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

Maple House accommodates up to four people with a learning disability in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. At the time of this inspection there were three people using the service.

This inspection took place on 29 August 2018. At our last inspection of the service in March 2016 we rated the service ‘good’. At this inspection we found the evidence continued to support the rating of ‘good’. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were safe at Maple House. Staff were trained to safeguard people from the risk of abuse and knew how to report any safeguarding concerns about people to the appropriate person and agencies. Staff understood the risks posed to people and followed current guidance about how these should be minimised to keep people safe from injury or harm. The provider acted to make improvements when things went wrong. At this inspection we saw improvements had been made following an incident involving a person to help reduce the risk of a similar incident reoccurring.

Risks posed by the premises were appropriately managed. The provider maintained a servicing programme of the premises and the equipment to ensure areas covered by these checks did not pose unnecessary risks to people. The premises were clean, and staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing and storing food. Medicines were stored safely and securely, and people received them as prescribed.

There were enough staff at the time of this inspection to meet people’s needs and keep them safe. The provider maintained a robust recruitment and selection process and carried out appropriate checks to verify staff's suitability to support people. Staff received regular training to keep their knowledge and skills up to date with best practice. Staff had work objectives that were focussed on people experiencing good quality care and support which were monitored and reviewed by the registered manager. Staff knew people well and understood people’s needs, preferences and choices. They were aware of people’s preferred communication methods and how people expressed their needs.

People and their representatives continued to be involved in planning their care so that they would receive personalised support. Staff followed current best practice, legislation and standards to support people to experience good outcomes in relation to their healthcare needs. People and their representatives were involved in reviews of their care which helped to ensure that the support provided continued to meet their needs.

People were supported to keep healthy and well, to maintain a healthy and well-balanced diet and helped to access healthcare services when needed. Good relationships had been developed with local health professionals. Staff shared information about the healthcare needs of people to aid professionals understanding of people’s needs, wishes and preferences. This helped to reduce some of the risks that people could experience accessing these healthcare services due to their disability.

The design and layout of the premises provided people with flexibility and choice in how they spent their time when at home. People participated in a wide range of activities an

This inspection took place on 8 March 2016 and was unannounced. At the last inspection in April 2014 we found the service was meeting the regulations we looked at.

Maple House is a small home which provides care and accommodation for up to four adults. The service specialises in supporting people with learning disabilities. At the time of our inspection there were three people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People and relatives we spoke to said people were safe at Maple House. Staff knew how to protect people if they suspected they were at risk of abuse or harm. They had received training in safeguarding adults at risk and knew how and when to report their concerns if they suspected someone was at risk of abuse. There were procedures in place for staff to follow to ensure concerns were reported to the appropriate person. They had also received training to ensure people were protected from discriminatory behaviour and practices that could cause them harm.

Where risks to people had been identified because of their specific needs, there was guidance for staff on how to minimise these in order to keep people safe from injury or harm in the home and community. Regular maintenance and service checks were carried out at the home to ensure the environment and equipment was safe. Staff kept the home free of trip hazards so that people could move safely around.

There were enough suitable staff to care for and support people. The provider had carried out appropriate checks to ensure they were suitable and fit to work at the home. Staff received relevant training to help them in their roles. Staff felt well supported by the registered manager and were provided with opportunities to share their views about people’s experiences could be improved. Staff had a good understanding and awareness of people’s needs and how these should be met. The way they supported people during the inspection was kind, caring, and respectful.

People were supported to keep healthy and well. Staff ensured people were able to promptly access other healthcare services when this was needed. People were encouraged to drink and eat sufficient amounts to meet their needs. Their food and fluid intake was regularly monitored to ensure they were eating and drinking enough. Where people had specific dietary needs staff accessed good practice research and guidance to ensure people received the support needed to maintain a healthy diet and lifestyle. People received their medicines as prescribed. These were stored safely.

Support plans had been developed for each person which reflected their specific needs and preferences for how they were cared for and supported. Support plans provided staff with guidance and information they needed to ensure people’s needs were met. People were appropriately supported by staff to make decisions about their care and support needs. These were discussed and reviewed with them regularly. People and their relatives were satisfied with the support people received. People were confident raising any concerns or issues they had with staff. There were arrangements in place to deal with people's complaints, appropriately.

People were encouraged to maintain relationships that were important to them. People were also supported to undertake activities and outings of their choosing. People were encouraged to be as independent as they could be in the home and community. Staff only stepped in when people could not manage tasks safely and without their support. The home was open and welcoming to visitors.

People and relatives spoke positively about the management of the home.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Only one of the people using the service was able to share with us their views and experiences. They told us they felt safe living at Maple House. A representative of another person using the service said they regularly observed the way staff interacted with people which gave them assurance their relative was safe in the home.

Senior staff regularly assessed potential risks to people’s safety, health and welfare both within the home and in the community. There was appropriate guidance for staff on how to manage these risks and keep people safe from harm when providing care and support.

People were cared for in an environment that was kept clean and hygienic. Staff had been trained in infection control and knew why it was important to maintain good standards of cleanliness and personal hygiene to reduce the risk of cross infection. The home was free from clutter and obstacles which meant people were able to move freely around the home.

There were enough staff on duty to meet the needs of the people living at the home. Staff on each shift were trained to deal with emergencies. A member of the management team was also available on call in case of emergencies.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted relevant staff understood when an application should be made, and how to submit one.

Is the service effective?

People we spoke with were satisfied with the care and support received from staff. A representative of one of the people using the service told us they felt staff had a good understanding of their relative's needs which they regularly tested by speaking with staff who cared for them.

People using the service and their relatives were involved in planning and developing their care and support. Their views and experiences were used to develop their plan of care. Their specific needs were taken into account and staff demonstrated a good understanding and awareness of these.

Staff encouraged and supported people to keep healthy and well through regular monitoring of people’s general health and ensuring people attended scheduled medical and healthcare appointments. People were encouraged to eat a well-balanced, healthy and nutritious diet.

Is the service caring?

People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. These interactions were warm, kind and friendly.

One of the people using the service said they liked their keyworker as they were “very nice.” A representative of one of the people using the service told us they felt staff were caring as their relative was very comfortable with them.

Is the service responsive?

People using the service met with their keyworker on a regular basis to discuss the care and support they received. People’s preferences and choices for how they were cared for and supported were documented in their care plans and staff were given appropriate guidance on how to meet these needs.

A representative of one of the people using the service told us they felt comfortable raising any issues and concerns they might have and were confident these would be dealt with by senior staff quickly.

Is the service well-led?

The provider carried out regular checks to assess and monitor the quality of service provided. The views of people using the service and the staff that cared for them were taken on board by managers. The provider had listened to feedback and made changes that improved the overall quality of service provided to people.

Senior staff investigated events such as accidents and incidents and used the learning from these to reduce risks to people using the service.

At our last inspection in May 2013 we identified areas where the provider was not meeting the essential standards of quality and safety. The registered manager sent us an action plan to tell us how the service was going to become compliant with the regulations. We carried out this inspection to review improvements.

We met with all three people living at Maple House. One person told us they were happy with the support they received and liked the staff. The two other people were unable to share direct views about the service but appeared comfortable and relaxed in their home. We spoke with the deputy manager and one member of staff on duty.

At this inspection we found there had been improvements. The arrangements for staff training and supervision had improved. Staff told us they had attended more training which supported them in their role.

We found that systems for managing medicines had been strengthened and the required records for people using the service were being accurately maintained. People using the service had accurate, personalised care plans, which had been updated to reflect their agreed care and support arrangements. This meant staff had the information they needed to meet people’s individual needs.

We met with all three people living at Maple House during the course of our visit. We also spoke with three members of staff and the registered manager.

One person we spoke with said that they were happy with the care and support they received. They told us that they took part in various leisure and social and activities of their choice although they could not recall being involved in a recent review meeting to discuss their needs. Other people were unable to share direct views about their experiences but appeared relaxed and contented when interacting with staff.

People were supported by a stable staff team who told us that they liked working at the home and that they could discuss any problems with the manager.

We found however that records of people's care and support needs were not being regularly maintained, reviewed and monitored. The overall systems for record keeping and the management of medicines needed improvement. There were also insufficient arrangements in place to ensure that staff were appropriately trained and supervised to carry out their role.

There were three people living at Maple House and we met with all of them during the course of our visit.

Due to their needs, some people that we met during our visit were unable to share direct views about the standards of care. In order to make judgements about the care that individuals received, we observed care practices; interactions with staff and tracked three people's records of care. Case tracking means we looked in detail at the care people receive. We also spoke with one relative on the telephone.

During our visit people were offered choices, spoken to respectfully, made to feel involved and showed signs of well being when interacting with both the staff and other people using the service. Staff were alert to changes in people’s mood, behaviour and general wellbeing and knew how they should respond to individual needs.

A relative told us, “I am very happy, I know X is well taken care of, no complaints at all.”

We saw that people were provided with a range of personalised and meaningful activities and supported by staff on a one to one basis when needed.

Plans of care were person centred, well created and closely reflected the specific needs of the person. This meant that staff had clear information on how to support their needs and lifestyles.

The home was clean, safely maintained and furnished to comfortable standards. People had the right specialist equipment to promote their independence and meet both their physical and sensory needs.

People benefit from a stable staff team who have worked at Maple House for a number of years.

Staff told us that they were happy working at the home and felt well supported by the registered manager. They felt there was good teamwork and a ‘family’ atmosphere.