Mary House provides accommodation with personal and nursing care for up to 12 people with learning and physical disabilities. At the time of the inspection there were 12 people living at Mary House. None of the people who were living at the service were able to speak with us but we did speak with some relatives.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We found the service was meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were recognised, respected and promoted.

Relatives spoke positively about the staff and their kindness. One relative said, “There is a very positive, enthusiastic team spirit” and a “great sense of fun”, which helped create a “warm and loving environment.” Relatives felt there were “lots of positives” about the service although some felt there were some areas that could be improved, such as communication.

The service was not always safe and improvements were needed. The majority of risks associated with people’s care and support had been identified and guidance about good practice was in place to reduce these risks and keep people safe. People were treated with dignity and respect. Staff understood the importance of supporting people to make their own decisions where possible. People received their medicines when they should and safely. 

People’s needs had been assessed. Relatives and staffs knowledge of people had been used to develop care plans. Care plans detailed people’s known preferences, choices and independence skills. The service had recently introduced an “active support” programme, to encourage further development of interaction and independence skills. People had sufficient quantities of food and drink and any special dietary needs were catered for.

People were treated with kindness and respect. Relatives told us people’s preferred name was always used by staff and this was recorded in their care plan.

People were encouraged to make their own day to day decisions about their care and support. Where people were unable to make complex decisions for themselves, such as whether to have hospital or dental treatment, the service had considered the person’s capacity under the Mental Capacity Act 2005. Records showed a person’s relatives and health care professionals had been involved in the best interest decision making process for that person. People had opportunities to undertake activities both within the service and in the local community.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law with the provider. The registered manager provided good leadership and support to the staff. Relatives had opportunities to feedback about the service provided, but some felt communication with management could be better. The senior management team had systems in place to monitor the quality of the service, so that people received care and support that met their needs.

We found there was a breach of Regulation 20 of the Health and Social Act 2008 (Regulated Activities) Regulations 2010.

We carried out this inspection to follow up on a compliance action made in December 2012 and April 2013 and a second compliance action made in April 2013.

We used a number of different methods including SOFI to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We observed staff interacting positively with people and providing person centred care.

We found that care plans clearly documented the needs of people and how they should be met. Where appropriate, specialist advice and support was obtained.

Records demonstrated that staff received appropriate training and supervision to perform their respective roles.

We carried out this inspection to follow up on compliance actions made in December 2012 and to inspect additional outcomes.

We used a number of different methods including SOFI to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We observed staff interacting positively with people and providing person centred care.

We found that care plans clearly documented the needs of people and how they should be met. However, it was not always clear from record keeping that people’s needs were appropriately met. Where appropriate, specialist advice and support was obtained. People’s representatives were involved in decisions about their relative’s care and treatment.

Records did not fully demonstrate that all staff had received appropriate training to perform their role. There were systems in place to monitor the quality of the care provided and this was being developed further to ensure they were more effective.

We used a number of different methods including SOFI to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We observed some staff interacting positively with people and providing person centred care. However, some care practices indicated that people’s dignity was not always respected.

We found that care plans clearly documented the needs of people and how they should be met. Where appropriate, specialist advice and support was obtained. People’s representatives were involved in decisions about their relative’s care and treatment.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse.

We asked parents for their views on their child’s care. They told us, “We’ve been told we can’t discuss anything with the carers because they’re concerned things might be taken the wrong way. I don’t know fully what she’s doing. We’ve been given a programme, but it’s not tailored for her. My wife feels our daughter needs her own individual programme”.

Another said “If my child is unwell I need to know. This doesn’t always happen”.

“The rooms and the home are immaculate, but there’s never a manager around at weekends – this is when people visit, and when we need to speak with someone, no-one gets back to you for ages”.

We asked parents about the activities available, they told us “I’ve asked for a timetable of activities, but they’ve refused”.

One parent said “I was led to believe that it would always be a female dealing with my daughter’s personal care, but I challenged this after seeing a man assist her”.

Mary House provides residential and nursing care for up to 13 people with profound and multiple learning disabilities. As a result of their disabilities people require support with all aspects of care including eating and drinking and with moving and handling. People were unable to communicate verbally and some used vocal sounds or body language and facial expressions to make their needs known. The building was purpose-built to meet people’s needs. A hydro pool was on site with access to appropriately designed changing rooms to meet people’s needs. A hydro pool is a pool used for water exercise and other therapy treatments. Facilities included an art room, a music room and a sensory room. At the time of our inspection there were 12 people living at the home.

We inspected Mary House on 19 and 23 December 2014 and identified a range of concerns. We took enforcement action and asked the provider to make improvements in staffing levels, care and welfare, equipment and in the monitoring of the service. Improvements were also required to be made in the management of medicines, nutrition, dignity and respect, complaints, records, staff training and infection control. The provider has written an action plan to address these improvements within a required time frame.

We inspected again on 06 May 2015 because we had received concerns about people’s safety. At the time of this inspection, the timescales to meet our regulations had not yet expired. This inspection therefore focused on the concerns and checked whether some of the improvements had been carried out in regard to people’s safety. At this inspection we found that improvements and compliance had been achieved in infection control, the management of medicines, records and recruitment. However further requirements were identified about the lack of sufficient staff with the right skills and knowledge and a lack of appropriate safeguarding procedures to ensure restraint was only used when absolutely necessary.

This inspection on the 20 July 2015 was to check whether appropriate action had been taken to implement improvements identified at our inspection in December 2014. We found that progress have been made although in some areas some improvements were still to be implemented. Although the timescales to meet our regulations had not yet expired in regard to the inspection of 06 May 2015, we found that the two further requirements identified at that inspection had already been fulfilled.

There was not a manager in post who had applied to become registered with the Care Quality Commission (CQC) at the time of our visit. A registered manager is a person who has registered with the CQC 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. A newly recruited manager had not yet started their duties in the service.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

All fire protection equipment was serviced and maintained.

People’s bedrooms were personalised to reflect their individual tastes and personalities.

Staff knew each person well and understood how to meet their support needs. A relative told us, “We find that staff are more alert about and respond better than a few months ago to individual needs”.

Essential staff training was up to date and additional training was scheduled to take place shortly. Staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal. This ensured they were supporting people to the expected standards.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements. However further applications that needed to be made were in the process of being completed.

Staff sought and obtained people’s consent before they helped them.

The service provided meals that were in sufficient quantity and met people’s needs and preference. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect.

People and their relatives were involved in their day to day care. People’s care plans were reviewed with the participation of relatives who were invited to attend the reviews and contribute.

Clear information about the home, the facilities, and how to complain was provided to people and visitors.

People were able to spend private time in quiet areas when they chose to. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed monthly and updated when their needs changed.

People were involved in the planning of activities. A broad range of suitable activities and outings was available.

The service took account of relatives’ feedback, comments and suggestions. People’s views were sought and acted on. Satisfaction questionnaires were sent to people’s relatives or legal representatives, and the results were analysed and acted on. Staff told us they felt valued under the registered manager’s leadership.

The acting manager notified the Care Quality Commission of any significant events that affected people or the service. The provider, directors and acting manager kept up to date with any changes in legislation that may affect the service. They carried out audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.