Marske Hall is registered to provide care and accommodation to a maximum number of 30 people who have a physical disability. The service also provides nursing care. At the time of the inspection there were 30 people who used the service.

At the last inspection in June 2015, the service was rated 'Good'. At this inspection we found the service remained 'Good'.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s independence was actively encouraged. The manager and staff displayed clear resolve to make a positive difference to people's lives. Activities were invigorating, outings and events were well thought through, varied and in plentiful supply. Staff encouraged and supported people to access activities within the community. Staff were supported by many volunteers whose personalities and interests were matched with people who used the service to ensure a positive partnership.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring.

Medicines were managed safely with an effective system in place. We did note that the room temperature in which medicines were stored was on occasions too hot. We pointed this out to the manager at the time of the inspection who told us they would take action to address this.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained. At the time of the visit we noted that water temperatures were taken and tested by the handyman infrequently. We pointed this out to the manager at the time of the inspection who took immediate action to address this. Water temperatures were taken and tested before people who used the service had a bath or shower to ensure they were of a safe temperature.

We spoke with people who used the service, relatives and staff and asked them if there were sufficient staff on duty to ensure people’s needs were met. We received a mixed response. Relatives told us the service was such a large building and this meant the staff had a large area to cover and at times made it difficult for them to find staff. We pointed this out to the manager who told us they would address relatives concerns and review staffing.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and all staff had completed up to date training. The manager had identified any gaps in training and arranged for refresher training to be provided.

Staff had an understanding of the Mental Capacity Act 2005 and acted in the best interest of people they supported. Staff clearly understood their role in supporting people with communication to help them make as many of their own decisions as possible. Staff told us about people’s care preferences, which were also recorded in their care plans.

People were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were kind, caring and interacted well with people. Observation of the staff showed that they knew people very well and could anticipate their needs.

Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were

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.

This was an unannounced inspection carried out on 8 and 14 July 2014.

Marske Hall provides personal and nursing care for up to 30 people with a physical disability. At the time of the inspection there were 28 people who used the service. Accommodation is provided over two floors. All bedrooms are for single occupancy and have a separate toilet and sink. Some of the bedrooms have a wet room and one has a bath. Communal areas include a large lounge, dining room, activities room, gym, conservatory and atrium. There is a large enclosed garden.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.We found a breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

The Registered Manager had been trained and had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood when an application should be made, and in how to submit one. This meant that people were safeguarded and their human rights respected.

We found that people were encouraged and supported to take responsible risks. People were encouraged and enabled to take control of their lives.

People told us that they were cared and supported by suitably qualified, skilled and experienced staff. People told us that there was enough staff to give them the help and support that they needed. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.

Staff who worked at the service were extremely knowledgeable about the care that people received. Staff and people who used the service spoke of person centred care. People who used the service and relatives told us they were very happy with the care that they received.

People told us that they were provided with a choice of healthy food and drink which helped to ensure that their nutritional needs were met. People told us that they liked the food provided.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People and relatives told us that they were supported by caring and compassionate staff. People we spoke with said they were happy with the care provided and could make decisions about their own care and how they were looked after.

We observed interactions between staff and people who used the service. We saw that staff were kind and respectful to people when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

People’s care and support needs had been assessed before they moved into the home. Care records we looked at detailed people’s preferences, interests, likes and dislikes and these had been recorded in their care plan. Staff and people who used the service spoke of person centred care; however care records did not always reflect this. Care records did not always show the most up to date information about people’s needs, support required and risks. Care records were not always evaluated on a regular basis.

We saw that people were involved in a wide range of activities both in-house and in the community. We saw that staff engaged and interacted positively with people. We saw that people were encouraged and supported to take part in activities. Activities were arranged both on an individual and group basis. People were given the opportunity to pursue their hobbies.

Appropriate systems were in place for the management of complaints. People and relatives told us that the registered manager was approachable. People we spoke with did not raise any complaints or concerns about living at the home.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the home had an open, inclusive and positive culture.

During the inspection we spoke with nine people who used the service. We also spoke in depth with the manager and the activity co-ordinator and in general to other staff. People told us that they were happy with the care and service received. One person said, “The staff are really good and very helpful.” Another person said, “I think that this is a very good home. Every one of the staff looks after me well.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services.

We saw that people lived in safe, accessible surroundings that promoted their wellbeing.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We found there was an effective complaints system in place at the home.

We spoke with six people who used the service. They told us they were happy living at Marske Hall. One person told us “I like living here.” They also told us “I can go where I like but would need a carer to come with me if I go outside.” Another person told us they go into the village every day. They also told us they were involved the neighbourhood watch scheme and checked people’s houses if they were on holiday.

We spoke with two relatives. One of the relatives told us “The care is excellent.” They also told us when they raised things with the manager they had been rectified. The relative commented that the home had beautiful gardens but they rarely see the service users out in them when they visited.

We inspected Marske Hall on 18 June 2015 and 3 July 2015. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 3 July 2015.

Marske Hall provides personal and nursing care for up to 30 people with a physical disability. At the time of the inspection there were 27 people who used the service of which 12 people required personal care and 15 people required nursing care. Accommodation is provided over two floors. All bedrooms are for single occupancy and have a separate toilet and sink. Some of the bedrooms have a wet room and one has a bath. Communal areas include a large lounge, dining room, activities room, gym, conservatory and atrium. There is a large enclosed garden.

The home had a registered manager in place. 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 last inspection of the service on 8 and 14 July 2014 we found that care records were not always accurate or fit for purpose. The registered provider sent us an action plan telling us they would be compliant by 30 March 2015. We checked care records at this inspection and found that improvements had been made.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual person. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual performance development review.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. However at the time of the inspection 41 of the 81 staff were due for refresher training in first aid or emergency aid. This meant that on some occasions there wasn’t a staff member who was qualified to administer first aid should the need arise. We pointed out our concerns to the registered manager who immediately booked a further 15 staff on first aid training in July 2015. The registered manager confirmed to us after the inspection that now further staff had received training there was now always a qualified person on duty to provide first aid. We were told that further first aid training had been booked for the remaining staff.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. Nutritional screening had been undertaken and people were weighed on a regular basis.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

We saw people’s care plans were person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people were involved in all aspects of their care plans.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

There were systems in place to monitor and improve the quality of the service provided. However the current tool used by the registered provider to identify trends and patterns for accidents and incidents was not always effective . At the time of the inspection accidents and incidents were not a common occurrence.

We saw there were a range of audits carried out both by the registered manager . We saw where issues had been identified; action plans with agreed timescales were followed to address them promptly. We also saw the views of the people using the service were regularly sought and used to make changes.