The Maples

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

Most people told us they felt safe with the staff supporting them but some people told us that their visits were sometimes late or missed. Records showed that a significant number of people's visits did not occur on time or as required. This placed their safety at risk. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category People's needs and risks were not always properly assessed and care plans did not always accurately describe the care they needed. Records showed people did not always receive their medicines as prescribed or in a safe way. The systems in place to manage medicines was not robust which placed people at risk of harm. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category Staff had a good knowledge of the action they should take to ensure people were protected from abuse. Staff were safely recruited. There were enough appropriately skilled and trained staff to meet people’s needs although feedback and information about missed and late visits indicated that staff deployment was not always appropriately managed.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The registered manager told us there were systems in place to ensure people referred to the service had their needs and risks assessed appropriately prior to receiving support. The registered manager told us referrals to the service were made by the Local Authority in the main. Once a referral was received, an assessment of the person's needs was completed with staff from the service with Local Authority involvement to ensure the service could meet the person's needs before they were accepted. Each person was then involved in developing their own care plan to ensure it met their needs and preferences. The manager told us that a quality assurance check took place two weeks after admission, to check the person was happy with their care plan, the support they were receiving and the staff team. When people's care plans were reviewed, we found the processes in place to assess, monitor and update information about people's needs and risks were not always effective. This meant that staff did not always have accurate information about people needs and risks.

People were referred to the service by the Local Authority. Multi-disciplinary meetings took place with social service teams as and when people’s needs, and support requirements changed. The Local Authority told us they recently visited the service to seek people’s feedback on the support they received. This feedback had been positive with no concerns reported.

There was no effective process in place to ensure people’s support plans were accurate, sufficient or up to date when their needs changed. Information about people’s health and care needs was not always clear and some support tasks specified in people's care plans were either not properly described or did not take place. People's care plans did not clearly identified the visit times and durations agreed and visit data did not show visits were taking place as needed to keep people safe. Where regular changes had been made to people’s visit times, there was little evidence people had been involved in or agreeing to these changes. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were systems in place to record and monitor accident, incidents and safeguarding events.

Three out of the four people spoken with felt safe with the staff team supporting them. One person said that they felt safe with some of the carers but not others due to having no regular carers. No-one we spoke with reported any current concerns with possible ‘abuse’ or disrespectful staff. Everyone we spoke with told us staff were kind, caring, respectful and compassionate. They shared comments about their experience saying, “I get on well with all the carers who come to me and at no time have I ever felt unsafe ”and another advised, “Yes I am fine with my carers now."

Staff received safeguarding training and knew what action to take if potential abuse was suspected. The registered manager told us all safeguarding allegations were reported to both the Local Authority and CQC and investigated.

The registered manager provided a copy of the provider’s safeguarding policy. This was satisfactory and outlined the responsibilities of staff and management in the identification and prevention of abuse. Staff completed safeguarding training which was refreshed annually. Safeguarding records showed safeguarding allegations/incidents reported ere treated accordingly, investigated and reported appropriately. However, on reviewing a sample of the provider’s complaint records, some complaints were of a ‘safeguarding nature’ but had not been identified as such by the provider.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Three out of the four people spoken with told us staff were sufficiently trained to provide them with the support and care they needed. Some people fedback they had experienced missed or late visits. One person said that they had been told by staff this was due to staff shortages. Most people felt staff were sufficiently trained to provide the care and support they needed. They shared comments such as, “They are mostly on time" and “They do turn up on time.” However two other people advised, “No they don’t arrive on time (we get a rota but it is never accurate on timings)" and "They never come on the times the carer tells me is on the rota they are always late.”

The registered manager told us staff rota arrangements were planned two weeks in advance. Staff members felt there were enough staff on duty usually, and staffing only became an issue when unplanned sick leave arose or other emergency that could not be foreseen occurred. As a general rule, staff felt able to complete their tasks with sufficient time with no scheduled visit times overlapping each other.

Electronic data relating to people's visits and the support they received, clearly showed visits did not always occur as planned, either timewise or duration wise. There were multiple incidences were people did not get their allocated support in terms of ‘hours’ or where visits were late. In some instances, there was evidence people’s visits were missed or the time completed did not match with the staff rota. This raised concerns about the deployment and management of staff on duty and identified a need for more robust oversite and management of calls. A staff training matrix was provided which showed staff members received adequate training to do their job role. Staff files contained evidence of supervisions and spot checks to monitor staff practice. Staff recruitment was safe with all required pre-employment checks carried out. Staff completed an induction which included appropriate training and an opportunity to shadow other more experienced member of staff.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People spoken with told us staff had access to their medicine information on their work mobile phone and recorded what had been given. People told us their medicines were stored in a locked cupboard in their own home. One person told us they had access to this cupboard, as they required to be able to administer their inhalers, as and when needed. Most people spoken with raised no concerns about their medicines. However, one person told us they had ongoing issues with the timeliness of their medicines which were time critical. Yet even after raising concerns about this, they told us they were still not receiving their medicines at the right times. Some people fedback that staff ordered their medicines for them and did not report any concerns. Other people ordered their own medicines or their family did it for them.

The registered manager was asked about how medicines were accounted for. They were asked if any stock/balance checks were completed to ensure the right amount of medicines in people's homes was in accordance with what had been administered. The manager replied that no stock counts were completed. The registered manager advised only controlled drugs had stock count sheets to record the amount of controlled drugs in people's homes. All other medicines had no stock count sheets or stock checks undertaken on them. Concerns were raised with the manager about this as the provider had no way of knowing without these checks, if medicines were administered as prescribed. The registered manager stated all staff administering medicine completed medication administration training and had their competency assessed prior to being allowed to administer medicines. Spot checks on staff practice were also undertaken routinely. There was no information about what type of allergies people experienced or the action to take if a medicine they were allergic to was administered in error. This was raised with the registered manager and the managrment team as a concern. No explanation was given as to why this information was not available. The manager was asked about self administration. They advised that a self administration risk assessment was completed to assess whether the person was safe to self administer medicines, before it was agreed. We found some people were self administering medicines with no self administration risk assessment in place and their care plan stated staff were to administer all medicines. The manager, QBP and regional manager offered no explanation for this. Following our on-site visit, the management team advised action was in progress to address this.

There was no robust processes in place to ensure the safe administration and management of medicines. Medicines were not always stored or disposed of safely which meant some people had copious amounts of medicines in their home. This was not safe practice. Care plans did not always contain information on who was responsible for ordering people's medicines. This meant it was unclear whose responsibility it was to re-order medicines when stocks became low. Where care plans did have this level of information, for example, family or staff to order, these delegated tasks were not always completed exclusively by the right party. The provider’s electronic medication system did not record or carry forward amounts of medicines already in stock at the beginning of each new cycle so it was impossible to tell how much medicine was in a person’s home or in stock at the start of the medicine cycle to enable a stock check to be reliably undertaken. The registered manager acknowledged no stock checks were completed to ensure medicines were given correctly. At times we saw people had not been given their medicines as there were no medicines in their home to give. There was no effective system or process in place to account for medicines and to ensure people received their medicines safely and as prescribed. Records showed staff had sometimes administered people's medicines without the required time interval between doses, which meant people were given too much medicine at any one time. Some people were assessed as not having the skills or capacity to administer their own medicines safely, yet were being permitted to do so, with no checks on their practice. When the person or other family members had administered medicines, there were no accurate records of when these medicines had been administered to ensure the next dose of medicine was given safely.