About the service Mapleford Nursing Home is a residential care home which provides personal care and nursing care for up to 54 older people, younger adults, people with a physical disability, sensory impairment or mental health support needs and people living with dementia. Accommodation is provided in 3 units over 2 floors, with a passenger lift available. At the time of the inspection 37 people were living at the home.
People’s experience of using this service and what we found
Staffing levels at the home were not always appropriate to meet people’s needs and to ensure their safety. Significant improvements were needed to the quality and safety of the home environment. Infection prevention and control practices at the home needed to be improved. People’s medicines were not always managed safely and in line with national guidance. Care plans did not always contain information about people’s risks to guide staff about how to support them safely. Not all staff had completed the provider’s mandatory safeguarding training. Staff we spoke with knew the action to take if people were at risk of abuse. Staff had been recruited safely to ensure they were suitable to support people living at the home.
People did not always receive support which reflected their assessed needs and preferences. They did not always receive support when they needed it and their safety was not always monitored effectively. Staff had not always received an appropriate induction or completed the training necessary to support people effectively. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice; we have made a recommendation about this. People’s care documentation did not always include information about their needs and preferences, including their dietary and healthcare needs. The home environment needed to be improved to ensure it was homely and comfortable and met people’s needs; we have made a recommendation about this.
People did not always receive personalised, high quality care which resulted in good outcomes for them. Staffing levels had been reduced without reference to people’s needs, the home environment was unsafe and unclean, and staff had not completed appropriate training. Many audits were not being completed regularly. When audits were completed and shortfalls identified, the necessary improvements were not always made. Many of the shortfalls we identified during the inspection had either not been identified by the manager or provider or had not been acted upon. This meant that appropriate standards of quality and safety were not being maintained at the home. There was little evidence of engagement with people or relatives to gain their views about the service and we found evidence of decisions being made about people’s care without appropriate consultation. There was a lack of appropriate oversight of the service by the provider; they had not visited the service regularly to monitor how the service was being run, the quality of care people were receiving and standards of quality and safety.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 5 November 2020).
Why we inspected
The inspection was prompted in part due to concerns received about a variety of issues, including medicines, infection control, poor, unclean and unsafe environment, staffing, people not receiving appropriate support and lack of effective management. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
At this inspection, we have identified breaches in relation to staffing levels, medicines, the safety and cleanliness of the environment, the management of people’s risks, people not receiving person-centred care or being consulted about their care, staff knowledge and skills and the provider’s oversight of the service.
You can see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
In relation to some of the breaches of regulation, we will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.