Mapleford Nursing home

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, 28 people were living at the home.

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

People’s medicines were not always managed safely and in line with the provider’s own policy. We observed enough staff on duty to meet people’s needs, although, staff felt the staffing levels could be increased. Staff had been recruited safely to ensure they were suitable to support people living at the home. All required health and safety checks had been completed and infection control procedures were being followed. Staff had received safeguarding training and people felt safe living at the home.

People and their relatives had not always been involved in the care planning process and care plans needed to be reviewed to ensure they were accurate; we made a recommendation about this. People were not supported to have maximum choice and control of their lives and staff did not 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. Staff had received appropriate training for their role. Significant improvements had been made to the design and decoration of the service.

Further improvements were needed to systems for auditing, assessing, monitoring and improving the quality and safety of the service. Policies and procedures were in place to guide staff. However, they were not always being followed. Staff did not always feel able to approach the management team with concerns. The provider had a development plan which they were working towards to improve the service. People told us they had no complaints and felt Mapleford Nursing Home was a nice place to live.

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

The last rating for this service was inadequate (published 23 March 2023)

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 the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mapleford Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management, person-centred care, consent and governance at this inspection. We made a recommendation in relation to care plans and referrals.

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

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over 2 consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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 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.

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.

Mapleford Nursing Home is a nursing and residential care home which provides nursing and personal care for up to 54 people, including older people, younger adults, people with mental ill health and people living with dementia. At the time of the inspection, 29 people were living at the home. Accommodation is provided in separate units on two floors.

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

People were supported to remain safe from abuse and avoidable harm. Staff were knowledgeable about the risks people needed support to manage. Risk assessments and risk management plans provided sufficient detail and were reviewed and updated when required. Relatives told us they were confident the home provided safe care.

People's needs had been thoroughly assessed and their preferences were reflected in their care plans. People's health needs had been regularly reviewed and updated to reflect any changes. The staff worked effectively with medical professionals to optimise people's health and well being.

Staff were kind and caring. People were respected and their views valued. People were supported to communicate, guidance in care records helped staff understand how best to understand and support people's communication.

People received personalised care which reflected their needs and preferences. Activities had been adapted which helped ensure people had enough to do. Any concerns people may have had had been responded to.

The registered manager provided clear leadership. Staff and relatives felt confident in the management of the service. The registered manager and provider ensured governance systems identified good practice and areas for improvement. Recent action plans had been completed which had improved the quality of audits and governance.

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.

Rating at last inspection

This service was registered with us on 15 July 2020 and this is the first inspection. The last rating for the service under the previous provider was Requires Improvement, published on 13 November 2019.

Why we inspected

This was a planned inspection based on the previous 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.

Mapleford (Nursing Home) Limited is a nursing and residential care home which provides nursing and personal care to up to 54 people, including older people, younger adults, people with mental ill health and people living with dementia. At the time of the inspection, 29 people were living at the home.

We found the following examples of good practice

¿ Preadmission assessments would be completed which helped ensure people's needs could be met. The proposed admissions procedure would allow people to be admitted safely from hospital.

¿ The management team were working closely with the local authority and clinical commissioning group and other partners including local GP and link nurses.

¿ The proposed unit was separated from the rest of the home. There was a separate entrance to the unit. There would be no movement of staff or residents between the proposed unit and the rest of the home. There were separate facilities which would allow for meals to be provided safely. Laundry would be kept separate and there were clear donning and doffing areas for personal protective equipment (PPE).

¿ National guidance was followed in relation to the use of (PPE) Regular Covid19 testing was in place for staff and residents. There was ready access to PPE and handwashing facilities. Hand gel was carried by all staff and supplies were readily available for visitors.

¿ The proposed unit was clean and clear of clutter, flooring had been replaced to maximise infection control. Some minor refurbishments were in the process of being completed which included decoration and window dressings.

¿ Staff identified to work on the proposed unit had volunteered and received training in relation to good infection control practice which included the correct use of PPE. Management assured us training would be refreshed and updated regularly to help ensure national guidelines were followed.

¿ There were effective policies, procedures and risk assessments in place to maintain good practice in relation to infection control and to provide safe and kind care.

We were assured this service met good infection prevention and control guidelines as required of a designated scheme.

Further information is in the detailed findings below.