About the service:

Mariantonia House is a residential care home that accommodates up to 13 people living with learning disabilities, autistic spectrum disorder, dementia or mental health. At the time of our inspection there were 12 people living at the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

What life is like for people using this service:

People received safe support with their medicines by competent staff members. The provider had systems in place to respond to any medicine errors. The provider completed regular checks to ensure that people were receiving the right medicine at the right time and people’s medicines were stored correctly.

The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors. The provider, and management team, had good links with the local community which people benefited from.

People received safe care and support as the staff team had been trained to recognise signs of abuse, or risk and understood what to do to safely support people. Staff members followed effective infection prevention and control procedures. When risks to people’s health and welfare were identified, the provider acted to minimise the likelihood of occurrence.

The provider supported staff in providing effective care for people through person-centred care planning, training and supervision. People were promptly referred to additional healthcare services when required. People were supported to maintain a healthy diet and had choice regarding food and drink. The environment where people lived was well maintained and suited their individual needs and preferences.

People received help and support from a kind and compassionate staff team with whom they had positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age and gender. People were supported to develop their independence.

People participated in a range of activities that met their individual choices and preferences and that they found interesting and stimulating. People were provided with information in a way that they could understand. Policies and guidelines that were important to people were provided in a format they could easily access.

The provider had systems in place to ensure the Care Quality Commission was notified of significant events in a timely manner and in accordance with their registration. The provider had effective systems to monitor the quality of the service they provided and to drive improvements where needed.

More information in Detailed Findings below.

Rating at last inspection: Good (date last report published 09 June 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

Mariantonia House Residential care home is registered to provide care and accommodation to up to 13 people who have a learning disability. At the time of our inspection 13 people were living there.

The inspection took place on 26 April 2016 and was unannounced. We returned to the home on 4 May in order to speak with people we were unable to see on our first visit. Our second visit to the home was also unannounced.

At the time of our inspection registered manager was 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.

People told us they felt well looked after and safe living at the home. Staff were able to tell us how they made sure people were safe and the action they would take if they felt people were at risk of abuse.

Risks to people’s safety were taken into account and staff were aware of how to reduce these. People’s medicines were looked after by staff and people told us they received these regularly. Records were maintained to show when staff had administered people’s prescribed medicines.

People gave their consent before they provided care and support. People received care from staff who had received training and were knowledgeable about people care needs. Healthcare professionals were involved in people’s care as needed to maintain people’s well-being. Relatives told us they were happy with the care their family member received.

People who lived at the home responded positively to staff. Staff supported people in a kind and caring way and communicated with people appropriately. Staff enjoyed their work and received regular support from the registered manager. There were enough staff available to support people so their care needs were able to be met. The suitability of new staff members was checked before they started work. People who lived at the home and staff felt involved in the running of the home and were consulted by the registered manager. The registered manager knew people well and about their care needs. The registered manager was aware of the how the service was maintained. Systems were in place to audit people’s medicines and to ensure equipment and services were safe for people. People knew how to make a compliant if they were unhappy with the care provided.

People were supported to do things they enjoyed doing in the home and in the wider community. People liked the food available to them and were able to make a choice of what they wanted to eat and drink. The registered manager was usually at the home and knew people’s care needs. Care plans were in place and were regularly reviewed and updated.

The inspection was carried out by one inspector. At the time of our inspection there were 12 people who were using the service. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five people who used the service, three staff who were supporting them and from looking at records. This evidence helped us answer the five questions detailed below.

Is the service safe?

People were treated with dignity and respect by staff. People told us they felt safe and we observed a relaxed atmosphere. We found that people received their medicines as prescribed by the doctor. There were risk management plans in place for people and health and safety. We looked at how new staff had been recruited. This showed us the provider had carried out all of the necessary checks before staff began working in the home.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was evidence of people and or their relatives invited to be involved with the development and regular reviews of care plans. Staff encouraged and supported people in leading interesting and enriched lifestyles. We saw that staff respected people’s individual cultures. We overheard people making choices about what they wanted to do during the rest of the day and discussing future activities with staff. One person told us: “I like living here. I’m going home for my birthday.” The people we spoke with all said they received the standard of care and support that matched their needs. Staff had received training to meet the needs of the people living in the home. Arrangements were made so that staff could accompany people in attending appointments with their GP and at hospitals.

Is the service caring?

The people we spoke with were positive about the way they were cared for and supported. A person commented about their care: “It’s very good, they look after me.” People were cared for by kind and attentive staff. We observed a relaxed and friendly atmosphere between people who used the service and staff. Staff encouraged and supported people in maintaining their independence. People were asking staff to do things for them. Staff responded to their requests promptly and efficiently. The home was supported by a team of health and social care professionals who worked closely with staff in providing people's care needs.

Is the service responsive?

Talking with staff and looking at records confirmed that staff acted on the recommendations made by professionals. The home had its own transport. This helped to keep people involved with their local community and to access their preferred activities. Records confirmed people’s preferences and interests had been recorded and care and support had been provided in accordance with people’s wishes. People said they could make a complaint if they wanted to and who they would make the complaint to. We saw that there was a written complaints procedure for people to access. The manager told us they had not received a formal complaint for a ‘few years’.

Is the service well led?

The service had a quality assurance system in place. Records showed us that improvements had been made when they were identified through monitoring processes. Regular audits had been carried out that enabled staff to make changes that could be of benefit to the people who used the service. Staff told us they were clear about their roles and responsibilities and the ethos of the service. Staff received regular supervisions by senior staff to ensure they remained competent for their roles.

At this inspection we spoke with four people who lived at the home to gain their experiences of the care, treatment and support that they received. People who lived at the home told us about their experiences of life at the home. One person told us: “It is excellent” and: “Whatever I need they (the staff) help me.” Another person said: “It is brilliant, I’m free to do what I please” and: “They (the staff) take me down to the doctors when I need to go.”

We saw that people were treated as individuals and supported to be involved in all aspects of their life as much as possible.

We found people who lived at the home were safe and their needs were met by staff that knew them well. Every person had an individual plan of care, based on their learning disability needs, and other social and health needs.

Our observations during this inspection supported that there was enough staff available to ensure people received the right care, at the right time. We found that minimum staffing levels identified and planned for were met.

We found that people had their own rooms which were private and personal to them. One person who lived at the home told us: “My room is nice and I like it. I have my own key so that I can lock it when I want to.” There were regular checks being completed to ensure that the premises were safe.

People who lived at the home told us that if they were not happy with the care and support they received they would tell the registered manager or staff. The views of people and families were used to improve the quality of services delivered.

Following our inspection in April 2012, we set compliance actions in a number of outcome areas where we had concerns. These included the systems in place for managing people's finances were not sufficiently robust to protect people from the risk of financial abuse. We also identified that how people’s medicines were being managed placed people at risk from harm.

The provider had submitted an action plan in response to these concerns. At this inspection we found that progress had been made in all of the outcome areas where we had previously had concerns and improvements had been made.

Ten people were living at the home when we inspected. We talked with five of them about their experiences of living there.

People we spoke with told us that staff treated them with respect and helped them to be as independent as possible. Throughout the day we observed staff supporting people with words of encouragement where needed whilst completing tasks. We also saw that time was taken to pass the time of day through general chat between people who lived at the home and staff. It was evident that staff had a good rapport with people and it became evident that the registered manager and staff knew people’s likes and dislikes.

People that we spoke with told us that they felt safe living at the home and had people they could speak with if they had any concerns.

We looked at medicine practices in the home and saw that people received their medicines in the right way and at the right time to meet their health conditions. One person who lived at the home told us about how they were supported to keep and take their own medicines.

People who lived at the home who we spoke with said that they had regular group and one to one meetings. People told us they shared their views about any improvements they would like staff to add into their care and support plans and to the daily life within the home.

We visited the service on 5 April 2012. There were thirteen people living there. People told us they liked living at the home and that staff helped them to do the things they wanted. They said that they could choose what they did and what they ate and drank.

People were dressed in individual styles and attention had been given to their personal care, so promoting their self esteem.

Care plans did not reflect people’s personal choices, desires or skills and abilities and as such were not personal to the individual. This meant people may not have their needs met in a way they prefer. There was a lack of opportunities for people to express their views about their care.

People had regular health checks and records were made of these so that all staff knew how to support people with their health.

We saw that staff had training in safeguarding and knew what to do to ensure that people were protected from the risk of abuse or harm. The systems in place for managing people’s finances were not sufficiently robust to protect people from the risk of financial abuse.

The procedures for managing people’s medicines had not been consistently followed which meant that people had not been protected from the risk of harm from unsafe practices.

There were systems for recruiting staff but these had not been consistently followed. This meant people had been cared for by a person who had not been suitably vetted to ensure they were suitable to work within the home.

There was a lack of systems in place to monitor the quality and safety of care to people.