Maples Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We identified 1 breach of regulation, person centred care. People were not always at the centre of their care. Staff were not always aware of people’s health conditions. Communication care plans were limited and did not always include details on how people should be supported to communicate effectively. The provider did not have oversight mechanisms to ensure records were accurate or always providing care in line with people’s care plans. There was little evidence to show how people were engaged with to make sure support was tailored to them.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from relatives about being involved in care reviews. On relative told us, they had not been involved. Another relative said, “[Staff] mention this now and again and ask how things are but no reviews as such.” A third relative said, “Yes, this was done before [my family member] came in [to the home]. A fourth relative said, “Yes, once a month they do Resident of the Day, and they will ask me to make any comments and if I would like to add anything to the care plans.” The purpose of ‘resident of the day’, is that staff review at a particular person’s care records and invite the person or their relatives to review care records.

Since the last inspection in July 2023, we saw care reviews involving people or their relatives had improved and were taking place more regularly, however, further improvements were still needed. Under observation I would add that the last inspection took place in July 2023 In the summary, I would also explain that the provider was in breach and remains in breach. The regional manager and the registered manager told us that they carried out regular ‘resident of the day’ reviews to which people or their relatives were invited to review people’s care needs. ‘Resident of the day’ gave opportunity for each person’s care records to be reviewed once a month But minutes of the staff meeting in June 2024 highlighted that resident of day needed to be more consistent. Staff we spoke with were not always able to explain the different types of dementia people lived with and what the individual impact on them was.

At the last inspection we identified a breach of Regulation 9 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this assessment this was still the case. People were not always at the centre of their care. Staff were not always aware of people’s health conditions. Care plans were not always person-centred, contained contradictory information and had not always been regularly reviewed and updated.

The provider operated a resident of the day review system, this gave opportunity for each person’s care records to be reviewed once a month. However, we found that even when care records had been reviewed, the process had not identified that care records were not always person-centred. Care plans lacked what people’s individual cultural needs were and how they could be supported with these. For example, there was one person who liked singing in their native language, but we did not see any activities in place that supported them to enjoy this activity.

Communication care plans were limited and did not always include details on how people should be supported to communicate effectively. The provider did not have oversight mechanisms had failed to ensure records were accurate or always providing care in line with people’s care plans. There was little evidence to show how people were engaged with to make sure support was tailored to them.

Social care plans were not in place or developed with people, to help keep them socially active and occupied and to prevent people from becoming socially isolated or bored. People spent the day sitting in chairs in communal areas or in their bedrooms with little staff engagement. The registered manager told us that they were aware that there were still some issues with care records and this was on their ‘to do list’ to rectify.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

At the last inspection in July 2013, we saw that people's communication needs had not been adequately assessed and recorded and there was no detailed plan in place to guide staff on how best to communicate with people. There were not always detailed plans in place to guide staff on how best to communicate with people. At this assessment, we found that this was still the case.

Accessible Information Standards (AIS) were in place for people. The AIS tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers get information in a way they can understand it. It also says that people should get the support they need in relation to communication. However, the care plan for one person who was unable to communicate verbally, did not have a communication risk assessment in place. Care records stated that person had difficulties expressing themself, and preferred to be communicated with verbally, and has special communication needs. There were no details and guidance for staff what these ‘special communication needs’ were. This person’s AIS form documented that the person did not have special communication needs. It also failed to document the person’s communication needs and their preferred method of communication.

Another person who used sign language, had no information or guidance for staff in their care plans on how staff should communicate with them.

Staff we spoke with, did not always know what the Accessible information Standard (AIS) was and were unable to tell us how information was provided to people in different formats. At the last inspection, the provider failed to offer support or training to assist staff in their communication with people, at this assessment we found this still to be the case. Staff had not received communication skills training on how to communicate well with people or understanding people’s individual communication needs.

At the last inspection in July 2023, we identified a breach of Regulation 9 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this assessment this was still the case. We were not assured the provider was making information available to people in alternative formats. We found people’s care plans and policies were not available in in accessible formats to suit people’s known needs such as in a picture format. We did not observe staff using different ways of communicating with people, such as signing, pictorials or symbols to support people to understand information, even when they were available. This limited the choice and control people had in their day to day lives on accessing information about them and that could support them. The registered manager told us, that information could be provided in different formats to suit people individually if required. However, we did not see evidence of this.

We saw there was adequate signage in writing and in pictorial format for the lounge, bathroom/toilet and dining room, to help people to orientate easily.

When we asked people if they knew how to report concerns, they were not always clear. One person said, “Not really, [on how to report a concern] but I would tell one of the Nurses or my [spouse].” Another person said, “I have to go through the staff that are in.” Relatives were clearer about who to report concerns to. One relative said, “[I would go] to the new manager.” Another relative said, “I would go to see the Deputy Manager.”

Staff we spoke to told us that they would either try and resolve concerns people had or report them to management. It was not clear that staff were aware or clearly understood that verbal complaints needed to be recorded and followed up in line with the complaints process

At the last inspection in July 2023, we identified was breach of Regulation 16 in relation to complaints as they were not always documented and investigated. At this assessment we saw the provider was no longer in breach of this regulation. However, improvements were still needed as verbal complaints were not always recorded. We saw that there was a complaints system in place and staff were encouraged to record discussions with relatives on incident forms, including the outcome. However, the complaints we reviewed, did not show that this was always done. Records showed remedial action taken, but notes were brief and required more detail. There was no clear conclusion documented as to whether the complaint was upheld or not.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People were not discriminated against, and people received equity in their experience regardless of their individual needs.

Although training records showed staff had completed Equality and Diversity training, staff we spoke to were not always of aware of people’s individual and diverse needs. People living with dementia were not always supported by staff who knew and understood different types of dementia and how it impacted them as individuals. Some staff we spoke to told us they did not know whether people followed a faith or not or if they received a culturally appropriate diet.

Processes were not in place to make sure people had equity in experiences and outcomes. People’s wishes and ambitions were not always recorded or monitored to ensure people were being supported to achieve these. There were no audits focusing on how people spent their time to drive improvements.

People or their relatives were not always involved in their ongoing support or setting outcomes that they wanted. Activity records and evidence of what the outcome was or what the person got from activities was not always accurate.

We saw that a residents/relative’s survey been carried out in January 2024, however, people and relatives we spoke to told us that they had not been asked to complete any surveys. One person said, “No [survey not completed], I don't know what [survey] is.” Another person said, “I don't think so”. A relative said, “No I haven't [completed a survey].”

Another relative said, “I don't think we have, no nothing from the Home.” Analysis of surveys was only available in graph form. It showed that the service had improved since the last inspection but we were unable to see responses to questions asked and there was no action plan showing what would be done to rectify any shortfalls identified.

We saw people had end of life care plans in place, if appropriate and people’s choices and preferences had been recorded. Where people or their relatives did not want to discuss the end of life wishes, this had been documented. We saw that there were 'Do not resuscitate' forms in place, for people where appropriate.

Managers told us they invited families to stay at the home for as long as they wished when a person was experiencing end of life care. They would provide food and beverages and could arrange to have a faith leader visit if requested.

We saw that staff had not received end of life training. This training was important as it would enable staff to understand on how to provide people with a peaceful environment as well as emotional support and managing anxiety.