Martha House

Updated 7 May 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors on the first day and one inspector on the second day.

Service and service type

Martha House is a ‘care home’. People in care homes receive accommodation and nursing 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The first day of the inspection was unannounced, the second day was announced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed the information we held about the service including previous inspection reports. We also looked at notifications about important events that had taken place in the service, which the provider is required to tell us by law. We contacted health and social care professionals to obtain feedback about their experience of the service. These professionals included local authority commissioners, the local authority safeguarding team. We used all of this information to plan our inspection.

During the inspection

Some people were unable to verbally tell us about their experiences, so we made observations of care to help us understand the experience of people who could not talk with us. We spoke with six staff, the deputy and registered manager as well as various administration staff and heads of departments. We also spoke with four visitors during the inspection.

We reviewed a range of records. This included three people's care records and aspects of other people’s care records as well as medicine records. We looked at a variety of records relating to the management of the service, including audits and checks, maintenance records, accident and incident records, complaints and policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found; all information requested was received. We also received feedback from two relatives of people that used the service.

Updated 7 May 2020

About the service

Martha House is a residential care home, providing nursing care, for adults with learning disabilities, autistic spectrum disorder and physical disability. Most people living at the service had profound conditions, complex care needs and were unable to communicate verbally.

There are two houses on site, Martha House and Frances House, both houses were included in our inspection. The site, including both of the houses are registered with CQC under one location name, Martha House.

At the time of our inspection, there were 14 people living in Martha house and eight people living in Frances house. There was a vacant room in Martha House in which people stayed for respite care. Both houses were purpose built, they provided accommodation for people on the ground floor, they were spacious, well equipped and welcoming. The site included a specialty activity suite with a hydrotherapy pool, a quieter area equipped with touchscreen televisions and specialist eye gaze equipment. Eye gaze is a system which enables some people to communicate by tracking their eye movement. There was also a communal area used for some events and social activities.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. Martha House was designed, built and registered before the guidance was published. The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 23 people and 22 people were using the service. This is larger than current best practice guidance.

However, as to the size of the service having a negative impact on people, this was mitigated by the building design fitting into the residential area and the other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, visible industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

While the design of the service did not meet current guidance, the service had however applied the principles and values of Registering the Right Support and other best practice guidance. This ensured that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. People's participation within the local community was encouraged and enabled.

People’s experience of using this service and what we found

People were supported to stay safe, relatives told us they did not have any concerns about the support people received. They were, without exception, very complimentary about the service, its staff and management as well as the support people received. Relatives we spoke with told us they found the staff were, “Exceptionally caring.”

Peoples needs were assessed before they moved to the service and further assessments were completed to ensure changing needs were met. Risks to people’s health, safety and welfare were assessed, identified and regularly reviewed. Accidents and incidents were recorded, analysed and used to inform learning to reduce the risk of reoccurrence.

There were enough staff to meet people's needs. Staff had a good knowledge of people’s support and communication needs. Medicines were managed safely, all staff administering medicines were trained and competency checked to ensure mistakes were minimised. Staff understood how to recognise abuse and the processes to follow should they have any concerns.

People’s capacity to make specific decisions was assessed and, where needed, best interest decisions were made with the involvement of other relevant parties. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. This was included in people’s care plans and reflected in the service’s policies.

We observed people being encouraged and supported to make their own choices and decisions. Some people choose their own food and drink and staff knew how to support people with specific eating and drinking requirements. Staff were trained and knowledgeable about their roles. People were supported to remain well and healthy and had access to external health care professionals.

People’s privacy and dignity was respected, people were encouraged to be as independent as possible. People’s diversities were considered and respected. Staff spoke to people in a kind and considerate way, people appeared relaxed and confident in their home.

Care plans reflected people’s needs and choices, guidance was clear and followed by staff so people received support in a consistent way. Relatives were involved in people’s care and their input into the running of the service was encouraged. People took part in a wide range of activities; staff were sensitive to the fragility of some people’s conditions and facilitated outings for family members to spend quality time with people.

People’s communication needs were assessed, staff knew how to communicate with people in meaningful ways and the service was equipped with specialized equipment to facilitate this. A complaints procedure described how people could make a complaint or raise a concern, an easy read, eyegaze and screen touch version was available. Some complaints had been received since the last inspection. These were logged and responded to in line with the provider’s policy; apologies were made when needed and all complaints were reviewed to inform learning.

There was an open and inclusive culture in the service. The registered manager and provider encouraged people, relatives and staff to feedback on any areas for change, so the service could improve. Staff felt valued and well supported, performance evaluation was robust. Auditing had identified any areas of concern and action was taken in response to this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 February 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.