably trained staff had been recruited. Sufficient improvements had been made in all areas of this service therefore this service is no longer in special measures. However the provider must now ensure the improvements are maintained. We will continue to review the service.

Maple Court Nursing Home provides support and care for up to 80 people, some of whom may be living with dementia. At the time of this inspection 63 people used the service. The service was divided into three separate units. Elizabeth suite (ground floor) provides general nursing care and support for up to 35 people. Saunders and Sycamore suites (first floor) provide support for up to 45 people with more complex nursing care and support needs.

The service had a registered manager. Since the inspection in February 2016 the service had a new registered manager. The registered manager was absent on the day of the inspection, 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.

Staff were aware of the action they should take where they had concerns regarding the safety of people. Appropriate action was taken when allegations of abuse and concerns with people’s safety were identified. Sufficient staff were available to keep people safe and meet people's care needs in a timely manner.

Risks to people's health and wellbeing were identified, assessed and reviewed to ensure the a

This inspection took place on 9 and 10 February 2016 and was unannounced. At our last inspection in January 2015 we judged that the service was good as the service had improved from the previous inspection in June 2014.

Maple Court Nursing Home provides support and nursing care for up to 80 people, some of whom may be living with dementia. At the time of this inspection 73 people used the service. The service is divided into three separate units. Elizabeth suite (ground floor) provides general nursing care and support for up to 35 people. Saunders and Sycamore suites (first floor) provide support for up to 45 people with more complex care and support needs.

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.

People were not always protected from the risk of abuse as people had been abused by other people who used the service. These incidents had not been identified as potential abuse; they were not reported or investigated.

Risks to people’s health and wellbeing were identified and reviewed, but lacked detail of the action needed to mitigate the risks. People’s management plans were not consistently followed.

There was insufficient suitable staff available to meet people’s individual needs. People experienced delays when staff were needed to provide them with the care and support they required.

The provider had a recruitment process in place. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed. However there have been continuous concerns regarding the recruitment and retention of staff and the impact this had on providing safe and effective care to people who used the service.

People’s medicines were not always managed safely, and some people did not receive their medicines in a timely way. Not all medicine monitoring documents were completed accurately and at the time of the administration.

Staff did not always receive the training they needed to be able to support people in a safe way. This meant some people’s specialist needs were not met safely or effectively.

People generally told us they enjoyed the food and were provided with suitable amounts of food and drink of their choice. Not all records for the purpose of monitoring people’s dietary needs had been fully completed to ensure people’s nutritional needs were fully met.

People had access to a range of health care professionals but the guidance from the professionals was not always consistently followed.

Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed.

Leisure and social activities were provided, but not all people got the support they needed to engage in meaningful activity when they needed to. People did not receive the right care at the right time.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate

The inspection took place 8 January 2015 and was unannounced.

At our previous inspection 17 June 2014 we asked the provider to make improvements. These were in relation to the care and welfare of people, assessing and monitoring the quality of service provision, safeguarding people from abuse, management of medicines, consent to care and treatment and staffing.

Maple Court Nursing Home provides nursing care and accommodation for up to 80 people. At the time of this inspection 55 people were living at the home.

The home has 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.

At this inspection we found improvements in all areas. There is room for further improvement in relation to ensuring the home followed and acted in accordance with the principles of the Mental Capacity Act 2008 (MCA). There was conflicting information in recording people’s capacity to make choices and decisions. The provider and manager have made arrangements for the improvements to be made.

There were sufficient numbers of staff to meet people’s needs. Recruitment for nursing staff was on-going. Staff received training that provided them with the knowledge and skills to meet people’s needs.

People’s medicines were stored, administered and managed safely.

People told us they felt safe and comfortable living at the home. Assessments were completed when people were identified as being at risk of harm.

People told us they enjoyed the food, had plenty to eat and drink and lots of choice. Where people needed help with eating, we saw staff provided the level of support that each individual required.

People were supported to see a health care professional when they became unwell or their needs changed. People told us the staff were kind and caring. We saw staff were thoughtful and considerate when interacting with people.

People had a plan of their care which informed staff of the person’s individual likes, dislikes and preferences. Not all plans had been kept up to date; staff told us that they were working towards a review of all care documentation.

There was a wide range of leisure and recreational activities available for people to enjoy. These were either group based or on a one to one basis.

The home had a complaint procedure; we received mixed views from people regarding their experiences of using this procedure. Complaints received were acknowledged and responded to within the timeframes of the procedure.

Meetings were arranged at regular intervals which gave people the opportunity to discuss their experiences and make suggestions for improvements.

Staff told us they felt well supported by the management team and there were clear lines of accountability. Arrangements were in place to check the safety and quality of the home with improvements made when necessary.

We visited Maple Court on a planned unannounced inspection which meant that the service did not know we were coming.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask –

Is the service safe?

Some people cannot make decisions because of frailty or ill health. Professionals and some relatives were involved in making decisions to ensure they were in the person’s best interests. Assessments were not always completed to determine the mental capacity of people who may find it difficult to make important decisions. We have asked the provider to tell us how they will make improvements.

The service placed people at risk because of unsafe handling of medication. People did not always receive their medicines as prescribed and intended. We have asked the provider to tell us how they are going to improve their service in relation to medication practices.

Is the service responsive?

We saw staff were allocated to work in the two units of the service. People who used the service and visitors told us the staff were very good at supporting them. However there were not enough staff and people reported delays when support was required. There was a reliance on agency staff to cover the shortfalls in the staffing levels. We have asked the provider to tell us how they will ensure staffing levels were sufficient to provide care and support to people in a timely way.

Is the service caring?

Most people who used the service told us that the staff were good and they were satisfied with the care and support provided. We saw that most staff were patient, understanding and kind in their interactions with people.

Visitors told us that they were satisfied with the care provided but they had to prompt staff with some aspects of their relative’s personal care needs. We have asked the provider to tell us how they will make the required improvements to ensure individual care needs were met.

Is the service effective?

Care plans were not person centred, lacked meaningful information and some were not reviewed or updated on a regular basis or when a change was identified. We have asked the provider to tell us how they are going to improve the recording and reviewing of people's care needs.

Is the service well led?

The service had systems in place to review the quality and safety of the service. Some issues had been identified and solutions had been planned. We have asked the provider to tell us how they are going to improve the quality of the monitoring of the service.

Improvements were needed to ensure that records were accurately completed, maintained and provided the necessary information to meet the needs of people who used the service.

This was a unannounced scheduled inspection.The service did not know that we would be visiting.

At the time of our inspection 74 people were living in the home. We spoke with staff, visitors and people who used the service that were able to tell us about their experiences.

One person who used the service told us: "I like it but it’s not like being at home, but I have nothing to grumble about". Another person told us: "So far so good, the staff seem fine they are all friendly and the food is good".

A visitor told us of their satisfaction with the care and support provided to their relative. Another visitor told us that in one of the units: "People just sit in there (the lounge) not doing anything".

Some people were unable to speak with us either because of frailty or personal preference. We spent time in the units to observe the activity and interactions between staff and people. We spoke with staff about the care and support they provided. They gave a detailed account of the specific individual needs of people. We saw that staff treated people compassionately; offering discreet assistance to those who required it.

We saw that staff were attentive and prompt when people required help and support. Staff told us that they had received training to help them understand how to meet the needs of people in their care.

We saw systems were in place for effective record keeping.

We saw staff supporting people in a respectful and dignified way. People who used the service were involved in making choices and decisions of what they wished to do and we saw people joining in with a variety of activities. We saw people who needed bed rest looking very comfortable and well cared for.

We spoke with staff about the care and support they provide each day, they offered an explanation of people's individual needs. We looked at a selection of care records to check the care being given to people. We saw some inconsistencies in the recording of people's care needs. The manager who acknowledged this stated that a new system of assessing and recording care needs was being introduced.

We spoke with staff about their understanding of safeguarding vulnerable adults, they told us what they would do if they had any suspicions of wrong doings. We saw records of safeguarding concerns that had been raised with the multi agency safeguarding team, this included the concern, the actions taken and the conclusions. Staff told us they had received training in safeguarding and that further training and updates were planned.

We saw staff present in all areas of the home, they were quick to offer help and support to people when it was needed. The manager confirmed that the staffing levels were currently sufficient to meet the needs of people who used the service.

We saw the service had an effective system for monitoring the quality of the service.