This announced inspection of Marlcroft took place on 24 September 2018. We made phone calls to family members of people living at the service on 25 September 2018.

We last inspected Marlcroft in March 2016. The service was rated Good. We found during this inspection that the service remained Good.

Marlcroft is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Marlcroft is a small care home for younger adults. At the time of our inspection there were four people who lived at the home and one person who was accessing the home during the weekends for respite care. The home is registered to provide care to five people.

Risks were well assessed and information was updated as and when required. We were able to view these procedures and how they worked. Staff were able to describe the course of action they would take if they felt anyone was at risk of harm or abuse, which included ‘whistleblowing’ to external organisations. People were supported to manage their medication by staff who were trained to do so. The registered manager had systems and processes in place to ensure that staff who worked at the service were recruited safely. Rotas showed there was enough staff to support people.

There was a supervision schedule in place, and all staff had received up to date supervisions and most had undergone an annual appraisal. Any that were due had been booked in to take place. All newly appointed staff were enrolled on the Care Certificate. Records showed that all staff training was in date.

We saw that where people could consent to decisions regarding their care and support this had been well documented, and where people lacked capacity, the appropriate best interest processes had been followed. The service was working in accordance with the Mental Capacity and DoLS (Deprivation of Liberty) and associated principles.

Staff were able to give us examples of how they preserved dignity and privacy when providing care. Relatives we spoke with were complimentary about the staff, the registered manager and the service in general. Relatives told us they liked the staff who supported their family member.

The complaints policy contained contact details for the local authorities and commissioning groups. There had been no documented complaints at the service since the last inspection.

Staff we spoke with demonstrated that they knew the people they supported well, and enjoyed the relationships they had built with people. Care plans contained information about people’s likes, dislikes, preferences, backgrounds and personalities.

Action plans were drawn up when areas of improvement were identified. Staff meetings and resident meetings took place. Quality assurance systems were effective and measured service provision. Regular audits were taking place for different aspects of service delivery.

Further information is in the detailed findings below.

This inspection took place on the 20 November and 2 December 2015. The inspection was unannounced.

Marlcroft is a three bedded bungalow registered with the commission to provide accommodation and personal care for a maximum of three younger adults with learning disabilities. This service is owned by Community Care Matters.The home is a domestic style property set within pleasant gardens and located within a residential area of Warrington. Care and support staff are on duty twenty-four hours a day. At the time of the inspection three younger adults were living at the home.

The home has 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.

This was the first inspection of Marlcroft since the home first registered with the commission on the 18 August 2015. All the people who lived at the home had previously lived together in another home which had also been operated by Community Care Matters. They moved in to Marlcroft together when the other home closed.

We found that people were provided with care that was safe, person centred, sensitive and compassionate. The home was managed and staffed by a consistent team of support workers who were well trained and well supported. They told us that the appreciated the support leadership and direction provided by the management team. The staff worked together as a cohesive team with the benefit of having shared aims and objectives.

The registered manager promoted a person centred philosophy of care which resulted in positive outcomes for the people who lived at the home.

We could see that they each person received care and support tailored to their individual needs, personal preferences and wishes. Whilst we were unable to communicate with them directly because of communication difficulties we were able to observe their interactions with staff who had developed effective methods of communication with them. We could see that the people who lived at the home were happy and content. They had positive relationships with the staff, with whom they shared a rapport and interactions often resulted in smiles and laughter.

People had care plans which were personalised to their needs and wishes. Each care plan contained detailed information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their characters and personal preferences’.

People were protected from the unsafe administration of medicines. Support workers responsible for administering medicines had received training to ensure peoples medicines were administered, stored and disposed of correctly. Support workers skills in medicines management were regularly reviewed by the team leader to ensure they remained competent to continue.

Relatives spoken with praised the registered manager for the quality of care provided. They told us that they had every confidence that their relatives were safe and protected from harm.

We could see that people were protected from avoidable harm because hazards that may cause them harm had been identified, risk assessed and effectively controlled.

Support workers had received training on safeguarding vulnerable people from harm and abuse. They understood the provider’s guidance to enable them to recognise and address any safeguarding concerns about people but there was some room for improvement. Some staff did not know which authority took the lead on safeguarding adults and did not have a thorough understanding of how those who reported abuse were protected under the law. The registered manager took action to address this during the inspection.

Support staff had an understanding of supporting people when they lacked capacity. It was clear that the relevant person was always placed at the centre of decision making and best interest principles had always been followed. However, there was room for improvement. Some staff lacked the required knowledge and confidence to carry out a mental capacity assessment and best interest decision process because their training had not covered these important topics. The registered manager wrote to the commission following our inspection and confirmed that action had been taken to address this issue.