We inspected this service on 21 and 22 November 2016. This was an unannounced inspection.

The Maples is a residential care home registered to provide accommodation for persons who require nursing (without) or personal care. They support up to 15 people who have autism and accompanying learning disabilities. The service was supporting 14 people at the time of inspection.

There was not a 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 service was being managed by a manager who had applied for registration with the Care Quality Commission.

At an inspection in September 2015 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection the provider sent us details of how they would meet their legal requirements relating to the three breaches.

At this inspection we found improvements had been made. People felt safe and were supported by staff that had the skills and knowledge to meet their needs. The service was continuing to work on recruiting to vacant posts and in the meantime took measures to ensure temporary staff were of a good standard. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

Relatives felt people were safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicines as prescribed. There were systems in place to manage safe administration and storage of medicines.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. These were regularly reviewed and updated when needed. Staff were aware of people’s needs and followed guidance to keep them safe.

People were supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager). Staff received adequate training and support to carry out their roles effectively.

The manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA.

People were supported to maintain their health and were referred for specialist advice as required.

People and relatives were involved in decisions about people’s support needs. People had care plans which detailed the support they required and how the support would be provided. Care plans were regularly reviewed and updated. Staff knew the people they cared for and what was important to them. Staff supported and encouraged people to engage with a variety of social activities of their choice in the community.

The service looked for ways to continually improve the quality of the service. Feedback was sought from people and their relatives and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The manager informed us of all notifiable incidents. The manager had applied to become a registered manager and had a clear plan to develop and further improve the service. Staff spoke positively about the support and leadership they received from the management team.

We inspected this service on 5 October 2015. This was an unannounced inspection.

The Maples is a residential care home registered to provide accommodation for persons who require nursing (without) or personal care. They support up to 15 people who have autism and accompanying learning disabilities. The service was supporting 13 people at the time of inspection.

There was not a 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 service was being managed by a manager who had applied for registration with the Care Quality Commission.

There were shortfalls in relation to care records. Some people’s care records had not been kept up to date. Other information to ensure people remained safe, such as risk assessments, had also not been kept updated.

Arrangements for accessing medication was not always effective and in line with national pharmaceutical guidelines.

Relatives felt those at the service were safe and spoke well of the staff and felt staff did their best to support their relatives in a caring way. However, we saw some poor practice by staff when delivering care.

Staff had not felt supported as not all staff had received adequate supervision and appraisal.

Staff were knowledgeable about people’s individual needs and preferences. They took the time to understand people where they had communication difficulties. People were supported to make decisions about their care.

Most staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.

People’s privacy and dignity was not always maintained when staff accessed their rooms.

Improvements were required to ensure the service was well led. A manager was in the process of registering with the Care Quality Commission. Robust quality assurance systems were not in place. Some of the improvements needed to improve the service had been identified by the management team and there was a plan in place to address them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we took and what action we told the provider to take.

The Maples is a residential care home for up to 15 people who have autism and accompanying learning disabilities. The service had three bungalows that could each accommodate up to five people. There was a registered manager at 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.

The service was effective in a number of areas, however, other areas required improvement. In one of the bungalows we found that staff were sometimes seen to be observing people rather than supporting them. We also found the physical environment in communal areas and were not always designed in a way that met people needs. We noted a number of concerns that relatives had shared with staff had not always been passed onto management to respond to.

Each person had risk assessments in place. These detailed clear risk management strategies that supported people to engage in activities and in social interaction. Each bungalow had suitable staffing numbers to meet the needs of people using the service. People’s records provided evidence that their needs were assessed prior to admission to the home. A range of professionals were involved in assessing, planning, implementing and evaluating people’s care and treatment.

Throughout our inspection we observed people were treated with respect and in a caring and kind way. The staff were friendly, patient and discreet when providing support to people. We saw the staff were knowledgeable about the care people required and the things that were important to them in their lives. Regular ‘service user meetings’ were held to ensure that people who used the service had a say in how the service was run.

We saw that supervision and team meetings were being used to ensure that a desired culture of active support was reinforced. The atmosphere in the home was open and inclusive. There was a clear system for monitoring and auditing the service which was used to identify and act upon areas of improvement.

At our last inspection on 5, 6 & 10 September 2013 we identified concerns about the way the provider respected and involved people who use the service. This was because they did not always protect people’s privacy, dignity and independence. At this inspection we found the provider had taken appropriate action to ensure people’s privacy, dignity and independence were respected.

During our last visit, we identified concerns about people’s care and welfare needs not being met. At this inspection we found the provider had taken appropriate action to ensure people who use the service experienced care, treatment and support that met their needs.

At our last inspection we found the provider did not operate effective recruitment procedures. At this inspection we found the provider had taken appropriate action to ensure people were cared for, or supported by, suitably qualified, skilled and experienced staff.

During our last inspection we found the provider did not take appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced staff. At this inspection we found the provider had taken appropriate action to ensure there were enough qualified, skilled and experienced staff to meet people’s needs.

At our last inspection we found the provider did not have suitable arrangements in place in order to ensure that staff were appropriately supported with training, supervision and appraisal. At this inspection we found the provider had taken appropriate action to ensure people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had been properly trained and supervised.

We previously identified concerns about the way the provider assessed and monitored the quality of service they provided. This was because they did not have an effective system in place to regularly assess and monitor the quality of service, or identify, assess and manage risks to the health, safety and welfare of people who use the service and others. At this inspection we found the provider had taken appropriate action to ensure they had an effective system to regularly assess and monitor the quality of service that people receive, and to assess and manage risk.

At our last inspection we identified concerns about the way the provider protected people from the risks of unsafe or inappropriate care and treatment because they did not maintain accurate and appropriate records. At this inspection we found the provider had taken appropriate action to ensure people’s personal records were accurate. Records required to protect people’s safety and wellbeing were being maintained. Other records in relation to people employed by the service were also accurate.

Some of the people using the service had complex needs which meant they were not able to tell us their experiences. People we spoke with told us they were happy living in the home. They told us they felt safe, cared for and listened to by staff.

We spoke with relatives of people who live in the home. One relative said,

“Our son cannot make many decisions, but where possible staff support him to do that”. “In general I feel the service provides good quality care… we were notified of the building changes, the name change of the home and the new management changes”. Another relative said, “Compared to the past history everything is now very positive. When I saw his own flat over the weekend I couldn’t believe when I said how nice the colour was that our son had chosen it all himself”.

Staff were knowledgeable of people’s specific health and personal care needs and how they wanted those needs to be met. We looked at people's care plans and supporting documents. We found peoples care plans detailed their needs, and how to meet those needs whilst minimising identified risks.

The provider had ensured staff received appropriate professional development and support to deliver care and support to the people who live in the home.

We found people and their relatives had opportunities to contribute their views about the quality of the service. The provider had systems for monitoring services provided.

We spoke to two of the people living at Dysons Wood House. One person told us that the home had changed for the better and he was happy with the support he received. He was aware of the new behaviour management systems and was happy that staff would be able to restrain people where necessary. He told us that under the previous management staff were not allowed to do this. He told us that he felt safe in the home but that one person tended to dominate the staff attention. He liked the new catering arrangements although he was worried his meal might get cold before he received it. The other person told us they enjoyed the meal they had on the day of our visit. Both were aware of the plans for changes to the physical environment and had been involved in discussions with staff about the changes. One was very well informed about the plans. He also told us the staff were very good but did say that some were 'a bit quick tempered and tended to raise their voices too much’.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We also spoke with three people who use the service, three relatives, and ten members of staff.

When we reviewed people’s care plans we found evidence of some service users’ involvement in making decisions about their care was absent. Relatives told us they were involved in annual reviews of care for their family members. However, one relative told us they were not involved in this year’s review, because the date had been changed at short notice and they were unable to attend the new date offered. Although we observed occasions where staff treated people with respect, and involved people who use services, we also observed occasions where they did not.

One person who uses the service we spoke with said “I can assure you, the quality of care is very good”. One relative told us “staff are caring” and another told us their family member was “well looked after and cared for”. When we spoke with staff, they were able to describe how they would support people who use the service to meet their needs. However, we found one person had not seen the dentist or optician for two and a half years. We saw some risk assessments were in place, but others were out of date or had not been completed at all. Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider did not have effective recruitment and selection procedures in place. Not all of the relevant checks had been completed before staff began work.

The provider did not take appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced staff on duty. There was a risk they would not be able to safeguard the health, safety and welfare of people who use the service.

When we spoke with staff they told us they felt well supported by managers and they had enough training to enable them to meet the needs of the people they supported. However, when we looked at staff training records we found the provider did not ensure that staff were properly trained and supported to provide care and support to people who use the service. There was risk that staff would not be enabled to carry out their role effectively.

The provider did not regularly assess and monitor the quality of the services they provided. They did not identify risks relating to the welfare and safety of people who use the service. The provider did not have regard to the comments made, and views expressed, by people who use the service, and those acting on their behalf. The provider did not ensure that people’s personal records were accurate. Records required to protect people’s safety and wellbeing were not being maintained. Other records in relation to people employed by the service were not accurate.

We have made a referral to the local authority safeguarding adults team, due to the concerns raised from this inspection.

We spoke with the person managing the service on the day of our inspection. Throughout this report, we have referred to this person as the acting manager. The location did not have a registered manager at the time of our inspection.