This was an unannounced inspection that took place on 24 August 2016.

Marston Court provides care and accommodation for up to 22 people with learning disabilities and autistic spectrum disorders, some of whom also have physical disabilities. On the day of our inspection there were 18 people using the service.

The service 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.

People told us they felt safe using the service and trusted the staff. Staff were trained in safeguarding and understood their responsibilities to safeguard the people using the service. They used their knowledge of people, and the trusting relationships they had formed with them, to keep them safe.

Since we last inspected risk assessments and care plans had been re-written and improved. This meant that staff had up-to-date information to keep people safe whilst also ensuring that their freedom was respected. Staff used recognised de-escalation and distraction techniques to support people safely if they became distressed.

There were enough staff on duty to meet people’s care and support needs and enable them to take part in activities. Staff communicated well with the people using the service and had the training and support they needed to work effectively with them.

People told us they liked the food served. We observed the lunchtime meal. Staff sat with people while they ate and talked with them helping to make the meal a sociable occasion. If people needed assistance to eat, or adapted cutlery, staff provided this. Menus showed people had a varied diet, based on their preferences, with choices at every meal.

Staff supported people to maintain good health and ensured they accessed healthcare services when they needed to. Some people had complex healthcare needs so staff worked closely with a range of healthcare professionals including GPs, District Nurses, physiotherapists, and learning disability experts. Staff advocated for people to ensure their healthcare needs were met and accompanied them to appointments.

People and relatives told us the staff were caring. They were kind and patient in their approach to people. They knew people’s preferences and how they liked to communicate. They encouraged people to express their views and make choices about all aspects of their lives including what to eat and drink and whether or not to take part in activities.

Care plans focused on people’s strengths and abilities and how the person wanted to be supported. Their likes and dislikes were recorded and other key information staff needed to know. Staff understood the importance of activities to enrich people's lives and the activities organiser provided both group and one-to-one activities to meet people’s needs.

People and relatives told us they would speak up if they had any concerns about the service. Staff listened to people using the service and others if they had any concerns and took action to resolve these to people’s satisfaction. If people were unable to complain verbally or in writing staff advocated for them to ensure their complaints were heard.

People, relatives and staff told us the service was well-managed. They said the registered manager had had a positive impact and brought about many changes and improvements to the service. Staff said they felt valued and staff turnover had reduced giving people more continuity of care.

People using their service and relatives were asked to share their views about the service in a number of ways including at one-to-one and group meetings, open days, and through surveys. People were listened to and changes made in response to their suggestions and ideas.

The culture at the service was open and posi

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, and to provide a rating for the service under the Care Act 2014.

The home provides care and accommodation for up to 22 people with learning disabilities, some of whom also have physical disabilities and/or mental health needs. The service is not registered to provide nursing care.

This was an unannounced inspection that took place on 15 July 2014. During the visit we spoke with nine people living at the home, five care staff, the registered manager, deputy manager, and the home’s regional services manager. Following our visit we spoke with two relatives of people who used the service and a local authority compliance manager.

On the day of our visit there were 19 people living at the home. There was a registered manager in post at the time of this inspection. 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.

People were safe at the home and staff knew what to do if they had any concerns about their welfare. Records showed staff had thought about people’s safety and how to reduce risk. They also knew how to protect people under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS).

People’s likes, dislikes and preferences were central to how their care was provided. Staff focussed on what they could do and how they could progress to become more independent. People had access to health care professionals when they needed it. Staff took prompt action if there were any concerns about a person’s health.

People interacted using both verbal communication and sign language and staff understood what they needed. People were treated with care and kindness and their privacy and dignity was respected. Their cultural needs were identified and met and they were encouraged to make choices about all aspects of their lives.

People were supported by appropriately recruited and trained staff who had the skills they needed to provide effective and compassionate care. People got on well with the staff who encouraged them to socialise and take part in a wide range of activities.

The premises were clean and fresh and people could move about the home and gardens freely. People’s bedrooms were respected as their own space and the décor and furnishings reflected their individual tastes and interests.

The manager had substantial experience in the care and support of people with learning disabilities. She was approachable and helpful. People were supported to share their views about the home in ways that took account of any communication difficulties they might have. Audits were in place to assess the quality of the service, and health and safety checks carried out to make sure the environment was safe.

We did not speak with or observe people using the service at this inspection. Please see our previous report for details of peoples' experiences of this service.

Our inspection of 7 May 2013 found that some people were not protected against the risks associated with medicines because they had not received their medication at the time they needed it. We carried out this inspection to check that the provider had taken appropriate action. We found that people were now receiving their medication at the time they required it and the service was now meeting this standard.

We were unable to talk with people using the service due to their complex needs. However, our observations showed that people were comfortable and confident with staff. We saw that staff were attentive to people and interacted positively.

We looked at the records of four people who used the service and found care plans were detailed and thorough and provided clear guidance to staff about how the persons’ care should be delivered.

People were supported to have adequate nutrition and hydration.

Staff we spoke with demonstrated a good understanding of the needs of people who used the service. Staff received appropriate professional development.

We found appropriate arrangements were in place for the obtaining, recording and administration of medicine. However, we found there had recently been a few occasions where lunchtime medication for two people had been missed. This meant that people may have been at risk as they had not received medication at the time they needed it.

The service had a robust quality assurance system in place.

Our visit of 11 July 2012 found that where people did not have capacity to consent to their care or treatment, legal requirements were not met. We found that when people had been deemed as lacking capacity to make a decision, there was no information as to whether a best interest decision had been made on their behalf and if so what the decision was. We also found that staff awareness and knowledge of relevant legislation was poor.

Please see our previous report for further information.

During our visit we found the service had improved its practice and was now compliant with this standard.

We saw that people looked relaxed and comfortable. Brief observations showed staff were responding appropriately to people and were treating them with kindness and respect. The service was preparing for a Halloween party and we saw that people were involved with making decorations at the time of our visit.

We were unable to communicate with people using the service; however, from observing people in both communal areas we noticed that people seemed confident and happy with staff.

All the interactions we observed between staff and people using the service were respectful and positive. We saw that staff were patient with people and gave them time to communicate their needs.

People were given a choice of meal using picture cards and we saw staff taking the time to explain the available options. We saw that one person was unable to choose their lunch option using the picture cards and so staff bought both meal options out and they were then able to make a choice.

We observed staff supporting people during lunch and saw that staff treated people with kindness and consideration.

We saw that the views of relatives and carers had been gathered in a recent survey. The results of the survey were positive and shared with participants. Where areas for improvement had been identified, the provider stated what they were going to do to address these.

We used observation of care being delivered as a way of understanding the experiences of people using the service because the people who were in at the time of our visit had complex needs which meant they were not able to tell us their experiences.

We saw that the staff were attentive and respectful towards people living at the service. They noticed when people were not comfortable and offered them choices in terms of what they did, what they ate and what they drank. We noticed that they understood the ways in which each person communicated.

The staff assisted people discreetly and the interactions we saw between staff and people living at the service were good. Staff made sure they always sat with people and spent time doing things they enjoyed such as reading. Most of the people living at the service were out on a trip to the Sea Life Centre.

We also spoke to two care managers employed by the local authority who were visiting

people living at the home. They told us that they felt the service had improved significantly and they felt the quality of care and of people's lives had improved since our last visit to the service. The staff we spoke with told us people enjoyed a much better quality of life and they said the staffing levels had improved.

The purpose of this review was solely to check on compliance with the warning notice issued about cleanliness and infection control.

Most of the people who live at Marston Court would find it difficult to help us understand their views. We observed people discreetly for approximately two and a half hours in the lounge and dining area staff refer to as the "quiet lounge."

Although we observed two members of staff who had a very pleasant, open and friendly manner with people using the service which they responded well to, most of the interactions we observed gave us concerns. We saw all of the staff talk about people using the service and their needs whilst in communal areas. This was done consistently. It was not necessary as communication about people could have been done quietly and discreetly which would have protected people's personal dignity. Some of the staff we observed seemed frustrated when people did not do what they wanted them to do, and this was noticeable in the tone of voice they used to speak with people. Given that many of the people using the service did not communicate verbally the tone of voice and non verbal communication style staff used was important and could affect their mood and behaviour.

We observed that people in the same living space seemed to have opposing needs. For example, there were people who looked distressed when there was noise surrounded by people who were agitated, distressed and noisy. One of the people we observed reacted very strongly to another person living at the service as they approached and they started screaming. This went on for some time until the staff identified that she did not want the other person near her. They moved the person away and the screaming stopped. This showed the staff were unaware of the potential triggers for behaviour and were slow to identify what could have caused the response. As a result of this other people were visibly upset and agitated at the noise.

We saw evidence of people who live at the service coming and going out in to the community, for walks and to the shops. People were asked if they would like to go out and if they chose not to we saw this was respected. We saw people ask when they were going out and they seemed to be looking forward to this.

We found the home was not clean or hygienic and there were significant risks of people using the service getting or passing on infections because of this. We could find no evidence that the provider or manager had effective systems in place to make sure that risks to people living at the service were properly identified, assessed, managed and addressed.

People have the opportunity to become part of their local community, trips out are supported by the service and enjoyed by the people who live there. People’s care records take into account their individual care needs but care workers do not always ensure they receive appropriate care.

People who were able to say, told us that they felt happy living at the home. One said “the staff are nice here”. Staff training and knowledge keeps them safe from potential abuse although the environment that people live in does not fully protect them from the risk of infection.

People told us there were enough staff to care for them but were not always able to have a say in the running of the service because of a lack of systems to gain their views.