We inspected The Marshes on the 29 and 30 September 2016 and the inspection was announced. We inspected The Marshes at the same time as we inspected the service's sister home, which was next door. The Marshes provides accommodation and personal care for up to six people with a learning disability and complex needs. The young adults require support with personal care, mobility, health, behavioural and communication needs. There were six people living at the service at the time of our inspection, however, three people were on holiday during our inspection. Accommodation for people is arranged on the ground floor, with a sleep-in room for staff in the staff office. The home was adapted to meet the needs of people living there. The home was adapted to meet the needs of people living there. The Marshes belongs to the large corporate organisation called 'The Regard Partnership Limited.' Regard provides care nationwide and have several homes within the local area.

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

Risks to people's health, safety and wellbeing had been assessed and plans were in place which instructed staff how to minimise any identified risks to keep people safe from harm or injury. However, risks assessments did not consistently embed, implement or follow nationally recognised tools and guidance such as the Malnutrition Universal Screening Tool (MUST). We have made a recommendation about risk assessments.

The registered manager and staff had received training and were knowledgeable about of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been completed for the decision ‘does the individual have the capacity to make decisions about daily living whilst living at The Marshes.’ However, assessments of capacity were not decision specific and incorporated a wide range of decisions into one assessment. This is not in line with best practice requirements. We have made a recommendation about mental capacity assessments.

Staff told us they worked as part of a team, that the home was a good place to work and staff were committed to providing care that was centred on people's individual needs. There was a strong caring culture in the care and support team.

People received care and support that was responsive to their needs. Care plans provided detailed information about people so staff knew exactly how they wished to be supported. People were at the forefront of the service and encouraged to develop and maintain their independence. People participated in a wide and varied range of activities. Regular outings were organised and people were encouraged to pursue their interests and hobbies.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Staff had access to on-going training and supervision to ensure they had the skills and knowledge required to support people effectively. Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal. However, documentation did not consistently record the stock level carried forward from one month to another. We have made a recommendation about the monitoring and documentation of medicines.

Staff treated people as individuals with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. They approache

There was a new manager in post at the time of this inspection although the previous manager's name appears on this report. We are awaiting documentation from the provider in order to update the information.

This was a follow up inspection to look at consent to care and treatment. We spoke with the new manager, area manager and two members of staff. The inspection was carried out by one inspector over two hours.

We considered all the evidence we had gathered and used the information to answer the question; Is the service effective? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service effective?

People who used the service had limited capacity to give their consent to care and treatment. We found that the provider acted in accordance with legal requirements where people lacked the capacity to make decisions for themselves.

People at the home had complex needs and were not all able to tell us about their experiences at the home. In order to get a better understanding we observed care practices, looked at records and spoke with staff. During the inspection we spoke with an area manager, deputy manager and two members of staff. We were unable to speak with the registered manager who was not on duty at the time of our visit.

Our inspection team was made up of one inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were systems in place to make sure people were protected against the risks associated with medicines. Medication was stored safely and there were clear records of administration. Staff had received training in the administration of medication and the use of controlled drugs.

CQC monitors the operation of the 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 have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People who used the service had limited capacity to give their consent to care and treatment. We found that the provider had not always acted in accordance with legal requirements where people lacked the capacity to make decisions for themselves. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. Staff had received training to meet the needs of the people receiving care.

Is the service caring?

People were supported by committed and caring staff. We observed that people appeared comfortable in the home and familiar with the staff that worked there. We saw that staff members spoke directly with people and supported them at an appropriate pace. One person told us they were happy and liked living there.

Is the service responsive?

People’s needs were continually assessed. Records confirmed people’s preferences, interests, goals and diverse needs had been recorded and support had been provided in accordance with people’s wishes. People had regular review meetings with keyworkers to make sure that changes in needs were identified and action taken.

Is the service well-led?

Staff had a good understanding of their roles in the service and that they were supported by management. There were quality assurance processes in place to maintain standards in the service. We saw that staff and people who used the service were given opportunities to express their views.

We used a number of different methods to help us understand the experiences of people who used the service. People had complex needs, which meant that they were unable to tell us their experiences.

Staff ensured that consent was obtained prior to providing care and support. Care plans provided comprehensive information about people’s abilities and needs. However, interactions between staff and people on the day of inspection were minimal and care observed was task orientated.

Specialist advice and support was obtained to meet people's individual needs. There were safe systems in place for the management of medication.

The home had a robust recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.

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

We observed staff interacting positively with people. Where appropriate, specialist advice and support was obtained to meet people’s needs.

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. They also understood the home’s complaint procedure.

People who use the service told us or expressed that they were happy living at The Marshes. People looked relaxed in the company of staff and with each other. One person was sitting in the garden enjoying the sunshine.

People had support to attend hospital and doctors appointments.

People took part in planning the menu and went out to buy the food, and then they were involved in cooking it. People also ate out at cafes and restaurants.

People who use the service expressed that they felt safe. We saw that people were relaxed in the company of staff.

People expressed that they felt that there were sufficient staff in place. We saw that people had one to one support when they needed it.