Maple Court

Maple Court Scarborough is a residential care home providing the regulated activity of personal care for up to 64 people. The service provides support to older people and people with dementia. At the time of our inspection there were 48 people using the service.

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

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.

Risks to people's health, safety and wellbeing had been assessed and recorded. Staff understood what actions were required to help keep people safe. People told us they felt safe at the home and with the staff who supported them. Staff had received training in safeguarding and felt confident in the processes in place to report any concerns.

The service was a modern build with a safe, homely environment. Risk assessments were used to keep staff and visitors safe and promoted good access to internal and external communal areas.

Where people required support to take their medicines these were managed and administered safely, with regular checks completed. We were assured by the measures taken to help ensure the prevention and control of infection. Where areas of the home required maintenance, actions were swiftly implemented to maintain standards. For example, to maintain a clean and pleasant environment.

Staff responded promptly and were attentive to people’s needs. The registered manager monitored staff deployment and ensured enough staff were always on duty. Ongoing recruitment meant there was a reduction on the reliance of agency staff which improved people’s experiences. Processes in place ensured only suitable staff were safely recruited into their roles.

People were supported by caring, friendly staff who knew their needs well. Staff received required training and checks to ensure they followed best practice guidance. People told us staff were skilled in their roles and supported them to maintain their independence wherever possible.

People received an initial assessment of their needs. Care records included up to date information which was being further improved to evidence people’s involvement with their care, support, and regular reviews. Care provided was personalised and supported people’s preferences and wishes. Information was provided in an accessible format which helped people to communicate and understand their support.

People’s health needs were being met. The service worked closely with other health professionals and external agencies to support them with their health and wellbeing. A health professional told us the service was a flag ship in the development of integrated care in responding to people’s ever-changing needs.

People and staff spoke positively about the management of the service and their openness to

feedback. The management team was proactively supported by resources at provider level and was approachable, maintained regular communication, and listened to the views of others.

A range of audits and checks were completed to maintain and where required, implement any required improvements.

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 9 December 2022).

At our last inspection we recommended that . At this inspection we found .

Why we inspected

The inspection was prompted in part due to a notification to the CQC of an incident associated with an allegation of abuse. The incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks to keep people safe from avoidable harm and abuse. This inspection examined those risks.

We undertook a focused inspection to review the key questions of safe, responsive, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. The provider had taken action to mitigate the risks, and this had been effective.

The overall rating for the service has remained good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Maple Court is residential care home providing personal and nursing care to up to 64 people aged 65 and over, some of whom may be living with dementia. At the time of the inspection, 42 people were using the service.

The home has two floors. The ground floor provides accommodation for people requiring residential care, and the first floor provides accommodation for people living with dementia. At the time of this inspection, Maple Court were no longer providing nursing care.

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

This was a targeted inspection to consider concerns that had been raised in relation to staffing levels impacting on the quality of care provided, access and response to call bells, available refreshments and infection prevention and control.

Based on our inspection of these areas we found there was sufficient staff on duty. The registered manager used a dependency tool to help calculate safe staffing levels. Agency staff were utilised to ensure staffing levels remained safe.

The registered manager maintained a close working relationship with employment agencies. This ensured people received consistent care and support from staff who understood their individual needs

Call bells were accessible to people and responded to in a timely manner. Where people were not able to use the call bell, appropriate safety checks were completed and recorded.

Accidents and incidents had been recorded with details of actions taken to mitigate associated risks.

The home was clean and tidy throughout and government guidance in relation to PPE was followed. PPE was available throughout the service and used appropriate by staff.

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 13 January 2022).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing levels impacting on the quality of care provided, access and response to call bells, available refreshments and infection prevention and control. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Maple Court is residential care home providing personal and nursing care to up to 64 people aged 65 and over, some of whom may be living with dementia. At the time of the inspection, 39 people were using the service.

The home has two floors. The ground floor provides accommodation for people requiring residential care, and the first floor provides accommodation for people living with dementia. At the time of this inspection, Maple Court were no longer providing nursing care.

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

People told us they felt safe and received kind and compassionate care. Staff responded to people’s needs in a timely manner and knew how to respond and report any safeguarding concerns.

Safe recruitment processes were followed, and although there had been recent challenges with recruitment, progress was being made.

Medicines had been stored, administered and recorded in line with best practice guidance. Effective infection prevention and control measures were in place to reduce the risk of spreading infections. Covid-19 guidance was being followed.

Risks to people had been assessed and recorded. Mitigation was in place where possible.

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.

Effective governance systems to monitor the quality and safety of the service was in place. Senior management visited the service on a regular basis to provide support and ensure they had effective oversight of the quality and safety of the service provided.

People, relative and staff views were listened to and acted upon. Clear action plans were in place where any shortfalls were found.

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 3 June 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the level of care people were receiving. A decision was made for us to inspect and examine those risks.

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 Court 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 Court is a care home providing residential and nursing care for older people who may also be living with dementia. The service is registered to support up to 64 people. When we inspected, 43 people were using the service.

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

The service was clean and free from malodour. Regular cleaning helped to make sure the environment and equipment used were hygienically clean and to reduce the risk of healthcare related infections.

Regular testing of staff and people who used the service helped minimise the risks associated with COVID-19.

Staff had training and access to the Personal Protective Equipment (PPE) they needed to keep them and the people they supported safe. We signposted the provider to resources to develop their approach in relation to social distancing and the safe and effective use of PPE.

Sufficient staff were deployed to safely meet people’s needs. Staffing levels had recently increased as the needs of the people using the service had changed. Staff had the time to help make sure people had enough to eat and drink.

Rating at last inspection

The last rating for this service was Good (published 3 June 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing levels. The overall rating for the service has not changed following this targeted inspection and remains Good.

The Care Quality Commission (CQC) have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maple Court 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.

We found the following examples of good practice.

The service was clean and free from malodour. Regular cleaning helped to reduce the risk of people catching or spreading COVID-19.

Staff received training on infection prevention control and the use of Personal Protective Equipment (PPE). There were good supplies of PPE, which staff used to help keep people safe. There was clear signage throughout the service on the correct use of PPE and good hand hygiene.

People who used the service and staff were regularly tested to help identify and contain the spread of COVID-19. Procedures were in place to make sure people self-isolated when necessary.

The registered manager followed a safe process to admit new people into the home. New admissions had to be tested to make sure they did not have COVID-19 before moving into the service.

Staff worked in separate teams, had separate entrances to the service and separate break areas to reduce the risk of catching or spreading COVID-19.

Appropriate arrangements were in place to minimise the risks associated with visitors coming into the service. Visitors had their temperature checked, were screened for symptoms of COVID-19 and were required to clean their hands and wear appropriate PPE.

We have also signposted the provider to resources to develop their approach.

Maple Court is a care home providing personal and nursing care up to 64 people aged 65 and over, some of whom may be living with dementia. When we visited 38 people were using the service.

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

Since the last inspection the provider and new registered manager had worked closely with professionals to implement new systems and recruit new staff. Significant improvements were seen at this inspection and the systems to check for quality and safety had sustained good levels of care for several months prior to this inspection. This demonstrated they were effective.

The staff team had been inducted, supported and trained which had brought stability to the service. Staff understood their roles clearly and they knew what was expected of them. People were treated with respect and dignity, they were also supported to maintain their independence.

People’s needs and preferences were known by the staff and this had led to people receiving person centred, responsive care. Staff had worked to improve or maintain people’s quality of life. Feedback from people and their relatives was positive and they also were able to tell us about the improvements they had felt in the quality of care they received. Staff had developed positive relationships with people which led to people feeling safe and happy.

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

The environment had been designed to keep people safe and help people living with dementia to find their way independently. People enjoyed access to a secure garden and were supported to access the community to take part in local activities. People told us they were offered a wide variety of activities to take part in if they chose this.

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

Rating at last inspection and update

At the last inspection we gave the service a rating of inadequate (published 15 October 2018) and there were multiple breaches of regulations. Following the last inspection we asked the provider to complete an action plan 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.

This service has been in Special Measures since 15 October 2018. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence 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 Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Maple Court provides nursing and personal care for up to 64 people. The service supports older people who may be living with dementia. At the time of our inspection there were 39 people who used the service.

There was a manager in post who registered with CQC in November 2017. 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.

Insufficient staffing levels were impacting on all aspects of the service and the system used to determine the numbers of staff required and deploy them around the service was not robust. The regional manager for the service took action on the second day of our inspection to make some improvements to this aspect of the service.

Staff did not receive appropriate training to enable them to effectively and efficiently carry out their job roles and duties. Meetings with staff to discuss work performance (supervisions) were in the form of individual and group settings. However, these did not always cover individual performance or offer staff an opportunity to discuss any work issues they may have. There was a lack of effective communication between the care staff, nurses and the management team. This meant people’s health and well-being was at risk of harm.

The management of medicines was not robust and meant medicines were not administered to people as prescribed by their GP. This put people at risk of harm.

The quality assurance system within the service was not being operated effectively. Audits completed by the provider and the registered manager showed several recognised concerns with regard to documentation and people’s health and well-being. However, insufficient action had been taken to mitigate these known risks.

The quality of the record keeping varied and some care records we looked at were not personalised and were inconsistent or incomplete. This meant staff did not have an up to date record of people’s care and treatment. Agency staff were used frequently in the service, but they and the permanent staff found it time consuming to access and read the electronic care records. Due to work pressures and the lack of organisation in the care service, care staff told us they did not always have the time to read the care records meaning they lacked knowledge of people’s care and support needs.

The assessment, monitoring and mitigation of risk towards people who used the service regarding hydration, nutrition, weight loss and pressure care was not robust. People had lost weight and their records of nutritional intake and care were not being completed or updated in respect of their changing needs.

People's privacy and dignity was not consistently respected. People were left waiting until late in the morning to get out of bed. Two people's anxious and distressed behaviours were not being met which meant they were left lying on the floor until staff had time to attend to them.

We found breaches of Regulations 10, 12, 14, 17 and 18 during this inspection in relation to dignity and respect, safe care and treatment, meeting nutritional and hydration needs, good governance and staffing. You can see what action we told the provider to take at the back of this report.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People could talk to health care professionals about their care and treatment and see a GP when they needed to. They received care and treatment when necessary from external health care professionals such as the district nursing team.

People had access to community facilities and a range of activities provided in the service. People and relatives knew how to make a complaint and eight out of the ten relatives/visitors who spoke with us were happy with the way any issues they had raised had been dealt with.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.