Maple House

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

We looked at all quality statements for Effective at this assessment. The service was effective. This showed an improvement since the last inspection. Assessments were completed by the service and used to develop care plans. Further work was planned to streamline these records and move to an electronic system. People’s nutrition and hydration needs were met, and we received positive feedback about the quality of meals. Processes were in place to support people with healthy eating and exercise. We saw evidence people’s preferences and choices were respected by staff.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We were told people and those important to them were more involved in assessments and the planning of their care. A relative said, “I feel [person’s] needs are met and [staff] do their best for [person].”

Staff told us they had more involvement in care planning and there was a keyworker system in place to support this aim. The registered manager acknowledged further improvement works were needed to streamline care plans, and explained there would be a move to electronic care planning going forwards.

Although care plans were being reviewed as part of the provider’s processes, some care plans referred to people by the incorrect name or otherwise lacked consistency. We gave this feedback to leaders so amendments could be made, however it had not been identified and promptly acted upon through their own quality assurance systems.

People’s nutrition and hydration needs were met in line with current guidance. A relative said, “I often smell home cooked food, and every Sunday [person] has a roast which [person] loves.”

Staff told us about how they provided tailored support for people to maintain a healthy weight, including supporting people to go to the gym.

The provider was in the process of establishing new oversight systems for monitoring people’s weight, body mass index (BMIs) and any associated risks such as malnutrition. However, this had not yet been implemented at the time of assessment.

People reported an improved staff approach. A relative said, “The staff team work well together, there is a change in that side of things. Staff have told me they feel more relaxed, and it is more friendly.”

Staff confirmed there were improved working relationships at Maple House and could also explain how they worked together with other services. A staff member said, “[Person] has choked before. SaLT (Speech and Language Therapy) came out and said [Person] is fine. We are still keeping an eye and take precautions with particular foods.”

Partners were positive about the provider’s approach to working together. A professional who works with the service told us, “We have found the service to be proactive in reaching out for support, they have taken on board feedback from visiting professionals and have continued to identify their own areas of improvement.”

Systems and processes still needed to be fully embedded to ensure consistency in how staff, teams and services worked together, to ensure changes made were developed and sustained.

People were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. A person told us about how they were going bowling, and about an upcoming football presentation ceremony.

Staff recorded people’s choices in daily care notes, such as outdoor activities to support health and wellbeing. A person’s care notes said, “[Person] went in the kayak and then chose to jump in. [Person] swam and floated round the river. [Person] appeared to enjoy this.”

People were involved in regularly monitoring their health, including health assessments and checks where appropriate and necessary with health and care professionals. Records were kept documenting any health care professional involvement, and the service was working more closely with the local authority.

People were supported to experience positive outcomes, including in relation to their quality of life. A relative said, “[Person] has a season ticket to the zoo, goes to the spa, and dance class.”

A staff member told us, “I am working with [person] today, assisting with activities. Making sure [person] is safe and happy.” Another staff member described plans to share people’s outcomes with their relatives. The staff member said, “[Relative] wants an achievement post to show ‘you said we did’, like if [person] has burned 500-600 calories at the gym.”

Processes had been established for monitoring people’s care, treatment and outcomes to ensure continuous improvements. This required further embedding to demonstrate the impact of any changes made.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. The service was seeking to comply with the MCA. We received mixed feedback about whether people were always offered choice and control by staff, with some positive views shared. However, 1 relative said, “I feel at times [person] is treated as a child, not an adult. They need to be able to make their own decisions.”

Staff received training about the Mental Capacity Act and DoLS. Some staff members did not always record how they offered people choice and control during incidents when the person was distressed, through positive use of language. We raised this with the registered manager to follow up.

Care plan records set out the need for people’s choices to be respected. Some decision-specific Mental Capacity Assessments were in place to check whether people could consent to certain areas of their own care and support, but rationale for differences in potentially related decision-making was not always clear. A MCA for an electronic seizure monitor was not in 1 person’s care plan, but later provided at our request. There was an oversight system for DoLS, and we found DoLS application outcomes had been notified to the CQC as required by law.