Maple House

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

We looked at all quality statements for Safe at this assessment. The service was not always safe. This showed an improvement since the last inspection. Improvements were still needed to recruitment processes, a continued concern from our last inspection. Risk assessments were in place, including in areas such as choking risk management and the use of physical restraint. Safeguarding systems and processes were in place to protect people from abuse and neglect. However, improvement work still needed to be embedded and sustained, to demonstrate an effective learning culture. People experienced safe pathways of care, and we received feedback from professionals who work with the service the provider was working with them towards embedding changes. Infection prevention and control measures were effective, and the environment was safe and well maintained. People received their medicines safely and as prescribed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received feedback the provider had made improvements following concerns identified at the last inspection, including in relation to the use of unsafe physical restraint by untrained staff. People told us they were satisfied lessons had been learned by the provider, and action taken. A relative told us, “The restraint training was out of date and that is unacceptable, but they (Maple House) have resolved that.” This had led to a significant reduction in serious incidents.

Staff described a new approach to monitoring and reviewing safety events. A staff member told us, “We have got lessons learned so any time there is an incident we look at what worked well, what didn’t work well, and patterns and we can adjust the approach as we can learn from this.” We discussed with the registered manager how further work was still needed to use this information to inform care planning, and to monitor and assess the impact of any changes made as a result.

Formalised reporting and analysis had been introduced for incidents, including the use of physical restraint. Incidents were also discussed at staff meetings. However, these systems were still in their infancy and required further development to show how learning identified was used to proactively shape and improve care. The provider told us they were committed to continuing this improvement work, and to embed good practice.

We received feedback care and support measures were planned and organised with people, their relatives and other system partners to promote continuity of care. A relative told us, “The communication is better about the care that is given.”

Systems and processes still needed to be embedded and developed to show sustainability. For example, the registered manager told us they planned to move to electronic care planning systems, to help simplify information and ensure clarity when people moved through the healthcare system, supporting safe care pathways.

The provider had worked with the local authority to drive improvements to quality and safety, reflecting a joined-up approach at system level. At the time of inspection, further checks were planned by the local authority to ensure these improvements and changes had been sustained by the provider. The work to drive improvement of quality and safety was still not fully implemented and embedded.

Whilst people had medical care plans and risk assessments held on file, as well as hospital passports, some care plan documentation was excessive or repetitive which could make it difficult to clearly set out people’s needs at the point of transitions. Action was already planned to create new digital records.

We received positive feedback from people’s relatives that people felt safe living at Maple House. A relative told us, “There have been no safeguarding investigations [for my person].”

Staff had up to date training in safeguarding and told us they were confident management would act appropriately in escalating concerns to external bodies such as the local authority. However, we provided feedback to the registered manager some records showed inconsistent staff practice in safeguarding people through recognising and challenging negative use of language. The provider told us they would act on our findings.

We observed staff acting to ensure people’s safety and well-being in a warm and relaxed environment. However, care records showed an inconsistent approach by some staff to ensuring people always felt safe when distressed or expressing their emotions. Further learning was required to embed improvements already made in this area.

Whilst there had been a limited number of safeguarding concerns identified at the time of this assessment, further work was required to fully analyse themes and trends over time. A safeguarding policy was in place.

Risks were assessed in a range of areas, including in relation to epilepsy, choking, and how to safely support people when distressed. A relative told us, “[Maple House] emailed to say there had been an incident. There are very few incidents and even if there is no physical contact I am informed.”

Staff we spoke with could tell us how to support people to reduce risk factors relating to areas such as choking, and anxiety or feeling upset. A staff member told us, “[Person] has trigger words like ‘sad’, or ‘can’t’ - you can tell by [their] aura as [person] will go quiet, you can tell [person’s] not quite right. I offer [person] a cup of tea or interact with [them], as [person] thrives off that.” This approach still needed to be consistently applied by all staff members, as set out in other sections of this report.

We saw staff had access to risk assessments, informed by external professionals which informed their practice. The provider was still in the process of streamlining documentation at the time of our assessment, to ensure it was always clear.

Processes were in place to review events where people communicated their needs, emotions or distress, to check whether staff managed this in a positive way that protected people’s rights and dignity, maximising learning for the future about the causes of distress. More work was required to ensure consistency of staff approach.

People were cared for in a safe environment designed to meet their needs. A relative said, “When you show up you can see staff take pride in it (the home). The staff do take that extra care to make sure it looks nice.” Another person’s relative told us, “I have no concerns at all about safety.”

Staff were empowered to raise any areas of the building which needed maintenance or repair for management review and action. A staff member told us, “We have a maintenance sheet now we can put [requests] on, everything we do they (management) fix it very quickly.”

Effective arrangements were in place to monitor the safety and upkeep of the premises. We observed the service was in good repair, with a rolling redecoration plan in place.

Health and safety checks were completed on the building, including for fire safety, water checks and equipment. People had individual Personal Emergency Evacuation Plans (PEEPs) recording the support they required in the event of an emergency, including the potential impact on the person of any sedative medications.

We received positive feedback there were sufficient staff deployed to support people safely and meet their needs within the home. However, relatives told us there was sometimes a lack of staff able to drive, which could limit people’s access to leisure activities in the community. A relative said, “Activities can be limited due to lack of car drivers.” We raised this with the provider for review.

Staff told us they had received training and support to develop in a wide range of areas such as positive behaviour support (PBS), restraint and autism awareness. A staff member said, “Restraint training was really good, I was really impressed with it. The trainer was really good.” Further action was required to ensure training was consistently embedded in practice as not all staff were fully compliant with training. The provider also needed to ensure robust staff recruitment practice.

Observations showed staffing ratios were met for people within the service. Rotas showed allocated fire marshals and first aiders on shift.

Whilst staff received training, supervisions and support, we found recruitment practices were inconsistent, in particular a lack of understanding at management level of the Home Office Sponsorship Licencing process. This meant there were gaps in some employment checks and records. The provider told us they would review documentation to ensure checks were in place going forwards.

People were protected as far as possible from the risk of infection because premises and equipment were kept clean and hygienic. A person’s relative said, “The home is always clean and tidy, even [person’s] bedroom is nice, and I have no complaints.” Another relative said, “There are good hygiene standards.”

There were clear roles and responsibilities around infection prevention and control. Leaders told us there were plans for staff to act as Infection Prevention and Control (IPC) Workplace Champions, taking a lead role in promoting good practice, following enhanced training in this area.

Improvements had been made since the last inspection to IPC practice, and the home was clean and well maintained throughout.

Staff received training in infection prevention and control (IPC) and food hygiene. Audits were carried out to check and confirm IPC measures within the home were satisfactory.

People told us medicines were given safely and as prescribed. A relative said, “The staff seem on the ball with medication.” Another relative said, “Medication is given on time.” We saw people’s needs were respected in relation to how they wanted to take their medicines, and the level of staff support they chose. A person’s records said, “I know what medication to take but I want staff to support me as I get very anxious. Staff need to dispense my medication and hand me the medication pot.” There were risk management strategies to support people in reducing anxiety and distress before considering the need for medication.

Staff told us they received training and competency assessments for medicines practice. A staff member told us, “I have had online medication training and [the team leader] did run through questions in the competencies in all the different situations.”

There were safe systems and processes for managing people’s medicines. There were no gaps in people’s Medication Administration Records (MARs) and the amount of medicines in stock were correct. Audits were completed for prescribed medicines and homely remedies. Staff received training in medication administration, including specialist training for buccal midazolam (an emergency medicine to use in the event of a seizure).