This inspection took place on 11 and 12 October 2018. The first day of the inspection was unannounced. This meant the staff and provider did not know we would be visiting. The second day was announced.

Maple Lodge Care Home 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 (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Maple Lodge Care Home accommodates 46 people across two floors in one purpose built building. Some of the people had nursing care needs and some of the people had a dementia type illness. On the days of our inspection there were 40 people using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

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 were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Maple Lodge Care Home.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider’s complaints policy and procedure was made available to people however there had not been any recent complaints.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People, visitors and staff were regularly consulted about the quality of the service via meetings and surveys.

The last inspection of Maple Lodge Care Home was carried out in May 2016. At that inspection we found the provider had breached regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have accurate records to support and evidence the safe administration of 'as required' medicines and prescribed creams. We carried out this unannounced focused inspection on 8 December 2016 to check whether the provider had made improvements to the way medicines were managed.

Maple Lodge is a care home which provides nursing and personal care for up to 46 people, some of whom may be living with dementia. There were 44 people living there at the time of our inspection.

There was a registered manager in place at the service who had been in that role for several years. 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 found the service had made improvements to the way medicines were managed.

The inspection took place on 24 and 27 May 2016. The first visit on 24 May 2016 was unannounced. The second visit on 27 May 2016 was announced. We last inspected the service in May 2014 and found the service met the regulations we inspected against at the time.

Maple Lodge is a care home which provides nursing and personal care for up to 46 people, some of whom may be living with dementia. There were 44 people living there at the time of our inspection, 10 of whom were accommodated on a ‘Time to Think’ assessment unit which gives people the opportunity to trial residential care.

The service had a registered manager. 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 found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records and procedures to support and evidence the safe administration of ‘when required’ medicines and prescribed creams.

You can see what action we told the provider to take at the back of the full version of the report.

On both days of our inspection there was a homely atmosphere. Staff interacted with people in a friendly and respectful way. People were encouraged and supported to maintain their independence and to pursue their interests and hobbies. The service was clean and well decorated.

People and relatives told us they felt the service was safe. One person said, “I feel safe as the staff take care of everything. I’m happy here because it’s great.” Another person told us, “It’s lovely here as we get well looked after. I’ve got no problems whatsoever.”

Staff we spoke with said they had completed safeguarding training and could describe different types of abuse and signs to be alert to. Staff told us they would report any safeguarding concerns immediately.

The provider made sure only suitable staff were employed. Thorough background checks were carried out before staff started to work with people who used the service.

There were regular reviews of people's health and care needs and staff responded promptly to any changes. People saw health and social care professionals to ensure they received treatment and support for their specific needs.

People's dietary needs were met. People were provided with a choice of meals and had access to regular snacks and drinks throughout the day.

People who used the service told us they were well looked after and staff were caring. One person said, “I love the girls here as they look after me so well. They’re marvellous.” Relatives also spoke positively about the caring attitude of staff. One relative told us, “I’m really happy with the care [family member] receives.”

Care plans were detailed and specific to people's individual needs. They were reviewed and updated regularly. When people's needs changed this was acted on promptly.

People knew how to make a complaint and were given information about the service.

People who used the service, relatives and staff told us the registered manager was approachable and efficient.

There were effective quality assurance processes in place to monitor care and safety and identify improvements. The views of people who used the service, relatives, staff and other health care professionals were frequently sought.

We spoke with 12 people who used the service and six relatives. Most people we spoke with made positive comments about the service provided.

One person told us “I am happy with the care and the staff are very nice”. Another person said “It is lovely here, staff are very nice, the food is very good, I am happy here”.

One relative said “The care is good and my parents are well looked after”. Another relative told us “Occasionally they run out of the special drink Dad has and I do not think this is right, but yes, most of the care is good and staff are very respectful and do preserve Dad’s dignity.”

We saw that suitable arrangements were in place to obtain consent to care and treatment from people. People experienced care and treatment and support that met their needs and protected their rights. We found there were sufficient numbers of suitably qualified staff and the provider had a system to regularly assess and monitor the quality of service that people receive. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We spoke with people who used the service about information available to them about the service provided at Maple Lodge. People told us they were “well informed” about the home and one person showed us a copy of the service user guide which they had kept in their bedroom.

The “residents meeting” minutes showed that the staff involved the people who used the service and their relatives in decisions about the home. For example, the minutes showed discussions around social activities, menus, residents’ choice, complaints and people’s rights. One person we spoke with told us, “The residents meetings are good. My daughter attends as well”.

People told us they were happy at Maple Lodge Care Home and that staff supported them well with their healthcare needs. People we spoke with told us they received regular medical care from their GP and from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required. One relative we spoke with told us, “The staff are wonderful carers and we are confident mom is well looked after”. Another relative told us, “They always let us know when something happens to dad. They are very good at keeping us informed”.

People who used the service told us they felt the home helped them to gain their independence. They went on to tell us, “The physios are wonderful and I think I am ready to go back home”.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

The service is safe. There are systems in place to make sure the environment is clean and infections are controlled.

People have good assessments of their needs and risks associated with their care and staff act in accordance with their plans.

Staffing levels were calculated so that there were always sufficient numbers of staff on duty to meet people’s needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

The care plans and risk assessments associated with people’s needs were comprehensive. Staff knew what people needed from those care plans and daily discussions they had about individuals.

There are systems in place where the nurses ensure that not only medical needs are met, but also diet and eating requirements get appropriate support from staff. We spoke to one visiting social worker who has had several people living in the home. She told us that the home communicate well with her to make sure peoples changing need were continuously met. Records showed that that people’s needs were being met. Recording was of a high standard

Is the service caring?

Observations of the staff and feedback from people living there and their relatives showed that staff within the home were caring. “One person told us they were comfortable leaving their relative there- they knew the person was happy and that he would get good care”.

Another person told us “it’s always the same; it’s always good the way staff care about people”

Is the service responsive?

The service is responsive. The care records showed that people’s needs were met, and that people’s care was changed when their needs changed. There was evidence throughout the care records of involvement by people living there and their relatives one person said, “I get told everything they do, I even get involved in medical care issues, and usually get to go with them”

Is the service well-led

The service is well lead by a very experienced registered manager. There were good systems in place to monitor the care provided. The registered manager was described as approachable to “give guidance and advice if needed”