The service offers both personal care and accommodation and support for up to 15 older people who may also have care needs associated with dementia. The service has two floors and there is access to these via a passenger lift and staircase. On the day of our inspection they had one vacancy and they do not provide nursing care.

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.

At the last inspection the service was rated as Good. At this inspection the service remained Good.

The service was safe. Staff showed knowledge of safeguarding procedures and knew what actions they would take to protect people. People were kept safe and risk assessments had been completed to show how people were supported with everyday risks. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. There were sufficient numbers of staff on duty. People’s medication was well managed and people received their medication as prescribed.

The service was effective. Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker. They also received regular support and felt well supported by management.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People were supported to maintain their health and had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.

The service was caring. People had agreed to their care and had been asked how they would like this to be provided. Where this had not been possible family and other healthcare professionals had been involved. People were treated with dignity and respect and staff provided care in a kind, caring and sensitive manner. Meetings had been held for the people living at the service, relatives and for the staff. People felt listened to and that their views and opinions had been sought and the service had made appropriate improvements.

The service was responsive. Assessments had been carried out and care plans were developed around people’s needs and preferences. The service had a clear complaints procedure in place which was clearly displayed. This provided information on the process and the timespan for response.

The service was well-led. Staff, relatives, healthcare professionals and those living at the service spoke positively about the registered manager and felt the service was well managed. There were systems in place to regularly assess the quality of the service and that people were kept safe.

We carried out an unannounced comprehensive inspection of this service on 19 and 20 October 2015. During this visit we found three breaches of the regulations. We also issued a warning notice in retrospect of the concerns identified during our inspection and to evidence that the provider’s monitoring systems had not identified these concerns before out inspection had taken place. At the previous inspection the provider had immediately complied with our warning notice.

Concerns raised included the provider’s audit and governance systems, which were found not to be effective and had not highlighted the areas of concern that were found during the inspection. Although the service had some quality assurance systems and audits in place, these were not adequate as they did not identify the areas of concern regarding risks in the environment, people’s deprivation of liberty, and complaints as part of this process. We also found that the service had not ensured that the premises and equipment used had been well maintained and kept safe. There were a number of issues raised around risks in the environment and also infection control.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulation and also improvements they were to make with their quality assurance. We undertook a focused inspection on 19 April 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these requirements. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Maranatha Residential Home on our website at www.cqc.org.uk

Maranatha Residential Home offers both personal care and accommodation for up to 15 older people who may also have care needs associated with dementia care.

The service had a registered manager in post. 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.

At our focused inspection on 16 April 2016, we found that since our last inspection, audit and governance systems had been put in place to support the management and running of the service. Improvements had been put in place with regard to quality assurance and to rectify concerns raised regarding risks in the environment, people’s deprivation of liberty, and complaints management.

We spoke with and spent time with people who used the service. We also spoke with two people's relatives and staff members.

We looked at four people's care records. Other records viewed included staff training records, menus, health and safety checks and staff and resident meeting minutes. We considered our inspection findings to answer five key questions; is the service safe, effective, caring, responsive and well-led? This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. Staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS.) This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

The premises were suitable, accessible and safe for people, but continued improvements to the environment would be beneficial to people.

The service was kept clean and staff practice ensured that people were protected, as far as possible, from the risk of infection.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People made comments such as, "This is the best home I have been in so far," "The staff are caring," and, "It's small and you feel you can get to know people."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

We found that people were supported to eat and drink well with any concerns about their nutritional well-being addressed.

Staff working in the service were supported through induction, on-going training and supervision to offer people care and support to meet their needs.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect.

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken in to account and listened to.

We saw that staff were responsive to people's changing wishes and needs and supported them well.

People told us that they felt able to raise any issues they might have and felt that the service would act upon their concerns.

People's care records showed that where concerns about their well-being had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had not benefited from having a registered manager in post to provide good and stable leadership for some time. However, an application was in the process of being submitted.

People had the opportunity to express their views about the service.

People we spoke with told us that they were happy and well cared for at Maranatha. People told us, "I am very happy and comfortable here," and, "I have no complaints. It is much better than the last place I was in." People enjoyed the food provided at Maranatha and told us that they were given choice.

We found that improvements were needed to ensure that peoples' individual needs were properly identified and planned for with their involvement wherever possible. Activities needed to continue to develop taking into account peoples' individual needs and backgrounds.

People were given choices in their day to day lives and able to follow their own preferred routines.

Improvements were needed to ensure that the service was kept properly clean. Robust systems needed to be developed to ensure that the risks of the spread of infection were minimised through proper monitoring. The premises also needed improvements to ensure that people lived in a pleasant environment.

Medicines were stored, administered and disposed of safely but some attention to detail was needed to provide a fully robust system.

Improvements were needed to ensure that staff were properly trained and supported to care for people consistently.

There were not effective systems in place for monitoring and improving the quality and safety of the service, taking into account the views and suggestions of people living there.

You can see our judgements on the front page of this report.

People living in Maranatha Residential Home were able to talk to us to a degree, but not always able to fully express their views about their care or experiences. We therefore used a number of different methods to help us understand the experiences of people using the service. We observed how people interacted with staff and management and spent time with people using the service.

During our inspection we saw that people received good care and that staff treated them with respect. We found that staff were trained in safeguarding vulnerable adults and worked in ways that kept people safe.

We spoke with five people who use the service and four relatives. People told us staff treated them with dignity and respect. They advised the care was "good". People gave positive comments, stating they were “happy” or, “liked” living at the home. A person said “I’m quite content”. Relatives told us, “The care is good”, and, “We are very happy”.

We found that people were not cared for by staff that were supported to deliver care and treatment safely to an appropriate standard. Not all quality assurance systems in place were effective in monitoring and improving the service.

On this occasion we did not speak with anyone who uses the service about the way the service manages their medicines.

People we spoke with said that they were happy with the way that the home manages their medicines on their behalf.

The inspection took place on the 19 and 20 October 2015.

Maranatha Residential Home offers both personal care and accommodation for up to 15 older people who may also have care needs associated with dementia care. On the day of our inspection there were 13 people living at the service.

The service had a registered manager in post. 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.

The provider’s audit and governance systems were not effective and did not highlight the areas that were found during this inspection. The service had some quality assurance systems and audits in place, however these were not adequate as they did not identify the areas of concern regarding risks in the environment, people’s deprivation of liberty, and complaints as part of this process.

The service had not ensured the premises and equipment used had been well maintained and kept safe. There were a number of issues raised during the inspection around risks in the environment and also infection control. The area of concerns were discussed with the proprietor and manager and they took immediate action to rectify these issues. All areas of risks identified had been completed by the end of our inspection.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice.

The deputy manager and staff did have knowledge of the Mental Capacity Act (MCA) 2005 and mental capacity assessments had been carried out where people were unable to make decisions for themselves. Deprivation of Liberty (DoLS) assessments had not been routinely completed for those who may need them and due to this people’s rights may not have always been protected.

People had been given information on who to complain to and the process for complaints. However, complaints had not been routinely recorded and people could not be confident that their concerns would be listened to, investigated or recorded appropriately.

Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. There were sufficient numbers of staff on duty.

People’s medication was well managed. Medicines had been administered and or stored safely and effectively for the protection of people using the service.

People had been involved in decisions about their care or how they would like this to be provided. Assessments had been carried out and care plans been developed around the individual’s needs and preferences.

Staff had been offered training to help ensure they had the skills and knowledge required for their role as a care worker.

People were supported to be able to eat and drink sufficient amounts to meet their needs and were able to choose alternatives if they were not happy with the choices offered on the menus. People were supported to maintain good healthcare and had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians. The service kept clear records about all healthcare visits.