Marner House

Updated 10 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 January 2018 and was announced because part of the service provided personal care to people in their own homes. We announced our inspection to be sure people and staff would be available to talk with us. The inspection was carried out by one inspector.

Before our inspection visit, we looked at and reviewed the Provider’s Information Return (PIR). This is a document that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We found the PIR reflected the service provided.

We also reviewed the information we held about the service. This included information shared with us by the local authority commissioners and statutory notifications. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority. A statutory notification is information about important events which the provider is required to send us by law.

We spoke with five people who lived at Marner House, one of whom lived in a ‘step down’ flat. We also spoke with one person who lived in their own home in supported living accommodation, and were supported by staff to live independently. We gathered feedback from staff including the registered manager, the therapy co-ordinator who also organised social activities for people, the deputy manager and two members of care staff. We also received feedback from a visiting social worker, and a health professional, who had regular contact with people at the home.

We looked at a range of records about people’s care including four care files. We also looked at other records relating to people’s care such as four medicine records and fluid charts that showed what drinks people had consumed. This was to assess whether the care people needed was being provided.

We reviewed records of the checks the manager and the provider made to assure themselves people received a quality service. We also looked at recruitment and supervision procedures for members of staff to check that safe recruitment procedures were in operation, and staff received appropriate support to continue their professional development.

Updated 10 February 2018

The inspection took place on 17 January 2018 and was announced. We gave the provider two days’ notice of our inspection visit, so that we could be sure the manager and people were available to speak with us. Voyage 1 Limited is a large provider of care services. Marner House provides accommodation, personal care and rehabilitation support for up to 12 people; eight people in the main house and four people in ‘step down’ flats.

The service specialises in providing rehabilitation to people that have an Acquired Brain Injury (ABI). An ABI can be the result of a traumatic brain injury from an accident, head injury or neurosurgery. The ABI can lead to permanent or temporary changes in a person’s functioning; their cognitive, physical, emotional or behavioural functioning. The service works closely with other professional organisations in providing the agreed rehabilitation care and support to people so that they can progress from living in the main house to one of the ‘step down’ flats before moving to supported or independent living accommodation. There were eleven people living in the home on the day of our inspection visit, four of which lived in ‘step down’ accommodation. For these eleven people, they received accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There were a further four people who lived in supporting living accommodation, where they received only personal care from staff in their own homes, on the site. A further two people were supported in their community in their own homes by staff employed by the provider. These arrangements ensured people lived as independently as possible. People’s care and housing in these circumstances were provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support only for these six people.

There was a registered manager in post who had been at the service for approximately six months. A requirement of the service’s registration is that they have 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 refer to the registered manager as the manager in the body of this report.

At our previous inspection in April 2016 we rated the service as Good, in all areas except Responsive. Responsive was rated as Outstanding. At this inspection we have rated the service Good in all areas.

The vision of rehabilitation was at the heart of the service and was shared by people at Marner House and the staff team. Staff were enthusiastic and positive about their work in enabling people’s brains to learn to do things, following acquired brain injuries such as from road traffic accidents.

People were encouraged and supported by caring and compassionate staff to follow their agreed rehabilitation plans. Staff were well trained and effectively used their skills and knowledge to develop trusting relationships with people using techniques in response to individual needs.

Staff understood their responsibilities to keep people safe and protect them from harm. Policies and guidance were accessible to staff to remind them how to raise concerns following the provider’s safeguarding and whistleblowing policies. Risks to people had been assessed. Staff were trained to support people to take positive risks; such as cooking and manage risks that could present a risk of harm or injury to people or others.

People had their prescribed medicines available to them, staff supported some people to take their medicines, other people were able to manage their own medicines and were encouraged to do so. Staff received training in the safe handling, administering and recording of people’s medicines.

People were involved in planning their care. Staff read people’s care plans and received an induction and training so that they knew people well. Further training took place to update and refresh staff skills and knowledge.

The manager and staff understood their responsibility to comply with the requirements of the Mental Capacity Act (2005) and worked within the principles of this. Management and staff had an understanding of the Deprivation of Liberty Safeguards (DoLS).

Health care professionals were involved in people’s rehabilitation plans care and staff followed guidance given by multi-disciplinary team professionals. People’s agreed rehabilitation care and support was reviewed when required and planned reviews also took place. Staff supported people to access healthcare appointments to maintain their wellbeing.

Staff understood the goal of person centred rehabilitation and promoted people’s independence whenever possible; toward achieving the overall goal. People were involved in making everyday choices about their activities, when they got up, and the food they ate.

People said staff were kind and respectful toward them. People’s feedback on the service was sought by the provider. People told us they felt they could raise concerns or complaints if they needed to.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. Where improvement was needed, action was taken.