Maples Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last inspection of the service in July 2023, we found 1 breach of regulation, meeting people's nutritional and hydration needs. People were not always supported to eat and drink sufficiently to maintain health and wellbeing. Although some improvements had been made, further improvements were still needed and the service was still in breach of this regulation. Overall people’s assessments included people’s health needs, background, personal care requirements, and allergies. But did not always document people’s likes and dislikes of food and drinks, especially when they were at risk of malnutrition and dehydration.

During our assessment, we saw people’s health, care, and communication needs were not always consistently assessed. For example, staff could not tell us about all the health conditions people lived with and the risks associated with these. We also saw there were gaps in care monitoring records. People were not always supported to eat and drink when required.

The provider had policies and procedures in place in relation to mental capacity, consent and restrictions on people’s liberty. People’s care records included mental capacity assessments and best interest decisions where people lacked capacity.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were appropriately assessed before they joined the service. However, people’s communication care plans and risk assessments were not always adequate or regularly reviewed. People’s communication needs and how staff should support them was not always clearly identified and recorded. Where care plans stated that people were supported with visual aids, in practice this was not the case.

Staff we spoke with did not always know people’s health conditions and how they could impact them. Information about people’s communication needs and current language spoken besides English was not documented in care plans or was not updated to ensure staff could effectively communicate with them. This meant that people may not be supported or their needs met in an effective and person-centred way, because staff were unable to understand them.

One person’s care plan clearly identified the need for visual aids, such as pictures and symbols to aid and improve communication. However, we did not see staff using any visual aids when communicating with them. Staff we spoke with confirmed that there were no visual aids in place to support this person, but they would rectify this.

The provider did not have a process in place to check and ensure staff fully understood people’s needs as set out in their care plans.

Following the onsite assessment the provider responded to our feedback, by sending us updated risk assessments and care plans.

Overall people were positive about the food and meals on offer; however, we received mixed feedback about people being given a choice. One person said, “[Staff] just give me a meal. No, they don't offer me another meal if I don't like it, but I will just walk off. Another person said, “[Staff] do give you a choice and they would give you something else if you didn't like it.”

The provider told and showed us the recognised assessment tool they used for identifying and managing pressure ulcer risk. However, records did not demonstrate support was provided was in line with outcomes of assessments.

Where people were identified as high risk of developing skin damage, repositioning charts demonstrated that people were not always repositioned frequently in line with information in their care plans. For example, one person was not repositioned every 2 hours, whilst another person was not repositioned every 4 hours as required. Repositioning charts for both people showed that they were not always repositioned onto a different side of their body to reduce the risk of skin damage. Repositioning charts were not regularly monitored and analysed to identify this poor practice. This meant that the provider could not be assured that people were being repositioned as per instructions in their care plans to mitigate the risk of pressure ulcers. Our lunch time observations throughout the home showed improvements were needed. We were not assured that people were encouraged to make meal choices for themselves if they could. Menus displayed were in small font and not accessible to people with a visual impairment or for those who could not access it at eye level. We saw that ‘show plates’ allowing people to see the lunch meals on offer before making a choice were available in some dining areas, but not in all. ‘Show plates’ were not used for people who ate in their rooms or in the lounge areas and for those living with dementia. Some people required support to eat and drink, however we saw that they were not adequately prompted or supported when this was a requirement documented in their care plans. This meant that they were at risk of malnutrition as they may not having enough to eat. Although there were alternative meals on offer, such as jacket potatoes, salads and toasties, we saw that people were unable to choose an alternative at lunchtimes as these had to be ordered in advance.

People told us that they received support from staff with daily living and care and treatment from other health professionals when needed. This included opticians, chiropodists and dieticians. One person said, “The optician and chiropodist come in time to time, and the dietician visits.”

Staff told us when healthcare professionals were involved in people’s care, they worked with them and followed their advice. Staff told us that if anyone had an accident, they would check the person and gage their pain threshold as well as calling for an ambulance straightaway.

There was not a robust process in place for staff to report shortfalls identified in relation to people’s care on a daily basis. For example, staff did not always inform managers if they saw food and hydration charts that showed people were not eating or drinking enough. Repositing charts showed people had not been repositioned in line with their care plan. This meant that shortfalls were not always identified in a timely manner, so that they could be rectified and drive improvements.

We saw that staff were task focused and that there was at times a lack of interaction and communication between staff and people.

People told us that GPs visited the home on a weekly basis to check on them if staff felt they would benefit from a visit or to support them if they were unwell.

Staff were not always aware about people’s health conditions, although it was documented in their care plans. Two people had a chronic health condition which staff were not aware of, did not have knowledge about and did not know how to manage. During the assessment, the regional manager printed of general information about the condition and told us they would ensure staff read it.

There were no risk assessments and management plans in place that covered all people’s health conditions, which included chronic illnesses. During the assessment, the provider told us that they would ensure that these were in place.

People did always experience positive outcomes, as they were not supported to work towards goals or aspirations.

Whilst staff completed monitoring charts, they did not always understand how to monitor outcomes or use this information to plan or update people's care needs.

At the last inspection in July 2023, we identified a breach of regulation 14 (Meeting nutritional and hydration needs) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this assessment we found there was still a breach of this regulation. People were not always supported to eat meals and drink enough, there was a lack of oversight of people's food and fluid intake. Fluid charts were not always completed appropriately, we saw there were gaps and person-centred daily fluid targets were not always recorded. There was a lack of oversight as food and fluid charts were not analysed, and food and fluid audits were not carried out to ensure that people were being supported with diets in line with the care plans and risk assessments. Care plan audits also did not identify these shortfalls, this meant people were put at risk and improvements could not be made. We observed that people were kept waiting long periods of time for their meals. We observed one person who was kept waiting for 30 minutes, pulling another person’s plate from them and eating from it with their hands. If people did not eat, staff took away the meal without prompting or encouraging them to eat. We saw two people were struggling to chew and eat certain foods such as vegetables and chicken and were taking these out of their mouth and putting it back In the plate. This had not been identified so that their care plans and risk assessments had not been reviewed and updated. We saw that details about people’s food preferences in care plans was minimal. We saw one person who required a low-calorie diet was being given lots of high calorie snacks and fortified milk. The review of their care plan had not identified this. We did not see staff using pictorial menus when needed to support people to make a choice or to remind them of the meals on offer if they were unable to recall the lunch they had chosen for the day.

We received mixed feedback from people and their relatives regarding if their consent was sought before providing care. Some people said that staff just told them what they were going to do. One person said, “[Staff] will always tell you what they are going to do but not always ask.” A relative said, “[Staff] will always tell [my family member] what they are there to help with.” Another relative said, “Staff do ask [my family member] if they can help.”

Staff told us they respected people’s rights to make their own decisions about what they wanted to eat, to wear or if they wanted personal care and they said they asked for people’s consent before supporting them. The provider and staff we spoke with, were able to demonstrate a good understanding of the principles of the MCA and understood what actions to take if someone had refused care.

The service was working within the principles of the MCA. People were supported to have some choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice. Staff had a good understanding of the MCA and the management and staff team ensured people were supported to consent and make choices about their support as far as possible.

There were policies and procedures in place and staff had received MCA training. If a person lacked capacity to make specific decisions, they would ensure the best interests decision making process was followed. This would include involving relatives, healthcare professionals and a power of attorney if appointed.