We carried out this unannounced inspection of The Maples on 10 August 2017. We previously carried out a comprehensive inspection at The Maples on 12 October 2016. We found areas of practice that needed improvement. This was because we identified issues in respect to how the provider actioned areas of improvement identified via audits and feedback. The service received an overall rating of ‘good’ from the comprehensive inspection on 12 October 2016.

We undertook this unannounced comprehensive inspection in light of information of concerns that we had received, and to look at all aspects of the service and to check that the provider had made the required improvements. We found that the service was providing good care and that the improvements had been made. The overall rating for The Maples remains as ‘good’.

The Maples is located in Peacehaven, East Sussex. It provides accommodation with personal care and support to 24 older people, some of whom were living with varying stages of dementia, along with healthcare needs such as diabetes and sensory impairment. On the day of our inspection, there were 20 people living at the service.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. Systems were now in place to record required actions and monitor their progress until completed.

The provider continued to have arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services. Accidents and incidents were recorded and analysed and people told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People felt staff were skilled to meet their needs and provide effective care. Additionally, people enjoyed taking part in meaningful and appropriate activities in the service.

People remained encouraged to express their views. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs continued to be met and they reported that they had a good choice of food and drink.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team and this was observed throughout the inspection.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. People and staff found the management team approachable and professional.

This inspection took place on 12 October 2016 and was unannounced.

The Maples is registered to provide residential care for up to 24 older people. At the time of the inspection there were 21 people living at the service. Two people were in hospital. The service is not registered to provide nursing care and when necessary people were supported by the community nursing team.

The last inspection of the home was carried out on 9 July 2013. No concerns were identified with the care being provided to people at that inspection.

There was a manager who had been in post since April 2016 who had commenced their registration with us and was awaiting their registration interview. 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 and staff had confidence in the new manager and said they had had a positive impact on the home.

The service was well led. However, some improvements were required to the ways in which issues identified in the home as needing improvement were actioned. The provider and manager agreed to improve the systems of formal quality assurance to ensure issues were addressed within an agreed time frame.

People living at The Maples told us they were very happy with the care and support provided. The manager and staff cared about their personal needs and preferences. One visitor told us “They do seem to know them well.” One person told us ““We have no worries at all here. We are well looked after.”

The risk of abuse to people was reduced because there were effective recruitment and selection processes for new staff. There were checks to make sure new staff were safe to work with vulnerable adults. Staff were not allowed to start work until satisfactory checks and employment references had been obtained.

People were supported by sufficient numbers of staff who had knowledge and understanding of people’s personal needs, likes and dislikes. Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care and/or a relevant representative.

People enjoyed the food in the home. They had a choice of food and staff catered for people with specific dietary needs and preferences when required. Food was plentiful and the size of people’s meals varied according to their appetite and preferences.

People were able to take part in a range of activities according to their interests. Activities included musical entertainments, arts and craft and quizzes. People wanted to be able to access the garden more easily. This was discussed with the provider who told us plans were in place to improve the outdoor facilities.

Medicines were administered safely. Medicines were administered by staff who had received suitable training. Safe procedures were followed when recording medicines. Medicines administration records (MAR) were accurate. Audits of medicines had been completed and appropriate actions taken to monitor safe administration and storage.

People had access to a range of health professionals. Where people's health needs had changed, staff worked closely with other health professionals to ensure they received support to meet their needs.

All incidents and accidents were monitored, trends identified and learning shared with staff and put into practice. The registered manager was supported by a regional operations manager who supported them with their one to supervision and identifying day to day issues in the home.

Each person received a copy of the complaints policy when they moved into the home. None of the peop

During our inspection we spoke with two managers, two care workers and a GP. We also spoke with two relatives and seven people who used the service. We attended a staff meeting to better understand the running of the home.

We found that people were happy with the service. One person said, “I like living here, the people are nice.” A relative said, “It’s a good home. It’s comfortable and they don’t put restrictions on anything.”

People’s needs were assessed and care was planned and delivered to meet individual needs. People’s health was monitored and help sought when needed. A GP told us, “They’re good at communicating with me if they have any concerns.”

People’s nutritional needs were monitored. People had sufficient choice and were offered a balanced and varied diet that met their needs. One person said, “The food is excellent, especially the fish.” A care worker said, “It’s proper dinners like you’d cook at home. It’s decent food.”

There were enough skilled and experienced staff to meet people’s needs. One person said, “They respond to bells quickly.” A relative said, “I think the staff have the skills they need to look after my wife.”

There were systems to gather people’s views and actions were taken as a result of feedback and critical incidents. However, we found these systems needed to be formalised.

We found that records were accurate, fit for purpose and were kept securely.

As part of this inspection we spoke with the provider, the registered manager (referred to as the manager within the report), four people who lived at the home and three care workers.

At previous inspections in April and June 2012, we had found the provider non compliant in relation to supporting workers. At this inspection we found improvements had been made. We found systems to ensure that care workers were supported to deliver care and treatment safely and to an appropriate standard were in place. This means we found the provider compliant in this area.

One care worker we spoke with told us "I like it here". When asked if they felt supported by the management they told us "Yes very much so". Another care worker told us "I'm happy here, it's lovely".

The people who lived in the home told us they were happy with the support they had been received. They confirmed that care workers were kind and attentive.

At our last inspection in June 2012 we found that not all care records were up to date and accurate. This meant the provider was not compliant in the outcome relating to records. At this inspection we found that whilst some improvements had been made, shortfalls were identified. The lack of robust documentation and accurate recording meant the home could not demonstrate that at all times people were protected from the risks of unsafe or inappropriate care and treatment. This meant that the home was still non compliant in this area.

At previous inspections in January 2012, March 2012 and April 2012 concerns had been identified in relation to the services provided at this home and action was needed to address the shortfalls. The provider sent us an action plan setting out how they were going to ensure the improvements needed were made and specified dates for their completion. Although improvements had been made further improvements are still needed in relation to two outcome areas.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

People who were able to give their views told us that they were happy living at the home. They told us that staff look after them well and didn't rush them. We heard staff speaking to people in a dignified and respectful manner and demonstrating patience and understanding when supporting people.

We observed that people were relaxed in the home. Some people had chosen to spend time in their own rooms and others were engaged in a range of activities in the lounge such as watching television, knitting, chatting to one another and reading the newspaper.

People told us they received their medicines when they needed them and that the home arranged visits to and from health care professional's on their behalf. Staff we spoke with had a good understanding of people's support needs and were aware of their medical conditions. Feedback from the community matron, the district nurse team and the continence team was positive. They said that communication with the home was good, that the home contacts them for support when needed and that they follow their advice.

Staff told us that they felt supported and that the management were approachable however newly recruited staff had not received a formal induction to the home and the home had yet to fully introduce and embed a system for the formal supervision and appraisal of staff performance.

Shortfalls were identified in relation to record keeping in the home. Not all required records were in place and others were not sufficiently detailed or reviewed and updated when needed.

People told us that the food was good. One person told us that they had been given a second helping of breakfast because they were very hungry. People told us that care staff were good, but “very busy”. One person told us, “I have to wait so long sometimes for staff to come, that when they arrive it’s too late fore them to help me”.

People told us that staff were kind to them and spoke to them in a “kind and caring manner”. One person said that they could not “speak too highly of this home”. People told us that they were given choices about their care and that the food was “very nice” and “nothing to grumble about”.

Some of the people we spoke with were happy at The Maples. One person told us that “staff do a wonderful job and this is now my home for life”. Another resident told us that “everybody is very nice and everything is perfect.” People were keen to talk to us about a recent power failure at the home. We were told that “it was not a good situation, but staff did everything they could”. Another person said that the days without electricity were “a horrible time, but staff did their best”.

People told us that The Maples was a busy home and that: “it’s ok here if you don’t need a lot of attention”. One person said “I get one bath a week, staff are too busy to give any more”. Another resident informed us that “I can’t complain at all”. One resident referred to some of the staff as being “kind” and said that they “will do everything you ask of them”.