We carried out a comprehensive inspection of Mapleford Nursing Home on 10 and 11 July 2017. The first day of the inspection was unannounced.

Mapleford Nursing Home provides personal and nursing care for up to 54 people, including people with mental ill health and people living with dementia. The building is purpose built and accommodation is provided in single rooms. Some have ensuite facilities. The home is situated two miles from the town of Accrington in East Lancashire. At the time of our inspection there were 36 people living at the home.

At the time of our inspection the service had a registered manager who had been registered with the Care Quality Commission (CQC) since March 2017. A registered manager is a person who has registered with the CQC 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.

During a previous inspection on 19 November 2015 and 6 January 2016, we found breaches of the regulations relating to a lack of accurate records, failure to protect people from the risk of unsafe care and a failure to consider the risks to people’s safety as part of the pre-admission assessment process. During this inspection we found that improvements had been made and the provider was meeting all regulations.

We found that there were appropriate policies and procedures in place for the safe management of medicines. We observed staff administering people’s medicines safely.

People who lived at the home told us they received safe care and they were happy with staffing levels at the home.

People told us they liked the staff who supported them and told us staff were caring. People felt that staff had the knowledge and skills to meet their needs.

We saw evidence that staff had been recruited safely. The staff we spoke with understood how to safeguard vulnerable adults from abuse and were clear about the action to take if they suspected that abusive practice was taking place.

We found that care plans and risk assessments were individualised and contained information about people’s needs, risks and preferences. They were updated regularly.

We found that staff received an appropriate induction, effective training and regular supervision. Staff told us that the registered manager and the general manager were approachable and they felt well supported.

The service had taken appropriate action where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe. We found evidence that where people lacked the capacity to make decisions about their care, their relatives had been consulted. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice.

People who lived at the home were happy with the quality and variety of the meals provided. We observed staff supporting people appropriately with their meals.

People received support with their healthcare needs and we received positive feedback from community health care professionals about standards of care at the home.

We observed staff communicating with people in a kind, friendly and respectful way. People told us that staff respected their privacy and dignity and encouraged them to be independent.

People were supported to take part in a variety of activities inside and outside the home. People who lived at the home and their relatives were happy with the activities available.

We saw evidence that the registered manager sought feedback from people who lived at the home and their relatives about the care and support provided and acted on the feedback received.

People who lived at the home and their relatives told us they thought the home was well managed. They felt that the reg

We carried out an inspection of Mapleford Nursing Home on 21 April 2015. The inspection was unannounced.

We last inspected this home on 21 November 2013 and found the service was meeting the regulations in force at that time.

Mapleford Nursing Home is registered to provide accommodation and support for 54 people who require nursing or personal care for needs associated with mental health and dementia. On the day of our inspection there were 43 people living in the home. The home is divided on two floors with bedrooms and bathrooms on each floor. The majority of rooms are for single occupancy but some rooms can be shared by two people.

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 told us they felt safe living in the service. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report potential abuse.

Risk assessments within people’s care records were completed accurately and reviewed regularly. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks.

Newly appointed staff were not allowed to commence employment until robust checks had taken place to establish that they were safe to work with people.

There were adequate numbers of staff on duty to support people safely and ensure that people’s needs were met appropriately.

Systems and processes in place ensured that the administration, storage, disposal and handling of medicines were safe.

There was a positive culture within the service that was demonstrated by the attitudes of staff that were supported through a system of induction and training based on people’s needs.

Staff understood the processes in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People had a good choice of meals and were able to get snacks and fluids throughout the day.

People had access to health care professionals to make sure they received appropriate care and treatment to meet their individual needs. Staff followed advice given by professionals to make sure people received the treatment they needed.

We saw that people were relaxed, comfortable and happy with the staff that supported them. Staff talked with people in a friendly manner and assisted people as required, whilst encouraging them to be as independent as possible.

There were regular reviews of care for each person who used the service which enabled individual care to be monitored.

Communication in the home was good and staff felt able to make suggestions. There were regular meetings for staff which gave them an opportunity to share ideas and give information about possible improvements to the registered manager.

People and their relatives knew who to speak to if they wanted to raise a concern. There were systems in place for responding to complaints.

Staff strived to provide good quality care for people and took the chance to learn lessons so improvements could be made in the future.

People using the service told us they liked living at the home where they felt safe. We found that members of staff had a good understanding of safeguarding procedures and told us they would report any concerns immediately.

We found that the required improvements to the system for monitoring the quality of the service provided had been made. This meant that staffing levels were determined by the care needs of people using the service. There was evidence to demonstrate that care plans were audited in order to ensure they contained detailed information about the care needs of each person.

People who were able to express their views told us that they liked living at Mapleford and were satisfied with the care provided. Members of staff explained what they were doing before they carried out care tasks so that people could give their consent. One person said, “The staff are always polite and helpful.”

Procedures and training for all members of staff were in place for the prevention and control of infection.

All the people we asked praised the staff team for the care they provided. One person said, “They’re good and helpful.” However, one visitor told us there wasn’t enough staff and they didn’t have time to organise activities on the dementia unit.

We noted that procedures were in place to monitor most aspects of the quality of the service provided. However, a system to effectively assess and monitor staffing levels in the home was not available.

People using the service told us they liked living at Mapleford and were satisfied with the care provided. One person said, “The staff are very helpful and the food is excellent.”

We saw that people were treated with respect and leisure activities were organised everyday.

We found that suitable arrangements were in place for the safe keeping and handling of medicines.

Members of told us they received the training they needed in order to provide safe and appropriate care for people using the service.

We noted that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.

Mapleford (Nursing Home) Limited provides accommodation, nursing and personal care for up 54 people living with a dementia or with mental health care needs. At the time of the inspection there were 42 people using the service.

Mapleford is a purpose built care home situated in a residential area of Huncoat approximately two miles from the town of Accrington. There is a car park for visitors and staff.

The service was managed by 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.

During this inspection visit we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to failing to maintain accurate records in respect of care and treatment and failing to protect people from the risk of unsafe care and failing to consider the risks to people’s safety on admission. The Care Quality Commission is continuing to investigate issues related to some of these breaches of the Regulations. As such the Commission is not yet in a position to determine the actions that may be taken at the conclusion of those investigations.

We found individual risks had been identified in people’s care plans and kept under review. However, we were concerned that safety measures had not been put in place to protect people from harm and to reduce the risks to themselves and others.

There was information to guide staff with responding appropriately to behaviours that challenged the service and staff had received training in this area.

The community mental health team and the rapid intervention and treatment team (RITT) had been involved in people’s care and support and had been contacted when staff needed advice.

There were sufficient skilled and experienced staff available to meet people's needs. The deployment and availability of staff had been reviewed following a recent incident.

Staff received a range of appropriate training to support them with meeting the needs of people in their care.

We found records were not reflective of care and treatment provided in relation to meeting a person’s health needs and the provision of pain relief.

The service was working within the principles of the Mental Capacity Act (MCA) 2005. Appropriate applications had been made where any restrictions were in place, which would help to ensure people’s best interests and safety were considered.

Each person had a care plan which reflected the care and support that was being given, the care people needed and how care would be delivered by staff. The information had been kept under review.

Information was gathered from a variety of sources and covered all aspects of the person’s needs before they moved into the home. However, we found that people’s behaviour and how this would impact on the safety of other people living in the home had not been fully considered. We were told the admission process had been revised following a serious incident.