About the service

Maple Court is a care home providing personal and nursing care up to 64 people aged 65 and over, some of whom may be living with dementia. When we visited 38 people were using the service.

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

Since the last inspection the provider and new registered manager had worked closely with professionals to implement new systems and recruit new staff. Significant improvements were seen at this inspection and the systems to check for quality and safety had sustained good levels of care for several months prior to this inspection. This demonstrated they were effective.

The staff team had been inducted, supported and trained which had brought stability to the service. Staff understood their roles clearly and they knew what was expected of them. People were treated with respect and dignity, they were also supported to maintain their independence.

People’s needs and preferences were known by the staff and this had led to people receiving person centred, responsive care. Staff had worked to improve or maintain people’s quality of life. Feedback from people and their relatives was positive and they also were able to tell us about the improvements they had felt in the quality of care they received. Staff had developed positive relationships with people which led to people feeling safe and happy.

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.

The environment had been designed to keep people safe and help people living with dementia to find their way independently. People enjoyed access to a secure garden and were supported to access the community to take part in local activities. People told us they were offered a wide variety of activities to take part in if they chose this.

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

Rating at last inspection and update

At the last inspection we gave the service a rating of inadequate (published 15 October 2018) and there were multiple breaches of regulations. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 15 October 2018. 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 no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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 we receive any concerning information we may inspect sooner.

This inspection took place on 8 and 13 August 2018 and was unannounced. The service registered with the Care Quality Commission (CQC) in November 2017 as a new service. This is its first rated inspection.

Maple Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Maple Court provides nursing and personal care for up to 64 people. The service supports older people who may be living with dementia. At the time of our inspection there were 39 people who used the service.

There was a manager in post who registered with CQC in November 2017. 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.

Insufficient staffing levels were impacting on all aspects of the service and the system used to determine the numbers of staff required and deploy them around the service was not robust. The regional manager for the service took action on the second day of our inspection to make some improvements to this aspect of the service.

Staff did not receive appropriate training to enable them to effectively and efficiently carry out their job roles and duties. Meetings with staff to discuss work performance (supervisions) were in the form of individual and group settings. However, these did not always cover individual performance or offer staff an opportunity to discuss any work issues they may have. There was a lack of effective communication between the care staff, nurses and the management team. This meant people’s health and well-being was at risk of harm.

The management of medicines was not robust and meant medicines were not administered to people as prescribed by their GP. This put people at risk of harm.

The quality assurance system within the service was not being operated effectively. Audits completed by the provider and the registered manager showed several recognised concerns with regard to documentation and people’s health and well-being. However, insufficient action had been taken to mitigate these known risks.

The quality of the record keeping varied and some care records we looked at were not personalised and were inconsistent or incomplete. This meant staff did not have an up to date record of people’s care and treatment. Agency staff were used frequently in the service, but they and the permanent staff found it time consuming to access and read the electronic care records. Due to work pressures and the lack of organisation in the care service, care staff told us they did not always have the time to read the care records meaning they lacked knowledge of people’s care and support needs.

The assessment, monitoring and mitigation of risk towards people who used the service regarding hydration, nutrition, weight loss and pressure care was not robust. People had lost weight and their records of nutritional intake and care were not being completed or updated in respect of their changing needs.

People's privacy and dignity was not consistently respected. People were left waiting until late in the morning to get out of bed. Two people's anxious and distressed behaviours were not being met which meant they were left lying on the floor until staff had time to attend to them.

We found breaches of Regulations 10, 12, 14, 17 and 18 during this inspection in relation to dignity and respect, safe care and treatment, meeting nutritional and hydration needs, good governance and staffing. You can see what action we told the provider to take at the back of this report.

People were supported to have maximum choice and control of their lives