Maples Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last inspection in July 2023, the provider was in breach of 2 regulations, safe care and treatment and staffing. At this assessment, we found some improvements had been made but the provider remained in breach of regulation. We found that risk assessments were either not in place, adequate or had not been updated following a change. Following the onsite assessment, we did see that some risk assessments had been put in place and care plans updated.

Staff were not always aware of people’s health needs and associated risks, there was not always clear guidance in place for staff to keep people safe, prevent or mitigate risks where identified. Overall staff received appropriate training except in relation to one specific health condition. People requiring pressure relief, did not always receive this consistently in line with the care plan. There were sufficient staff at the service. However, they were not always deployed effectively to meet people’s needs in a timely way and staff task focused as there was little interaction and communication between staff themselves and staff and people. It was not always clear to see how learning was disseminated to all staff to: However, they were not always deployed effectively to meet people’s needs in a timely way. Staff were also observed to be task focused as there was little interaction and communication between staff and people. It was not always clear to see how learning was disseminated to all staff. People told us they felt safe living at the home and staff told us they felt supported by management.

Although recruitment practices were robust, the process for induction was not, as not all staff had completed the induction process. However, we saw improvements made since the last inspection in July 2023. These included risk assessments for people living with diabetes, now included guidance on the acceptable range of hyperglycaemia or hypoglycaemia (high or low blood sugar).

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they reported accidents and incidents when they occurred. The Regional Manager told us it was practice for them to review all accidents and incidents at the end of each month. This meant that learning from accidents and incidents was not shared with staff as and when they occurred to prevent and mitigate further accidents and incidents.

There was a system in place to record and investigate accidents and incidents, however, the provider did not have a clear system in place to ensure learning was disseminated to all staff in relation to accidents and incidents and how to minimise risks in the future to continually identify and embed good practice. Accidents and incidents audits failed to identify themes and trends in relation to individual people, which could minimise the risk of accidents and incidents involving them in the future.

Overall people and their relatives told us that they were happy with the care they received from the service.

Leaders told us that they completed assessments of people’s needs before they moved into the service and also if they had been in hospital and were returning to the service. This ensured effective transition from people’s home or between care settings.

Care plans showed the involvement of other health care professionals such as GPs and district nurses.

People and their relatives told us they felt safe living at the home. One person told us, “[Staff] are good. They are nice.” A relative said, “Yes, I am happy with the staff who look after her. I feel that she is safe.”

Staff understood their responsibilities in relation to safeguarding. They had completed safeguarding training and were able to demonstrate knowledge of different types of abuse and reporting procedures if they had any concerns of abuse.

There were safeguarding, whistleblowing and duty of candour policies in place to help protect people from potential abuse. There was guidance in place for staff on how to raise concerns. The provider understood their responsibility under the duty of candour and took responsibility when things went wrong. Deprivation of liberty safeguards applications were submitted to the local authority when people’s liberties were restricted to receive necessary care and treatment. This was monitored by the registered manager and reflected in people’s care plans.

Risks to people were not always identified and managed to ensure people were kept safe. Risk assessments and management plans did not always include information about how to minimise associated risks and maintain people’s safety in accordance with people’s specific needs.

Staff we spoke with were not always aware of people’s individual health conditions and the risks involved to ensure support was provided safely. For example, one staff member said, “I don’t know about all of [person’s] conditions.” Another staff member said, “I am not aware of all the health conditions [person] has, I don’t really know. I don’t look, but they are all in the care plans.”

We observed moving and handling techniques. People who required assistance with mobilising, were safely supported by staff using appropriate equipment.

At the last inspection in July 2023, we identified a breach of regulation 12 (Safe Care and Treatment) 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. Risk assessments were not always in place, adequate or had not been updated following a change in relation to choking, behaviours that caused distress, epilepsy, asthma, health conditions, repositioning and communication. For example, there were no risk assessments for 2 people who lived with a chronic health condition. Staff spoken to were not aware that people had this condition and the potential risks associated with it. There was no epilepsy risk assessment for one person, although seizures were documented in the person’s daily notes, this information was not easy to find and available to staff. The lack of epilepsy seizure recording forms meant that the provider could not identify themes and triggers to mitigate any further episodes. At the last inspection we identified that staff had not received epilepsy training. At this assessment we found that this was still the case. There were no behavioural charts in place for people who presented with behaviours that cause distress.Care plans gave guidance to staff to use VERA framework, which was a framework that helps staff to achieve better communication with older people. However, staff and managers did not know what this VERA framework was and the purpose of it. There was no guidance for staff on how to use this framework or guidance for staff to follow when people displayed behaviours of distress. The management team told us they were aware that further improvements were needed and were consistently working to achieve them. Following the onsite assessment, the provider sent us some updated risk assessments and care plans. However, this process has not been operational for enough time for us to be sure of consistent and sustained good practice.

During the assessment, we saw the lift to the kitchen and laundry room was out of service. The regional manager showed us that there was a risk assessment in place for this. We saw that hot trolleys were in place to keep food warm and the menu had been altered to have less liquid food such as casseroles. This kept spillages to a minimum.

The home environment was tidy and well maintained; however, we saw that a downstairs toilet was used to store trollies and a Zimmer frame. We brought this to the attention of management, as this could be a hazard and a risk to people. However, on the second day of the assessment we saw that this had not been rectified and continued to pose a risk.

At the last inspection in July 2023, the design of the home did not consider that the needs of people living with dementia. The décor of the home was somewhat clinical, walls were painted magnolia, not all people's bedroom doors had been painted in different a colour. Not all bedroom doors displayed people's names, memory boxes or a memorable picture to enable people to find their room with ease. We recommended that the provider should seek guidance from a reputable source on how design which was conducive to people who live with dementia. At this assessment we saw that people’s bedroom doors had been painted different colours and had their names and a memorable picture on bedroom doors to help people’s orientation. However, dining rooms on the first floor and lounges were still bland and void of colour, there were no pictures, photos or posters which were meaningful to people.

We saw there was appropriate signage, with pictures throughout the home to help people orientate easily around the home. Risks from the premises were managed and records kept up to date. This included fire safety, electricity, gas, Legionella prevention and control and lifting equipment, such as hoists and bath chairs.

We saw there was a business continuity plan in place for managing the service in an emergency. There was an up-to-date Fire Evacuation plan in place and regular fire drills were carried out.

Overall relatives told us that there were enough staff, however, they said that staff were not always visible and had to be sought out. One relative said, “Sometimes [staff] take a while to come.” Another relative said, “Sometimes at weekends I’ve noticed, there seem to be less staff. I have spoken with the manager, but they have said it is the same as in the week, but sometimes I do have to go and look for someone.” Some people and their relatives told us that call bells were not always answered in a timely manner. One person said, “Some staff come quickly but it is a bit slower at night”. Another person said, “If [staff] don't come quickly, I will ring again.” A relative told us, “We usually go and find someone if we are here.”

We received mixed feedback about staffing levels. Some staff members said there were enough staff, however, there could be shortages when staff were on leave or sick. Other staff said they did not feel that there were enough. One staff member said, “We feel we need more staff, [management does not], sometimes one [staff member] has to lift [one person] when it requires two’.

Staff were not effectively deployed at lunch time. On the second day of the assessment there were 4 staff members on the ground floor dining room supporting 11 people. Some people were kept waiting up to 30 minutes for their lunch. Staff were very task focused because if people did not eat, they took away their meals without any interaction. We saw that staff were not always sure of their role and observed them discussing what needed to be done. For example, whether they should be serving meals or supporting people to eat and drink. One person told us, “Each team in the day needs to be clearer what the other team has been asked to do. That would save time.”

At the last inspection in July 2023, we identified a breach of regulation 18 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as staff were not effectively deployed. At this assessment we found there was still a breach of this regulation. There was a lack of communication between staff to ensure they understood what their roles were and carried out these effectively during lunchtimes. The provider used a dependency tool to determine staffing numbers to safely meet people’s needs. However, the dependency tool used was a guide, there did not appear to be a clear process to show how staffing levels were determined and there was conflicting information about what the minimum safe staffing levels should be and how they assessed this. Recruitment and selection processes were in place. The provider had an induction policy in place which outlined expectations for all staff to receive an induction and complete the care certificate. We saw that nurses were receiving an induction but not all care assistants recruited since the last inspection in July 2023 had. The provider had recognised this shortfall and told us they were taking steps to rectify this. The provider’s supervision policy stated that formal supervision with a manager must happen at least once per year. This meant that staff had limited opportunity to meet with a manager regularly throughout the year to review and monitor workloads and performance. There was also limited opportunity to identify learning and development. This meant the provider could not be assured that staff performance was consistently effective. Records we looked at showed 7 staff members had not had an appraisal in the last 12 months. There is a system in place to ensure staff received ongoing training to ensure they have the knowledge and skills to meet the needs of the people they care for. Staff had not received communication skills training.

We saw and people and their relatives told us that staff always wore personal protective clothing (PPE). On relative said, “Yes, [staff] have plastic aprons and gloves on when they help [my family member]. Another relative said, “Yes [staff] wear aprons and gloves.”

Staff were aware of how to protect people from the risk of infections. One staff member said, “I make sure that I am wearing PPE and wash my hands.”

We saw the home was clean and odour free, this included people’s bedrooms and bathrooms. PPE was readily available to staff.

There were infection control policies in place and staff received training in infection prevention and control. Regular infection control audits were carried out to identify shortfalls and the action needed was taken. We carried out a tour of the service and found areas were clean and tidy.

People received their medicines safely and in a timely way. Records indicated that people did not go without their medicines and any gaps in medication administration records (MAR charts) were identified and followed up by staff. People and their relatives confirmed that they received their medicines in a timely manner. One person said, “Staff always make sure that I get [medicines] on time.” A relative said, “The staff give her medication. There have been no problems.”

Staff competency checks for medicines administration was carried out regularly. Staff we spoke with were knowledgeable about each person’s medicines and knew how to support them. Staff told us they were confident to raise questions or concerns with the GP or pharmacy if needed. For example, we saw evidence where staff had requested a review of a prescribed medicine.

At our last inspection in July 2023, medicines were not always securely stored or managed appropriately. At this assessment, overall medicines were safely managed; however, some improvements were still needed. Although, locked cabinets were now installed in people’s bathrooms, topical creams were still not always securely stored. This was because cabinets were left unlocked, or topical creams were left on top of cupboards or cabinets. On the second day of the site visit we saw that all topical creams were securely stored. There were processes in place to record and report on medicine errors and near misses that occurred. The records reviewed showed an understanding of why errors had occurred. Staff were expected to complete stock checks after each administration of a medicine. However, we found there were times when the stock count didn’t tally correctly or stock the stock count was not documented. This meant it made it difficult to see where a medicine had been missed or a record not completed correctly. We will assess all of this at our next assessment to ensure improvements had been implemented and were operational for enough time for us to be sure of consistent and sustained good practice.

Medicine competency for all staff had not been carried out to ensure that they were competent to administer medicines safely. The service had an up-to-date policy in place for medicines management. Other medicines including controlled drugs were stored safely and securely. The clinic rooms were temperature controlled and staff monitored ambient room and fridge temperatures to ensure medicines were stored in line with manufacturers recommendations. There was a process that was followed to ensure people transferring between care locations had accurate and up to date information about their medicines This information ensured there was a continuity of care.