Mary House

Updated 12 July 2023

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 Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

Mary House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Mary House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. The registered manager worked at the service two days a week. However, there was also a manager with day-to-day responsibility for the running of the service and they facilitated the inspection so are referred to in this report as the manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We reviewed the information we held about the service and the service provider. We looked at notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We used all this information to plan our inspection.

During the inspection

We spent time observing how staff interacted with people to help us understand the experience of people living at the service. We spoke with the registered manager, the manager, 2 nurses and 11 staff members. We looked at a range of records relating to the home, which included records relating to health and safety, and the management of the home. We spoke with 6 people’s relatives and received correspondence from a further 5 relatives. We received correspondence from 6 health and social care professionals. We looked at 4 people’s care plans, audits, training data, 2 staff recruitment records, quality assurance records and meeting minutes. We have continued to seek clarification from the provider to validate the evidence found.

Updated 12 July 2023

About the service

Mary House is a care home providing personal and nursing care to up to 15 people. The service provides support to people with complex learning disabilities, autistic people, and people with physical disabilities. At the time of our inspection there were 14 people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support:

Risks to people were not always managed safely. Medicines were prepared in advance of giving them and not signed by the staff member who had given them. Medicines that were prescribed on an as required basis were not always managed safely. There was limited oversight to ensure some people had enough to drink throughout the whole day.

The systems in place ensured that people were protected from abuse and improper treatment. Mary House was kept clean. Although there were high staff vacancies the service used regular agency staff who knew people well. 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.

Right Care:

Although records of activities were basic and lacking in detail, we observed that staff worked with people in a person-centred way to involve them as far as possible in all activities. The number and range of activities had increased since our last inspection, and people were going out more to places of interest. Staff were caring in their approach and people responded warmly to them. We saw people smiling and responding with happy faces when staff spoke with them. Staff ensured people’s privacy and dignity was always maintained.

Right Culture:

Systems to monitor the quality of records in relation to staff recruitment, daily records and incident reporting were not effective as they had not identified the matters we raised. The management of medicines was not effective, but the service had recognised this and was seeking advice and support and actively trying to improve in this area.

We received mixed feedback from parents and professionals. Most felt that the service had made significant improvements and were on track to improve further. Although all recognised the improvements, further work was needed to improve communication, to be more accessible and to work together in people’s best interests.

Staff felt supported by the management team. All staff had attended a supervision meeting and staff meetings were held to give staff the opportunity to share their views on the running of the service. Staff morale had improved since our last inspection and all staff spoken with felt positive about working at the service.

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 17 December 2022) and there were breaches of regulation. We served the provider Warning Notices under Section 29 of the Health and Social Care Act 2008. The notices required the provider to become complaint with breaches relating to person centred care and governance.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mary House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified continuing breaches in relation to safety and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.