Maple Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Maple Lodge accommodates up to five people. At the time of our inspection there were five young people with learning disabilities and other complex needs living at the service. Maple Lodge is a detached bungalow in a cul-de-sac in Colchester which forms part of a group of similar properties owned by the same provider. Each property is a distinct service, though there are some shared communal facilities and joint social events.

This unannounced comprehensive inspection took place on the 19 and 23 July 2018.

At the last inspection in May 2017, the service was rated as requires improvement. We had concerns people were not always safe as staff did not have the necessary guidance about how to safeguard people from abuse and there were shortfalls in the storage and management of people's medicines. The requirements of the Mental Capacity Act 2005 were not being met when making decisions for people who lacked capacity. We also found some staff did not treat people with respect. A lack of oversight by the manager meant these shortfalls had not been picked up and resolved as required.

At this inspection we found the provider had addressed our concerns and we rated the service as good in all areas.

There was a new registered manager in post who had arrived at the service at the end of 2017. 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.

The new registered manager was a passionate leader who inspired staff to share in the improvements at the service, which were ongoing and based on research into best practice. The culture of the service had become more person-centred and there was a focus on respect and openness. There were systems in place to check on the quality of the care, though there was room for improvement in the oversight the provider had of the service. There was limited impact during our inspection from this however due to the strength and quality of the registered manager.

The registered manager had focused on reducing risk at the service, in particular reducing the number of medicine errors. Every area of medicine administration had improved, from staff skills to guidance and quality checks. This demonstrated a commitment by the new manager to ensure people at the service received safe support.

There were improved systems when concerns had been raised that people were at risk of abuse. Investigations were open and the registered manager communicated well with outside organisations as necessary. Staff knew who to contact if they were concerned about people’s safety.

Risk was well managed in a personalised manner through effective assessment and planning. Measures to reduce the spread of infection were practical and effective. There were enough safely recruited staff to meet people’s needs.

Staff felt well supported and valued. They were enabled by the registered manager to develop specialist skills and gain a better understanding of the needs of the people they supported. The staff team worked together and communicated well to provide consistent support. People’s physical and mental wellbeing was promoted and they received support to access health and social care professionals when required.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where

Maple Lodge is a residential care home that provides personal care and support for up to five people who have a learning disability and/or autistic spectrum disorder. On the day of our inspection there were five people living at the service.

There was 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. The manager is registered for this service and one other local care service and is also one of the organisation’s directors.

This inspection took place on the 9 May 2017 and was unannounced.

Prior to our inspection we received information of concern regarding incidents of alleged abuse against people who used the service. Despite a previous, recent reminder to the registered manager of the need to do so, we found they had on three occasions in the last four months failed to notify the Care Quality Commission (CQC) as they are required by law to do so of alleged safeguarding incidents of abuse towards people who used the service. This included incidents investigated by the police.

Staff had been provided with training in Safeguarding Adults from abuse. However, policies which guided staff in how to report poor practice and safeguard people from the risk of abuse had not been regularly reviewed. These policies contained out of date information and did not provide staff with up to date, relevant guidance in line with local safeguarding protocols and current regulatory requirements.

We found shortfalls in the proper and safe management of people’s medicines. Controlled drugs were not held safely and there was a lack of audit trail which meant it was not possible to carry out audits. There was a lack of robust and effective audits which would have identified the shortfalls that we found at this inspection to enable the provider to respond to medication errors. The provider's medicines management policy, which provided staff with procedural guidance for ensuring the safe administration of people's medicines, did not provide the level of detail required in line with current legislation including National Institute for Clinical Excellence (NICE) guidance for managing medicines in care homes.

People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Staff were provided with training relevant to their roles and responsibilities. People were not always treated with respect. Whilst most staff demonstrated caring attitudes to people who used the service, the culture and practices had been undermined by some.

The requirements of the Mental Capacity Act 2005 were not being met. Decisions were being made on behalf of people without the correct process having been followed to determine this was appropriate. Staff were making decisions on behalf of people without appropriate assessments to support decision making which put people at risk of not having their human rights upheld.

People's needs had been assessed and care and support plans outlined their preferences and how they should be supported. People were supported to access the community and follow their interests. There were systems in place to support people to maintain their health and wellbeing. People had balanced nutritious food provided. People’s weights were regularly monitored and recorded. However, we noted that some weights recorded showed significant losses and gains from week to week with no information recorded as to any actions taken in response. People were supported to access health care including learning disability and epilepsy specialists.

There were systems in place to manage complaints and review incidents, audit performance as well as monit

Maple Lodge provides support and care for up to four people living with learning disabilities and autism. There were four people living in the service when we inspected on 12 June 2015.

There was a registered manager 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.

People received care that was personalised to them and met their needs and wishes. The atmosphere in the service was friendly and welcoming.

Appropriate recruitment checks on staff were carried out with sufficient numbers employed. Staff had the knowledge and skills to meet people’s needs. People were safe and treated with kindness by the staff. Staff respected people’s privacy and dignity and interacted with people in a caring and compassionate manner.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. The safeguards are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to deprive them of their liberty. This is usually to protect themselves. At the time of our inspection the registered persons had consulted with the relevant local authorities who had determined if people were being deprived of their liberty and so needed to have their rights protected.

Staff knew how to recognise and respond to abuse correctly. People were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were provided with safe care where risks were identified proactively and management plans were in place in respect of known risks. Care and support was individual and based on the assessed needs of each individual. Appropriate arrangements were in place to provide people with their medicines safely.

Staff supported people to be independent and to meet their individual needs and aspirations. People were encouraged to attend appointments with other healthcare professionals to maintain their health and well-being.

People received all of the care they needed including people who had special communication needs or who were at risk of becoming distressed. People had been consulted about the care they wanted to receive and they were supported to express their individuality. Staff had assisted people to pursue a wide range of interests and hobbies. There was a system for resolving complaints.

People had been consulted about the development of the service and regular quality checks had been completed. The service was run in an open and inclusive way and people had benefited from staff receiving good practice guidance.

People voiced their opinions and had their care needs provided for in the way they wanted. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. People knew how to make a complaint and any concerns were acted on promptly and appropriately.

People were provided with a variety of meals and supported to eat and drink sufficiently. People enjoyed the food and were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

There was an open and transparent culture in the service. Staff were aware of the values of the service and understood their roles and responsibilities. The manager and provider planned, assessed and monitored the quality of care consistently. Systems were in place that encouraged feedback from people who used the service, relatives, and staff and this was used to make continual improvements to the service.

During our inspection we used different methods to help us understand the experiences of people who used the service. Where people were unable to tell us about their experiences, we used observation and noted people’s responses to staff. We saw that people appeared calm and relaxed in the presence of staff.

We saw that each person had their own unique communication plan which staff and other professionals used to support them in understanding people’s wishes and aspirations.

We saw that care plans and risk assessments were regularly reviewed with people who used the service or relatives if they were unable to fully participate. We saw that staff were knowledgeable about people’s needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences.

We saw that the provider had an effective recruitment and selection process in place.

We saw that there was a complaints policy and procedure in place which was in an easy read format. The staff were able to explain the complaints procedure. People who used the service told us they were aware of how and who to complain to.

The registered manager is no longer working at Maple Lodge. The provider has been asked to notify us when they have completed the deregistered process.

People who lived at Maple lodge had very complex needs and they had different ways of telling us about their experiences. On the day of the inspection, we observed that people were supported by staff who engaged with them in an encouraging and direct way. The staff were aware of the individual needs, communication styles and behaviour of people who used the service.

Maple Lodge had made improvements since our last inspection in June 2012. These included reviewed and updated care plans, risk assessments and behaviour management strategies. Consent to care and support arrangements had been implemented and person centred activities were now in place which gave people more choice and control in their lives.

The changes made to the administration of medication in the home meant that people were kept safe and protected from the risks associated with the management of medicines. Staff training and support had improved in order that the staff could perform their caring role satisfactorily.

A quality assurance system was now in place which included action plans, regular audits to check quality and safety, better recording and information sharing about people's needs. People at Maple Lodge could be assured that systems and processes were in place to keep them safe and to protect their rights.

The people who lived at Maple Lodge had different ways of communicating such as through words and sounds, gestures and body language. They did not respond to many of the questions that we asked them. We saw that some people were engaged in different activities such as household tasks and the staff encouraged people to participate in those activities in a respectful and patient way.

The people who lived at Maple Lodge had different ways of communicating such as through words and sounds, gestures and body language. They did not respond to many of the questions that we asked them. We saw that people were engaged in different activities and were supported and respected by the staff team during our visit.