Maple Leaf House is a nursing home which provides care for up to 30 people. This includes older people, younger adults and people with mental health conditions including dementia. On the day of our visit there were 28 people living there.

At the last comprehensive inspection on 25 February and 1 March 2016 we identified two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to medicine management and governance. As the provider had not complied with the required standards, we issued them with a warning notice in relation to medicines and asked them to improve. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Maple Leaf House’ on our website at www.cqc.org.uk, the service was rated.' At that inspection we rated the home as “Requires Improvement”

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. We undertook a focused inspection on the 19 July 2016 to check that they had followed their plan and to confirm they now met the legal requirements. We found the improvements needed to ensure the safe management of medicines had been made. Following this focused inspection the rating of the key question “Safe” was changed from “Requires Improvement” to “Good” however the overall rating of the home remained as “Requires Improvement.”

At this inspection we found that improvements had been made and sustained and the provider was now meeting the legal requirements.

A registered manager was in post. 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. Following our inspection the registered manager left the home to work for another home owned by the provider. At the time of writing the report a new manager is in the process of registering with us.

The home provided safe care for people who lived at Maple Leaf House. There were enough skilled and knowledgeable staff on duty to meet people's needs and staff were deployed effectively to support safe care. The provider undertook comprehensive checks on the suitability of prospective staff to work at the home.

Staff had received training which gave them the knowledge and skills they needed to provide effective care. Staff had a detailed knowledge and understanding of people's needs which further supported their training and helped to provide personalised care.

Some of the people who lived at the home lived with dementia. Staff knew how to support people with dementia well. They understood the importance of accepting the person's reality and working alongside it, providing re-assurance and support. Staff also understood the importance of gaining people's consent before undertaking any task on their behalf, or before supporting a person with that task.

People were happy, settled and demonstrated positive relationships with staff. Relatives and visitors told us they were welcomed when they visited.

People enjoyed the meals provided and had a range of choices throughout the day. The meal time experience was a pleasant occasion. People were offered a range of drinks throughout the day so they were not thirsty.

People had a range of activities to engage them during the day and the registered manager at the time of our inspection was working with an external company to improve on the activities offered.

Staff were alert to risks associated with people's care. When people required the support of healthcare professionals, the home’s staff ensured they were referred in a timely way. Staff acted on the advice of the healthcare professionals involved

Maple Leaf House is a nursing home which provides care for up to 30 people. This includes older people, younger adults and people with mental health conditions including dementia. On the day of our visit there were 16 people living there.

The home had a manager but they were not registered with us. They had been appointed following our last inspection. 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.

We carried out an unannounced comprehensive inspection on 25 February and 1 March 2016 at which we identified a breach in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicine management. As a result of the breach of the legal requirements and the impact this had on people who lived at Maple Leaf House, we rated the key question of ‘Safe’ as ‘Requires improvement’. As the provider had not complied with the required standards, we issued them with a warning notice and asked them to improve. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Maple Leaf House’ on our website at www.cqc.org.uk.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. We undertook a focused inspection on the 19 July 2016 to check that they had followed their plan and to confirm they now met the legal requirements. We found the improvements needed to ensure the safe management of medicines had been made.

Maple Leaf House is a care home which provides care for up to 30 people. This includes older people, younger adults and people with mental health conditions including dementia. On the day of our inspection there were 14 people living at the home.

The home had a manager but they were not registered with us and had only been in position for three weeks. After our visit we were informed that this person had left their employment at the service and a new manager had been appointed. They were due to commence their employment shortly. 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 last comprehensive inspection this provider was placed into special measures by the CQC. This inspection found that there was enough improvement overall to take the provider out of special measures.

At our previous inspection on 8 and 14 October 2015, the provider was not meeting the required standards. We identified four breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to improve staff training, the arrangements for safeguarding people and to improve the management of risks. This included risks associated with medicine management. The provider was also required to develop systems and processes to check and improve the quality and safety of the care and service people received. The provider sent us an action plan which stated action would be taken to ensure the required improvements were implemented by no later than January 2016.

During this inspection we checked whether improvements had been made. We found sufficient action had been taken in response to two out of the four breaches in regulations. Further improvements and action was needed to address the breach in Regulation 12 related to how people’s medicines were managed. Also Regulation 17 related to having systems and processes that were effective in improving the service. You can see what action we told the provider to take at the back of the full version of the report. The provider was continuing to work to ensure on-going improvements were maintained.

Medicines were not managed effectively because staff were not working to a clear policy and procedure that demonstrated safe practice. The provider was asked to take immediate action following the first day of our inspection to ensure this was addressed. The provider responded by undertaking some initial actions to improve safety of medicine storage, however, further work was required to ensure safe medicine management in the home.

The provider had implemented quality monitoring systems and processes to assess if people were receiving a quality service and to determine if staff felt the home was operating effectively. Whilst people and staff were positive in many of their comments about the home, there were areas identified for improvement that had not been sufficiently actioned. We also found audit processes were not always accurately completed to ensure they were effective in identifying areas for improvement.

There was a system to record complaints and people told us they felt able to approach the manager if they had any concerns. However, complaints had not always been recorded in a central record and they had not always been responded to in writing to demonstrate the action taken in response to them. Discussions with staff and people suggested sometimes complaints were addressed satisfactorily, but at other times they were not always resolved to people’s satisfaction.

People we spoke with were positive about the home and we saw they were relaxed and content around staff to help them feel safe. Relatives of peop

This inspection took place on 8 and 14 October 2015 and was unannounced. Maple Leaf House is a care home which provides care for up to 30 people. This includes older people, younger adults and people with mental health conditions including dementia. On the day of our inspection there were 16 people living at the home.

The home had a manager but they were not registered with us. 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.

People we spoke with told us they liked living at the home and felt safe. However, we found risks associated with their care were not being identified and effectively managed to keep them and staff safe from harm.

Medicines were not always managed effectively. Sometimes medicines prescribed for people had not been given and it was not clear from records why this was. In some cases people had not been given the medicine they needed to manage their health conditions because it was out of stock. Staff competencies in regards to medicine management were not routinely checked to ensure safe medicine management within the home.

There were sufficient numbers of staff to meet people's needs on the day of our visit, but we could not be confident this was always the case because duty rotas were not accurate. New staff went through recruitment checks to ensure their suitability prior to working with people in the home.

People were positive in their comments about living at the home but some people’s needs were not being met effectively. This particularly applied to those people who had behaviours that challenged themselves, staff and others. This was because many staff had not completed training linked to people’s needs to support them in their role.

People had a choice of meals and most comments were positive about the food provided. We saw people who needed assistance to eat were not rushed and were supported to eat at their own pace. Where people had additional needs associated with eating and drinking, advice had been sought from a health professional although this was not always followed.

The provider was not meeting their legal responsibilities under the Deprivation of Liberty Safeguards. There were people in the home who were subject to restrictions in regards to their care which had not been authorised by the local authority.

The service was not consistently responsive to people's needs. Although people's choices were mostly respected and listened to, people who had difficulties communicating had limited stimulation and opportunities for their social care needs to be met. A lack of background information about people’s interests and preferences meant there were people who did not experience person centred care.

There was a system to record complaints and people told us they felt able to approach the manager if they had any concerns. However, complaints had not always been recorded in a way that would enable the provider to monitor them and ensure people were satisfied with the responses made.

The provider and manager did not have sufficient systems and processes in place to assure themselves that the home was providing a quality service to people. People had limited opportunities to provide their opinions of the service and to be involved in decisions related to their care. Audit processes were not effective in ensuring sufficient improvements to the service were made in a timely manner.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service will therefore be placed 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.