The inspection took place on 21 February 2017 and 6 April 2017. The inspection visit on 21 February was unannounced but the second visit was announced.

The service provides residential care for up to 42 people, some of whom are living with dementia. At the time of our inspection 40 people were using the service.

A registered manager was in post. 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 previous inspection in October 2014 we found that people were receiving high quality care which responded to people’s individual needs. At this inspection we have found that these standards had been maintained and in some areas further improved. This meant that people received an outstanding level of care which responded to their individual needs and preferences. Skilled and caring staff supported people in the way that they chose.

People received safe care which met their individual needs and preferences. There was a strong commitment to enabling people who used the service to be as independent as possible through robust risk assessment to keep them safe. Risks were assessed and documented in care plans and environmental risks were very well managed. The manager and staff demonstrated a very good oversight of risk.

Staff were trained in safeguarding people from abuse and the manager referred incidents appropriately to the local authority safeguarding team for investigation. Internal investigations into safeguarding incidents were carried out in an honest and transparent way. The service worked well with other professionals to investigate any safeguarding matters.

There were enough staff to keep people safe and to enable them to live their lives in the way they chose. Staff were recruited safely as there was a robust recruitment procedure in operation. The service was overstaffed by 10% to further ensure care and support was delivered consistently by staff who knew people well. Staff had time to spend with people and people’s needs were met promptly.

Medicines were managed safely and people received their prescribed medicines when they needed them. Staff were trained and verified as competent to administer medicines.

The service was clean and infection control measures were in place. All staff had a good understanding of how to reduce the risk and spread of infection.

Staff received an excellent work based induction and a variety of relevant and person centred training to help them carry out their roles. Training was innovative, challenged staff and was designed to drive continual improvement. Staff were supported with regular meetings, supervision and values driven appraisal of their performance. Staff were very positive about the training they received and felt valued by the manager and the organisation.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. Practice related to MCA and DoLS was very good and in line with legal requirements.

People who used the service praised the food highly. People were referred to appropriate healthcare professionals, such as dieticians, promptly if they required this support. There was sensitive support at mealtimes for people who need

We carried out this inspection on 16 October 2014. This was an unannounced inspection.

The Martins provides residential accommodation for up to 42 older people, some of whom are living with dementia. At the time of our inspection 41 people were resident.

There was no registered manager in post at the time of our inspection and this has been the case since 23 December 2013. The current manager was employed by the service in May 2014 and is in the process of applying to become the 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 who used the service told us that they were happy with the care and support provided. They said that the staff were kind and told us that they felt safe. We saw that people were treated with respect and that their dignity was maintained. The service offered people choice and we saw that where people had stated a particular preference this was respected. 

Staff were knowledgeable about the care and support needs of people who used the service. They received the training they needed to carry out their roles safely and effectively. They told us that they felt supported by the manager and we saw that they were encouraged to develop their skills in order to improve the quality of the service. 

We found that the service had assessed how many staff  were needed to keep people safe and to meet their needs. The number of staff on duty over a period of six weeks matched the assessment. Throughout the service there were enough staff and a large number of volunteers provided additional opportunities for people to follow their own interests and hobbies.  We found on one particular unit  that additional staffing was needed  to ensure that people could attend activities and receive all the support they needed to eat their meal at the correct temperature. 

We found that medicines were managed safely by staff who had received training in how to administer them. 

There was a friendly atmosphere at the service and we observed people busy playing games, chatting, doing their shopping, feeding the birds and walking around the gardens. All the people we spoke with told us they enjoyed living at the service and were very positive about the staff. We asked seven members of staff and one volunteer if they would be happy for one of their relatives to live at the service and they all said that they would. 

People who used the service, and their relatives, were involved in planning and reviewing their care. People were able to share their views at regular resident meetings or during the annual surveys. Relatives were positive about the care provided and were given opportunities to give feedback and make suggestions to improve the experience for people who used the service. The manager also assessed and monitored the quality of the service by carrying out a series of structured audits. 

We saw that complaints were responded to promptly and appropriately and any feedback was used as a possible learning point in order to improve the service.  

We spoke with six people using the service. The all confirmed to us that they felt safe and that staff treated them kindly. All six people told us that the food was good and that there was always something they enjoyed eating. The six people confirmed that they had constant access to fluids and that they did not feel dehydrated, including night time. One person states, "Staff are kind and helpful. If I need assistance they are quick to give it." Another person said, "The food is very good. If I don't want what's on the menu it is never a problem to have something different." We spoke to a healthcare professional who supported people using the service. They confirmed to us that care standards were high at The Martins.

Staff demonstrated a good knowledge of providing compassionate care to people with mental health needs and we saw that they communicated sensitively and positively with people. People were provided with a varied and nutritious diet and people's individual preferences and needs were catered for. Medication was administered promptly and recorded accurately.

We spoke with people using the service in the residential unit and they all told us that they felt safe, happy and well looked after. One person said, "I feel at home here. Staff are kind and I get the support I need to remain as independent as possible". Another person told us, "The new manager has reduced the number of agency staff used and I find that comforting. It is nice to know who is going to be giving you care."

During our visit on 25 October 2012, we used the Short Observational Framework for this inspection (SOFI) in order to understand the experiences of people living in Lark Close. SOFI is a specific way of observing care to help us understand the experiences of people who may not have been able to talk with us. We noted that staff treated people with dignity and respect. They ensured that people had time to make decisions about what they wanted to do. Staff supported people to make choices around food and joining in activities.

We found that the service was meeting people's care needs and so supporting their health and wellbeing. Staff were competent and communicated well with people using the service. Where appropriate, staff had received training in providing support to people with dementia. The service had interpreted the implications of the mental capacity act and applied them locally. People had benefited from regular access to other healthcare professionals including music therapists. People were able to maintain a good quality of life.

We visited The Martins on 22 September 2011 and were able to speak with a group of nine people living in the home. We also talked with others on a one to one basis. They were positive about the home, although some concerns were raised about recent staff changes and how busy staff were. One person said staff were ”splendid” and “very cheerful”. They also told us that meals were good and they always had a choice.

Some people were unable to talk with us because of their care needs. We observed that staff were observant and considerate when delivering their care and support. There was good positive interaction and staff openly shared their thoughts about how things might be improved by introducing more activities to engage people throughout the day.