This inspection took place on 20 December 2017 and 2 January 2018. The visit on the 20 December was unannounced. The visit on the 2 January 2018 was announced.

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 45 people in one building with all bedrooms and facilities located on the ground floor. The service specialises in providing care to people living with dementia. At the time of this inspection 42 people were using the service.

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.

Not all of the people using the service were able to verbally tell us their thoughts about the service. We spent time sitting and chatting with people in the lounge areas and during mealtimes. We saw that people were comfortable with staffs approach to them and it was evident that staff knew people well.

People and their relatives felt that the service was safe. Staff were aware of the policies and procedures in place for safeguarding people. Staff had received training in relation to safeguarding people.

Staff supported people in a kind and caring manner whilst respecting individual’s privacy and dignity.

People's medicines were managed safely and appropriate storage facilities were in place.

People’s living environment was clean and tidy and effective control measures were in place to protect people from infection.

Systems were in place to ensure that people’s rights were maintained under the Mental Capacity Act.

People’s needs were assessed and when a need was identified, care plans had been developed to inform staff as to what support a person needed. Family members felt involved in their relative's care planning process.

People had access to activities within the service and the local community with the support of an activities co-ordinator.

The registered provider had procedures in place that ensured the safe recruitment of staff. This helped ensure that people were supported by staff who were suitable to work with vulnerable people.

A complaints procedure and recording system was in place. People and their relatives knew who to speak to if they wanted to raise a concern about the service.

The CQC were notified as required about incidents and events which had occurred within the service.

People were cared for by staff who had received appropriate training. Staff completed a variety of training relevant to their role and responsibilities. This helped ensure that people receive safe effective care and support.

This inspection took place on the 7 and 13 October 2016 and was unannounced.

Maple Lodge provides residential care without nursing for up to 44 older people. Some people living at the service were living with dementia. All accommodation is provided at ground floor level. People had access to secure outside seating areas. Car parking facilities were available at the rear of the building and the service was situated close to local amenities. There were 31 people living at the service at the time of our inspection visit.

At the time of this inspection there was a new manager in post who was in the process of submitting their application to register with the Care Quality Commission. 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 of this service on 5 and 9 November 2015 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements, in relation to safeguarding people, mitigating risk, management of medication, training and support for staff and systems in place to assess, monitor and improve the service. We received an action plan from the registered provider detailing how and when they intended to make improvements to the service. At this inspection we found that the registered provider had made improvements to the service.

At the previous inspection in November 2015 we found that insufficient and ineffective systems were in place to assess, monitor and improve the service. During this inspection we found that improvements had been made in this area. However, we have made a recommendation that the registered provider strengthen their processes to ensure that all aspects of the service are considered in the auditing process. This was because the auditing systems had failed to identify a lack of records in relation to the care people received and pressure relieving equipment.

We have made a recommendation about records. Night care records lacked detail about the care and support people received through the night.

We have made a recommendation about the setting and monitoring of pressure relieving mattresses.

Not all staff had received training for their role. The registered provider had recently employed a trainer to identify, plan and deliver training throughout the service to ensure that all staff receive the training they required.

Procedures and information was available to assist staff to identify and report any concerns they had about a person’s safety. In addition, information was also available to people who used the service, family members and visitors on how to raise concerns about a person they may feel was at risk from abuse.

The atmosphere within the service was busy with lots of conversations taking place between people and their many visitors. It was evident that strong effective relationships had been formed between people and the staff that supported them. When invited, staff offered positive touch and hugs to offer reassurance.

Systems were in place for the management of people’s medication. Designated storage facilities were available to ensure that people’s medication was kept safe. Records of medication administered were maintained and checks were carried out on a daily basis to help ensure that people had received their medication safely.

Safe recruitment procedures involved obtaining appropriate written references and a Disclosure and Barring Service (DBS) check prior to a member of staff commencing their full employment. These checks helped the registered provider ensure that only suitable people were employed at the servi

We inspected the service on the 05 and 09 November 2015. The inspection was unannounced.

Maple Lodge Residential Home provides residential care without nursing for up to 44 older people. People living at the service may be living with dementia. There were 34 people living at the home when we visited.

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

People’s care plans were in place, although not all care plans contained sufficient details to ensure that care staff had enough information to deliver care to people. Care plans were not regularly reviewed to help ensure they reflected people’s needs. People or their representative had not always involved in planning their care and enabled to make choices about how they wanted their care to be delivered. Not everyone had risk assessments in place. Those in place had not been regularly reviewed or always linked to care plans.

We looked at the medication processes within the home; we found that some quantities of medication had not been recorded for one person. This potentially placed the person at risk of harm.

Some of the people who lived at Maple Lodge did not have the capacity to make their own decisions about their care. The staff’s understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) was limited. Some people had recently been subjected to DoLs. There was no clear guidance for staff about how to support people to make decisions.

There were sufficient staff on duty to meet people’s needs safely. There was a training programme in place although some of the training was out of date, such as safeguarding training and moving and handling training. Staff were appropriately recruited.

People who lived in the home said the food was good; people’s nutritional needs had been assessed, although one person’s dietary needs had not always been provided in accordance with their care plan.

Staff interaction with people was observed to be good during the inspection, with activities being provided by the activities coordinator.

We saw that complaints and concerns had been responded to appropriately when raised by people or their representatives.

Following our inspection the management structure has improved. The registered manager is now dedicated to managing the home five days a week

Staff told us the registered manager was approachable and they generally felt supported and valued, although we found that regular supervisions for care staff had not taken place since March 2015.

There were limited quality monitoring systems in place, regarding obtaining people’s views and opinions about the service delivery. Some audits / checks had not been carried out.