This inspection was unannounced and took place on 16 December 2016. It was carried out by It was carried out by one inspector, a specialist advisor in dementia care and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service

Maple Leaf Care Home provides nursing and personal care for up to 48 older people living with dementia. At the time of our inspection, there were 45 people receiving care at the service. There was a registered manager for the service at the time of this inspection. This is a person who has registered with the Care Quality Commission. They are responsible for the day to day management of the regulated activity of personal care at the service. Like providers, as a registered person they have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in June 2014 the provider was meeting the requirements of the Health and Social Care Act 2008 and related care standards.

People and relatives were confident of people’s safe care at the service. The provider’s staffing, emergency and contingency planning arrangements helped to ensure that people received safe care. Recognised incident reporting and safeguarding procedures were understood and followed when required to protect people from the risk of harm or abuse.

Risks to people’s safety from their health conditions or environment were assessed before they received care. Identified risks were regularly reviewed and managed by staff who understood and followed the care actions required for their mitigation. People medicines were safely managed.

People were provided with the equipment they needed for their safe support. The environment and equipment used for people’s care was regularly checked and maintained to ensure safe use.

People and relatives were happy with their care, often describing this as good or excellent. Staff understood people’s health conditions and related care requirements, which their care plans showed.

People were supported to eat and drink sufficient amounts, maintain a well-balanced diet and access external health professionals when they needed to. Staff followed any related instructions for people’s care when required.

Staff training arrangements were comprehensive to ensure safe, effective care delivery and related staff competency. Arrangements for individual staff supervisions were not being consistently maintained. Management improvements were assured to rectify this.

People were provided with personal care in line with legislation and guidance in relation to consent. Staff understood and followed the Mental Capacity Act 2005 to obtain people’s consent or appropriate authorisation for their care when required. Care plan record keeping improvements were assured to consistently account for decision specific care in people’s best interests.

People received care from staff who knew them well and were kind, caring and respectful. Staff understood and promoted people’s choices, rights and comfort in their care. People and relatives were made to feel at ease and welcome by staff and they were involved, informed and consulted to help agree people’s care.

People’s care was individualised but not always timely. Staff were visible but sometimes did not observe or respond in a timely manner when people needed assistance.

Staff were usually mindful of people’s needs. They supported people in a way that was meaningful and helped to reassure them when required. People were regularly supported to engage in social and recreational activities and practice their religious faith in a way they chose.

Environmental adaptations and equipment often helped to enable people’s freedom of movement environmental engagement, orientation and recognition. Relevant specialist advice was secured to help inform service improvements to fully ensure th

A single inspector carried out this inspection. We spoke with the relatives of three people who lived at the home.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

All of the relatives we spoke with told us that the provider’s staff cared for people in a safe and effective way.

People’s capacity to understand had been appropriately assessed and decisions made in their best interests.

The provider had effective systems to identify and manage risks to people’s health, safety and welfare and to make improvements where required.

Appropriate infection control arrangements were in place.

People were cared for by enough appropriately skilled and experienced staff.

Is the service effective?

People’s care needs were properly assessed before they received care, which was delivered in line with their individual care plan. People’s care plans were regularly reviewed to ensure their needs were being met.

People’s relatives were happy with the standard of care provided and they told us that care was designed and delivered to meet people’s individual needs.

Is the service caring?

The three people’s relatives we spoke with were positive about the care provided. Their comments included, “I am fully involved in deciding on the best care and support. It’s a fantastic place with a great ethos.” And, “There is a good standard of care here. I am happy my relative is at this home.”

Staff understood people’s needs and we saw they interacted with people in a caring and respectful manner.

Is the service responsive?

The provider informed people about how to complain and people’s relatives we spoke with said they knew how to do this. They also told us they were happy with people’s care and had not needed to complain.

The service had recorded the details of accidents and incidents that had occurred. These had been investigated and the cause of the issues identified. Service improvement actions plans had been put in place.

People’s relatives told us that they thought the provider was responsive.

Is the service well-led?

A registered manager was in place.

The provider had an effective system in place to check the quality of care provided. Records showed that regular checks were carried out to identify and manage risks to people’s health, safety and welfare. Where improvements were needed, action plans had been put in place to deal with them.

Relatives we spoke with told us that they were involved in the planning of care and attended meetings and reviews of care but we saw consent forms were not always signed. We saw that capacity assessments were not used to determine the level of decision making a person was able to understand.

Relatives we spoke with told us that they were satisfied with the care provided. Two told us they would not want their relative to be anywhere else and one said “The dignity here is top class”. Other relatives described the service as friendly and approachable and they confirmed call bells were answered promptly.

We received mixed feedback about staffing levels. Three relatives we spoke with told us that they thought there were insufficient staff. One said “Staffing is inadequate” and another said there was no time for staff to speak to people and that mealtimes were an issue. Three other relatives did not raise any issues about staffing and one told us “Staffing is pretty constant”. Staff also gave us mixed feedback about staffing with one stating the provider’s staffing standards were high and another saying insufficient staff was an issue for mealtimes. Our observation noted people receiving their breakfast late. This meant that there had been little improvement to staffing since our previous visit in February 2013.

We spoke with six members of staff, the manager, deputy manager, administrator, four relatives and two visiting professionals during the visit. We spoke with two relatives and four visiting professionals by telephone following the visit.

Our observation showed us that staff showed warmth and encouragement towards people and maintained their dignity. Relatives we spoke with confirmed that staff showed respect to the person they were involved with.

We saw that the service used the correct legal processes when decisions needed to be made where people lacked capacity and that best interests assessments were completed where necessary. We saw that proper authorisations were in place where a person’s liberty was being restricted.

All relatives we spoke with confirmed that appropriate advice and guidance was sought from health professionals and that they were kept informed of any health issues. One relative told us "Health issues are picked up very quickly" and another said they were very pleased with the efforts made to ensure their relative did not develop a pressure ulcer. One relative described the staff as wonderful.

We saw that there were occasions when there were insufficient staff and that this meant there were delays in people receiving assistance at key times, such as meal times.

We saw the provider had a system for assessing and monitoring the quality of the service and responded to complaints appropriately.