This inspection took place on 9 November 2016 and was unannounced. At the last inspection of the service on 10 November 2015 we found breaches of the Health and Social Care Act 2008 in that medicines were not always managed safely and medicine audits were not conducted in line with the provider policy to ensure safe practice. Quality assurance systems in place were not always effective, operational or conducted in line with the provider’s policy to ensure issues were promptly identified and acted upon. We carried out this inspection to check the outstanding breaches had been met and also to provide a review of the rating for the service.

Maple House is a small care home that provides care and support for up to five people with a learning disability. At the time of our inspection the home was providing support to five people. There was an acting manager in post at the time of our inspection and they were in the process of registering with the CQC to be the registered manager for the service. 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 the provider had made the required improvements and was now compliant with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to the health and safety of people using the service were assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People’s support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint. There were robust systems and processes in place to monitor and evaluate the service provided. People’s views about the service were sought and considered through service user meetings and satisfaction surveys.

This inspection took place on 10 November 2015 and was unannounced. At our previous inspection in March 2014, we found the provider was meeting the regulations in relation to the outcomes we inspected.

Maple House is a small care home that provides care and support for up to five people with a learning disability. At the time of our inspection the home was providing support to five people and had a temporary manager in post.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not managed safely and appropriately and medicine audits were not conducted in line with the provider policy to ensure safe practice.

There were some quality assurance and governance systems in place to monitor the quality of the service provided, however these were not always operational, used or conducted in line with the provider’s policy to ensure issues were promptly identified and acted upon.

There were safeguarding adult’s policies and procedures in place to protect people from possible harm and incidents and accidents were recorded and acted on appropriately.

Assessments were conducted to assess levels of risk to people’s physical and mental health and care plans contained guidance to provide staff with information that would protect people from harm by minimising assessed risks.

There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work. There were appropriate levels of staff on duty and deployed throughout the home to meet people’s needs.

There were arrangements in place to deal with foreseeable emergencies and there were systems in place to monitor the safety of the premises and equipment used within the home.

People were supported by staff that had appropriate skills and knowledge to meet their needs and staff received regular supervision, training and an annual appraisal of their performance.

Staff demonstrated good knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) including people’s right to make informed decisions independently but where necessary to act in someone’s best interests.

People were supported to eat and drink suitable healthy foods and sufficient amounts to meet their needs and ensure well-being. People had access to health and social care professionals when required.

Interactions between staff and people using the service were positive and staff had developed good relationships with people. People were supported to maintain relationships with relatives and friends. Care plans documented people’s involvement in the care and where appropriate that relatives were involved in their family members care.

Staff were knowledgeable about people's needs with regards to their disability, race, religion, sexual orientation and gender and supported people appropriately to meet their identified needs and wishes.

People were supported to engage in a range of activities that met their needs and reflected their interests.

People and their relatives told us they knew who to speak with if they had any concerns. There was a complaints policy and procedure in place and complaints were managed appropriately.

The temporary manager was knowledgeable about the requirements of being a registered manager and their responsibilities with regard to the Health and Social Care Act 2014.

The provider took account of the views of people using the service and their relatives through annual residents and relative’s surveys.

At our inspection on 10 March 2014, we followed up a compliance action that we had taken following our inspection on 01 November 2013. One person told us they were supported by staff to manage their medicines and were happy with the care they received. Staff we spoke with told us the refresher training and recently introduced electronic medicines management system were effective in informing their practice, and minimising errors in handling people’s medicines. We found the provider had made suitable improvements to ensure the safe use and management of people's medicines. This included appropriate arrangements in relation to the obtaining, administration and recording of medicines.

We spoke to four people who used the service, each of whom told us they were happy living at the home. One person told us "couldn’t be any better, nine out of ten”. Another person told us "no complaints, staff are nice”. People told us they were supported to undertake meaningful and stimulating activities and were looking forward to a planned group holiday. We saw that people’s rooms were personalised and each person using the service had a key-worker they could talk to regarding their care needs. We found suitable arrangements were in place for obtaining and acting in accordance with people’s consent in relation to the care and support provided to them. People's health and social care needs were assessed and regularly reviewed to ensure their welfare and safety. The provider had effective recruitment procedures in place to ensure that people’s needs were met by competent and experienced staff. People told us they knew how to make a complaint and we found this was in line with the provider policy in place which had been shared with them. However, we found that medication records were not always accurate and the provider did not have suitable arrangements in place to manage medicines.

Our inspection at Maple House on 13 November 2012 followed up issues raised at our inspection on 27 March 2012 such as the quality of people's risk assessments, arrangements for managing people's money, staff support, quality assurance and the quality of records.

We spoke to one person who used the service but another two declined to be interviewed. One person told us "it's a nice place" and "everything's ok". They told us the staff were friendly and they felt safe. The provider carried out a survey in 2011/12 which involved each person who used the service. The results relating to Maple House were overall positive, but where negative comments had been made, such as with the food choice, the service had discussed the issues during a house meeting. This had resulted in some changes such as with the menu.

People's care needs were assessed and each had relevant risk assessments in place, for example when going into the community. Staff were aware of people's support needs and they evidenced when they had delivered the required care for people through daily logs. External professionals were involved in people's care such as a local epilepsy team.

Staff knew about safeguarding adults and the provider had responded appropriately when concerns had been raised. People's money was managed safely. Staff received training although some refresher courses were due to be updated. The provided made changes as a result of quality assurance and its records were appropriate.

During our visit on 27 March 2012 we spoke to people who use the service who told us they were happy living at Maple House and they felt well cared for by the staff.

People also told us staff involved them when their care plans were reviewed. A key worker system was in place, and people told us they got on well with their key workers and could speak to their key workers if they had any problems.