Maple Lodge Care Home

Maple Lodge Care home is a residential care home providing accommodation and personal care to 50 older people at the time of our inspection. The service can support up to 60 people in one adapted building on ground level.

People’s experience of using this service and what we found

Parts of the environment required an upgrade as they were unclean and tired. Some areas had been improved and others were part of an improvement plan.

People and their relatives told us they felt safe living at Maple Lodge care home, and they were happy with their care and support. Feedback from people and their relatives reflected that staff knew and understood people well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests, the policies and systems in the service supported this practice.

Medicines were stored, managed and administered safely and records regarding people’s medicines were completed effectively. Fire safety was managed well, and appropriate checks were in place. People received the medicines they needed to support their health needs. The registered manager closely monitored the use of any ‘when required’ medicines. These were managed in an individualised way.

Infection prevention control practices were in place. All essential visitors had to wear appropriate personal protective equipment (PPE). Additional cleaning of all areas and frequent touch surfaces was in place and recorded regularly by staff. Training included putting on and taking off PPE, hand hygiene and other COVID-19 related training.

There were systems in place for communicating with people, their relatives and staff regarding people’s care and support.

Individualised risk assessments were in place to ensure people could take risks safely. Staff were confident about how to raise concerns to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and follow up

The last rating for this service was requires improvement (published 10 December 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Recommendations

We have made a recommendation regards further improvement of the environment.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Maple Lodge Care Home is a residential care home providing accommodation, nursing and personal care to 48 older people at the time of our inspection. The service can support up to 60 people in one adapted building.

People’s experience of using this service and what we found

Medicines were not always managed well, recorded accurately or in place. The providers medicine administration policy was not always followed. Auditing of medicines highlighted some of the issues found.

We received positive feedback from people and their relatives who told us they were happy living at Maple Lodge Care Home. People told us they felt safe because the challenges of the pandemic had been handled well by the staff and provider. Staff told us they felt supported by the manager and the culture of the home was positive with a teamwork ethos.

Infection prevention control practices were in place. All essential visitors had to wear appropriate personal protective equipment (PPE), and complete NHS Track and Trace information. Training included putting on and taking off PPE, hand hygiene and other COVID-19 related training. Some misuse of PPE was observed during our inspection. This was addressed by the manager during and after our inspection.

Individualised risk assessments were in place to ensure people could take risks safely. However, these were not always followed for some people. Staff were confident about how to raise concerns to safeguard people. Safe recruitment and selection procedures ensured suitable staff were employed. However, records were not always kept on staff files as per their policy.

People were supported by enough staff to meet their needs safely and a dependency tool to calculate staffing levels was used, however, in one area at busy times staff deployment was low.

There were systems in place for communicating with people, their relatives and staff regarding peoples care and support. People were supported to keep in touch with their friends and relatives. Over site and quality assurance from the manager and provider didn’t always address issues found during our inspection.

We have made recommendations about the deployment of staff and auditing of staff records.

Rating at last inspection and update

The last rating for this service was Good (published 19 February 2021)

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this report. The provider had taken some action during the inspection to mitigate risks and continued to liaise with the inspector after the inspection to advise of further improvements scheduled and/or carried out.

Why we inspected

The inspection was prompted in part due to concerns received about medicines and infection control. 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

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risks to people regarding their medicines, record keeping and management oversite at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Maple Lodge Care Home is a residential care home providing personal and nursing care to 51 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

The care home accommodates people in one adapted building, with a separate unit for people living with dementia.

People’s experience of using this service and what we found

People living at Maple Lodge Care Home were supported to remain safe. Risks to people were assessed and reviewed on a regular basis. Staff were recruited safely, and people received their medication as prescribed.

People were supported in line with government guidance around COVID-19. Staff understood their roles clearly and knew what was expected of them and the principles of keeping people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Care plans described the support people needed to maintain their mental and physical health. Changes to people's needs were quickly identified and amendments were made to reflect their up to date care.

The provider and registered manager were focused on continuous learning and developing the service. Quality assurance systems effectively monitored the service and drove improvements when they were needed. Lessons learnt were used as learning opportunities to continuously develop the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 27 April 2020) and there were two breaches of regulation. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to falls, pressure area care and weight risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maple Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Maple Lodge Care Home is a residential care home providing personal and nursing care to 41 people aged 65 and over at the time of the inspection, including people living with dementia. The service can support up to 60 people.

The care home accommodates people in one adapted building, with a separate unit for people living with dementia.

People’s experience of using this service and what we found

People were at risk of harm due to health and safety and equipment shortfalls in the service. Bedrails did not fit mattresses correctly to reduce the risk of people becoming entrapped in them. Health and safety checks had not always been completed or followed up when areas for action had been identified. The provider had been informed of these risks and had not acted in a timely way to take action to keep people safe. The provider responded to these concerns during the inspection. Further work was needed to ensure there was learning from the provider and this shared with the staff team.

Staff did not always feel work priorities were communicated to them effectively by the registered manager. This created confusion about what was expected and when tasks needed completing. The provider was working with the registered manager and staff team to improve working relationships and communication.

There were sufficient staff to provide safe care to people. People received appropriate support to take their medicines safely and they were satisfied with this.

People were supported by knowledgeable, skilled staff, who understood their care and support needs. People were supported to eat enough; their dietary needs were accommodated. The provider worked alongside health and social care professionals to ensure people received effective care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received kind, compassionate care from staff who understood their emotional needs and wanted to improve their quality of life. People were treated with respect; their equality and diversity needs were acknowledged.

People received person-centred care, based on their needs and preferences. People’s life histories were discussed and used as opportunities to reminisce. People felt part of a community at Maple Lodge Care Home. A daily afternoon activities session provided an opportunity for people and staff to spend time together and created a warm, positive atmosphere. The registered manager engaged relatives, staff and other professionals in the running of the service. The service had links to the local area.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 10 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was the first inspection of Maple Lodge Care Home since it was purchased by Burlington Care Limited.

Maple Lodge provides residential and nursing care for up to 60 people. At the time of our inspection 46 people were using the service. The service is divided into three separate units for residential, nursing and dementia care.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of our inspection a manager had been appointed to the home and had applied to CQC to register. Immediately following the inspection the manager’s application to become the registered manager was approved by CQC.

We found people had in place fluid charts to ensure they did not become dehydrated. Although we did not observe anyone at risk of dehydration there was no record of the amounts people needed to drink each day. The daily amounts recorded were not totalled. The manager explained they had recently put the fluid charts in place and agreed to take immediate action to improve them.

We found people lived in an environment where regular checks were carried out to keep them safe. These included checks to reduce fire risks in the home.

We saw that the provider had a staffing structure in place with rotas which showed consistent levels of staffing. We spoke with the manager about the staffing levels on a night time. Although we found there were no serious night time incidents relating to a lack of staffing we recommended the provider reviews staffing levels as a precautionary measure.

People’s medicine was stored securely. All the staff who administered people's medicines had received training to ensure they could do this safely. People received their medicines in a safe way.

Staff had been trained in how to safeguard vulnerable adults. They told us they felt confident to approach the manager about any concerns they may have.

Recruitment procedures were in place and had been followed to ensure staff employed in the service were suitable for their roles. Staff employed in the service had all the required employment background checks, security checks and references taken up. They received appropriate training, supervision and appraisal to carry out their roles effectively.

The provider had started to make changes to the environment to ensure people with dementia type conditions were able to maintain their independence. We recommended the provider and the manager use best practice guidelines to further develop the home into a dementia friendly environment.

Staff were described to us as friendly and caring by relatives and people who used the service. We observed staff treated people with respect. Personal care was carried out behind closed doors to maintain people’s privacy and dignity.

The service adhered to the principles of the Mental Capacity Act. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Complaints were taken seriously by the manager. These were documented, investigated and responses were provided to the complainants.

The service was well-led. The new manager spoke with us about the home being at low ebb when Burlington Care Limited bought the home. They were aware staff had been subject to a succession of managers and felt they had to work to gain the trust of the staff. Staff spoke to us in positive terms about the manager and told us they had made improvements to the home.

Quality checks and surveys were carried out by the managers to monitor the service. This had led to actions being taken and improvements made. Feedback on the service had been collated and reviewed by managers. This was largely positive. The manager had also introduced a “You Said, We Did” notice which showed people what steps had been taken in response to their wishes.