Marbleside Care

Marbleside Care is a supported living service for people with a learning disability. Some people lived in flats while others shared a house and amenities such as kitchens, bathrooms and lounges. People received care and support to help them live independently in the community. There were 12 people using the service at the time of our inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The management team had developed a culture centred around each person. Everyone was seen as an individual and their values and choices were respected. People were involved in all areas of their care and the service. Decisions about the service were made together by everyone.

During the pandemic restrictions, people had planned activities in their own home. Everyone had joined in and told us they had enjoyed themselves. People had been involved in recruiting staff and there were enough staff to support people when they wanted.

People had control over all areas of their life and were supported to achieve their goals and ambitions. They were supported to take managed risks when they wanted to. People were supported to remain comfortable in their own home at the end of their life.

Everyone knew how to protect themselves from COVID-19. Staff followed national guidance and people were supported to keep their homes clean.

People were confident to raise any concerns they had and these were addressed. People were supported to understand the risks of abuse and keep themselves safe. When concerns were raised the registered manager and staff took quick action to protect people. People’s medicines were managed safely.

People were asked for their views weekly and these were acted on the ensure people’s needs and wishes were always met. An effective quality assurance process was in place and any shortfalls were identified and addressed. The registered manager analysed why things had gone wrong and took action to stop them happening again. Staff were kept informed of any changes and were clear about their roles in the service.

The registered manager was part of local and national groups and kept up to date with changes in guidance and best practice. They used these to develop the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 27 July 2019).

Why we inspected

We carried out an announced comprehensive inspection of this service on 24 and 25 June 2019. We found the provider had taken action to meet legal requirements and improve the service However, we needed to be assured that improvements made would be embedded and sustained.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marbleside Care on our website at www.cqc.org.uk.

Marbleside Care is a supported living service for people with a learning disability. Some people lived in flats while other shared a house and amenities such as kitchens, bathrooms and lounges. People received care and support to help them live independently in the community. There were 19 people using the service at the time of our inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The provider and manager were taking action to develop the service in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive were beginning to receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

There had been significant improvements to the service since our last inspection. One person told us, “This is our home now, a new home where the staff care about us”. A staff member told us the changes to the service had improved people and staff’s self-esteem because everyone now felt valued. All the people and staff we spoke with agreed with this.

The provider now had oversight of the service. The manager and provider completed regular checks on the quality of care people received. People and staff were asked for their views, which were listened to and acted on to improve the service each person received. Records of people’s care had improved but further improvements were needed to make sure they were always complete.

A manager was working at the service and had applied to be registered by us. They and the provider understood their legal responsibilities and had shared information with us and others when they needed to.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were now involved in making decisions about their lives and were beginning to work towards achieving their goals.

People were protected from the risks of harm and abuse and any concerns they or staff had were listened to and acted on to keep people safe. People were treated with dignity and respect and their lifestyle and equality needs and choices were understood and respected. People had privacy.

Risks to people had been assessed. People were now supported to be independent, understand risks and take them when they wanted to. Staff supported people to remain healthy and gave them advice about healthy eating. People’s medicines were managed safely. People were protected from the risk of infection.

People had planned their support with staff and were encouraged and supported to set and achieve goals to be as independent as possible. People were taking part in a wider range of activities and were now cooking and cleaning for themselves. Plans were in place to support people to share their end of life preferences.

There were now enough staff working at the service each day to support people. People told us staff were there when they needed them and had time give them the support they wanted. Staff had the skills they needed to support people and were supported by the management team. People were involved in the safe recruitment of staff.

The provider and manager had plans in place embed the improvements made at the service and to make further improvements.

The service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected many of the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support had begun to focus on them having as many opportunities as possible for them to gain new skills and become more independent. We will continue to monitor the service to ensure these principles are embedded and sustained.

Rating at last inspection and update.

The last rating for this service was inadequate (published 1 March 2019) and there were multiple breaches of regulation. The provider changed the name of the location from Dorriemay House to Marbleside Care in May 2019. This did not affect the rating of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Dorriemay House provides care and support to people living in five ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. People using the service lived in 14 ordinary flats and bedsits across Margate and a single ‘house in multi-occupation’ shared by 20 people. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. People living in the house shared two kitchens and two lounges. There was an office on site. There was also a café where people living in the house or in flats could purchase meals.

Not everyone using Dorriemay House receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could not live as ordinary a life as any citizen.

A registered manager was working at the service. 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. The registered manager did not fully understand the requirements of registration and had not notified us of some events that had happened at the service so we would check the appropriate action had been taken.

The provider and manager had not kept up to date with changes in good practice around the care and support of people with a learning disability. They had not developed a positive culture at the service and people were not referred to in respectful ways, valued as individuals or fully involved in planning the service they received. They did not always have privacy.

The quality of the service was not kept under review. The provider and registered manager relied on staff to complete checks and audits and did not know they were not up to date. They were not aware of the shortfalls we found during our inspection. People had been asked for their feedback about the service but their views had not been acted on.

People were not protected from the risk of harm or abuse. Concerns people raised had not been listened to and action had not been taken to support people to keep themselves safe. Complaints people raised were dismissed without being investigated.

Risks to people have not been comprehensively assessed and action had not been agreed with people about how to keep them safe while they developed their independence. Clear guidance had not been provided to staff about how to support people with the risks associated with health conditions. Some people had behaviours which challenged staff. Guidance had not been given to staff about how to support people to manage these behaviours. Where guidance had been provided by health professionals staff did not know about it and it was not followed. The registered manager did not know about good practice around behaviours which challenged.

People’s medicines were now stored in their home, however the registered manager had not acted on our recommendation to consider guidance on managing medicines for adults in community settings and staff had not been given some of the information they needed to support people to manage their medicines safely.

Staff were not recruited safely or supported to develop the skills, knowledge and experience they needed to care for people. People did not receive all the care they needed because the registered manager had not planned staff deployment to meet people’s needs and to the levels commissioned by the local authority.

Records about people were not detailed. Information was not available about areas of people’s care and no information was available about one person. Staff relied on people and each other for information as they did not have time to read people’s care plans.

People had not been supported to plan and achieve goals and planned care was not regularly reviewed with them to make sure it reflected their needs and wishes. Assessments of people’s needs before they began using the service were very basic and the provider relied on the local authority referring people whose needs the service could meet and providing them with all the information about the person. People, including those who were older or unwell had not been supported to share their wishes and preferences around their care at the end of their life.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Some people were not given choices in ways they understood. The registered manager had not acted on our recommendation to consider current guidance on the principles of the MCA and take action to update their practice accordingly.

The provider had not taken action to comply with the assessable information standard and only the complaints process was available in an easy read version.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

This service provides care and support to people living in five ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. People using the service lived in 14 ordinary flats and bedsits across Margate and a single ‘house in multi-occupation’ shared by 20 people. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. People living in the house shared two kitchens and two lounges. There was an office on site and sleep in arrangements. There was also a café where people living in the house or in flats could purchase meals.

Not everyone using Dorriemay House receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

A registered manager was working at the service. 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 the last inspection on 19 October 2016, we asked the provider to take action to make improvements to the way they assessed and mitigated risks, managed medicines, checked the quality of the service and recorded information.

Records in respect of each person had improved since our last inspection, however further improvements were required to make sure people’s records contained all the information staff needed to provide consistent care and support. The provider had a plan in place to achieve this. Information about people was stored securely.

The registered manager had improved the checks completed on the quality of the service since our last inspection. However, these had not identified all the areas for improvement we found during our inspection and further improvements were necessary.

People’s medicines were managed safely and people received their medicines in the ways they preferred and as their healthcare professional had prescribed. Further improvements were required to the way people’s medicines were stored, including supporting people to store their medicines in their own home and to manage their medicines with support where necessary.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff assumed people had capacity and respected the decisions they made. When people needed help to make a particular decision staff helped them. Decisions were made in people’s best interests with people who knew them well. The registered manager had identified that they did not fully understand their responsibility to assess people’s capacity to make specific decisions and we have made a recommendation about this.

Changes in people’s health were identified quickly and staff supported people to contact the relevant health care professionals. People were encouraged to eat a balanced diet which met their health needs. People planned what they cooked and prepared it with staff support where necessary. Some people choose to eat at the on-site café.

Staff were kind and caring to people and treated people with dignity and respect. People told us staff gave them privacy and only entered their home with permission. Everyone was supported to be as independent as they wanted to be. People received care in the way they preferred at the end of their life from staff and health professionals.

People told us they had enough to do during the day and were involved in their local community. They used community facilities such as the local gym and joined local groups including the District Partnership Board. The local District Partnership Board is a group where people with learning disabilities, their carers and families can talk about the things that are important to them in their lives and supports people to take action to make changes and improvements for the wider population. People had opportunities for lifelong learning and some people had jobs.

People were not discriminated against and received support tailored to their needs and preferences. Assessments of people’s needs and any risks had been completed. Each person had planned their care and support with staff, including taking risks when they wanted to. No two people received the same support. Staff supported people to tell other professionals involved in their care, such as the multidisciplinary team, about their needs and wishes and helped them follow any advice and guidance given. Accidents and incidents had been analysed and action had been taken to stop them happening again.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. People knew how to make complaints and were confident to raise concerns. Action had not been taken since our last inspection to make sure the complaint process was accessible to everyone in a way they understood and we have made a recommendation in relation to this.

There were enough staff to provide the care and support people needed. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Staff felt supported by the registered manager, were motivated and enthusiastic about their roles. A senior staff member was always available to provide the support and guidance staff needed. The registered manager worked other service provider’s to keep their knowledge up to date and continually improve the service.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of all significant events at the service.

Services are required to prominently display their CQC performance rating. The registered manager had displayed the rating in the entrance hall of the service and on their website.

This is the second consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

The service was last inspected in September 2013 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Dorriemay House provides care to people in their own homes, people had their own flat within a shared building. The service provides care and domiciliary support for older people and people with a learning disability. The service also offered people access to several communal areas including a restaurant, a cafe, community kitchens, lounge areas and a games room. Most people received support and care from staff via several visits to their home each day. On the day of our inspection visit, the service was providing support to 18 people.

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. We refer to the registered manager as the manager in the body of this report. On the day of our inspection visit the registered manager was not available to speak with us, we spoke with the supervisor of the home. We spoke with the registered manager following our inspection visit.

Medicines procedures required improvement to ensure people always received their prescribed medicines, and that medicines were managed according to manufacturers' guidance.

Risk assessments and risk management procedures required improvement to ensure risks to people's health and wellbeing were being minimised. People’s care records required updating to ensure people’s support and care needs were identified, monitored and maintained, according to their personal preferences.

Quality assurance systems required improvement to identify areas where actions needed to be taken to improve the quality of the service.

There was regular communication with staff whose views were gained on how the service was run. Staff were supported by managers through regular meetings. There was an out of hours’ on call system in operation which ensured management support and advice was always available for staff.

There were enough staff to deliver the care and support people required. People told us staff were kind and knew how people liked to receive their care.

People felt safe with staff and within their environment. Staff understood how to protect people from abuse and keep people safe. The character and suitability of staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

Staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us staff had the right skills to provide the care and support they required.

The managers understood the principles of the Mental Capacity Act (MCA), and staff respected people’s decisions and gained people’s consent before they provided personal care.

Everyone felt the managers were approachable. Communication was encouraged and identified concerns were acted upon by the managers. People knew how to make a complaint if they needed to.

People were able to consent to the care, treatment and support they received. One person told us 'I can make my own mind up about how the staff help me; if I don't want to be helped they understand.'

People who used the service also commented that they got on well with the small team of staff that supported them and felt the staff were concerned for their welfare. They said they were asked for their views about the service and felt able to influence the way their care was provided. The provider encouraged the involvement of people who use the service in the running of the organisation and valued their input.

The home was clean and tidy throughout even though there were building projects underway.

We found that the provider had efficient recruitment processes and procedures in place and that all of the staff had received criminal records checks.

We saw evidence that the provider had sought advice and guidance from other professionals in regard to managing risks and any problem behaviours. Monitoring processes had been introduced to ensure that people's support plans remained up to date and fit for purpose.

People told us that they lived living at Dorriemay House and were supported to engage in a variety of activities. They said that the staff treated them with dignity and respect.

We saw that people were offered choices and their dignity and independence was respected. We saw some positive interactions between staff and the people who live at the service. Staff assisted people in a professional, yet warm manner and explained what they were doing when they supported them.

People we spoke with told us that they liked living in the home and that staff were friendly and caring. We saw that people looked relaxed. The people we spoke with told us that they were satisfied with the care and support received. One person said "I feel safe here, I am very comfortable". Another said "The staff are kind and always find time to chat with me".

Staff told us they felt that they were supported and trained to carry out their roles and meet the needs of the people who use the service.