Martha House

About the service

Martha House is a residential care home providing personal care to 14 people at the time of the inspection. The service can support up to 14 people.

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

Right Culture: We received a potential concern in relation to staff culture. The provider, registered manager and senior staff had taken immediate steps to address this. We found there was a positive and person-centred culture, which focused on meetings people’s needs. Relatives were positive about the service and staff team, and their views were echoed by health and social care professionals who regularly worked with staff at Martha House. People were supported by trained staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. There were effective systems for monitoring and improving the quality of the service and learning from incidents.

Right Support: 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’s freedom was not unnecessarily restricted, and people were not physically restrained. People lived in a safe, clean, well equipped, well-furnished and well-maintained environment. People had a choice about their living environment and were able to personalise their rooms. Staff focused on people’s choices and preferences, so they had fulfilling and meaningful everyday lives. People were supported by staff to pursue their interests. Staff worked proactively with people, relatives and health and social care professionals to maintain people’s health and wellbeing. Staff supported people to take their medicines safely and as prescribed. The registered manager was working with staff and other organisations to review how people’s medicines were managed.

Right Care: People were supported by staff who knew them well and were kind and attentive to them. There was an approach to supporting, people so their individual preferences and lifestyles were respected. Staff understood how to protect people from abuse and told us they were encouraged to speak up if needed to protect people. People’s needs were identified, their care was planned, and their needs were met. People took part in a range of meaningful activities and had good relationships with staff and their families.

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

Rating at last inspection

The last rating for this service was good, (published 17 August 2021).

Why we inspected

The inspection was prompted in part due to a concern received about the culture of the home. A decision was made for us to inspect and examine this.

We found no evidence during this inspection that people were affected by this concern. Please see the Well-led section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Martha House is a residential care home providing personal and nursing care to children, young and older people with learning disabilities or autistic spectrum disorder. People at Martha house may also live with physical disabilities.

Martha House accommodates up to 14 people in one adapted building. People living at the home had access to communal facilities including sensory and activity rooms, lounge areas and garden facilities. There were 14 people living at the home at time of inspection.

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

Temporary changes to the senior staff leading the home had been made, and to the overall number of staff supporting people, since our last inspection. However, there were enough staff to care for people who knew people’s safety needs. Recruitment checks were made on new staff before they could care for people.

People’s risks had been assessed and relatives were complimentary about the way people’s changing safety needs were met. Staff knew what action to take if they had any concerns for people’s safety. Systems were in place to manage the administration of people’s medicines so these would be administered as prescribed.

Safe practices were followed to reduce the risk of infection such as the use of visitor pods and PPE. We found the risk of infections could be further reduced through maintenance of porous areas, for example in bathrooms. The registered manager agreed to address this.

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.

The registered manager, provider and senior staff checked key areas of the quality and safety of the care provided. Some of the provider’s checks had not been undertaken. The registered manager and provider had rescheduled these, so they could be further assured people continued to receive good care.

The registered manager had ensured The Care Quality Commission was now notified of key events in the home. The provider and registered manager had introduced new opportunities to promote discussion and to support staff during periods of temporary management changes and revised staffing levels. Relatives told us they valued the care provided because of the way the home was run.

People’s relatives had opportunities to visit their family members in line with changing government guidance. The registered manager assured us they would update the provider’s website to reflect this.

We expect health and social care providers to guarantee autistic people and 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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. This included the model of care and maximising people’s choice, control and independence. Care provided is person-centred and promotes people’s dignity, privacy and human rights. The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

The manager, senior managers and support staff shared person centred values in relation to how people were supported. People were supported to make clear choices for example what they did and how they spent their day.

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

Rating at last inspection

The last rating for this service was good, (published 09 June 2018).

Why we inspected

We received concerns in relation to the management of service, staffing and people’s access to visitors. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

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.

Martha House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Martha House accommodates up to 14 people within one purpose-built building, and specialises in the care of people with learning and physical disabilities. At the time of our inspection visit, there were 13 people living at the home.

A registered manager was in post and present during our inspection. 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 time of our last inspection in December 2016 we rated the home as Good. At this inspection we found the service remained Good overall, although there were some areas where improvements were required

Discrepancies identified by staff during the home’s weekly medicines count had not always been investigated to confirm people had received their medicines as prescribed. The provider had failed to notify us of the authorisation of two people’s Deprivation of Liberty Safeguards applications, as required under their registration with CQC.

People were supported by staff who understood how to recognise and report any form of abuse or discrimination. The risks associated with people’s care and support needs had been assessed, recorded and plans implemented to manage these. Staffing levels meant people’s individual needs could be met safely. All prospective staff were subject to pre-employment checks to ensure they were suitable to support the people living at the home. Measures were in place to protect people from the risk of infection, including appropriate use of personal protective equipment (PPE) by staff.

People’s individual needs and requirements were assessed before they moved into the home. Staff received relevant training and ongoing support to ensure they had the skills and knowledge needed to work safely and effectively. People received encouragement and physical assistance to eat and drink, and any associated risks were managed. Staff helped people to access a range of healthcare services to ensure their health needs were monitored and met. People’s rights under the Mental Capacity Act 2005 were understood and promoted.

Staff had taken the time to get to know people well, and adopted a kind and caring approach towards their work. Staff and management encouraged people to express their views and be involved in decision-making that affected them. People were treated with dignity and respect.

People received consistent, personalised care that reflected their individual needs and requirements. The provider’s complaints procedure promoted good complaints handling.

The management team promoted open communication with people, their relatives and the community professionals involved in their care. Staff benefited from effective leadership and were clear what was expected of them. The provider took steps to involve people, their relatives and staff in the service, and welcomed their views.

Martha House is a nursing home that is registered to provide accommodation for up to 14 people with complex learning disabilities. At the time of inspection there were 13 people living at Martha House.

There was a registered manager 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 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 10 February 2016. Although a breach of legal requirements was not found we did have concerns about how the service was managed. We also had concerns about how medicines were administered. After the comprehensive inspection, the provider wrote to us to say what they would do to in relation to the concerns we had about the management of the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they had now addressed these concerns. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Martha House on our website at www.cqc.org.uk

After our last inspection we asked the registered persons to take action to ensure that medicines were administered safely. At this inspection we found that improvement had been made. The nurses who were responsible for administering medicines made sure that medicines were given in line with people’s prescriptions and by staff that had received appropriate training in medicines.

After our last inspection we asked the registered persons to take action to make improvements to the way management communicated with the staff. At this inspection we found that improvement had been made. Staff felt supported and more involved in the running of the service. Communication had improved and there were systems in place to keep the registered manager up to date with what was happening in the home and to identify any concerns early on. Feedback from the staff and relatives was gathered on a regular basis and any areas identified for action were acted upon.

After our last inspection we asked the registered persons to take action to make improvements to staff confidence and morale. At this inspection we found improvement had been made. Staff felt supported and could contact the registered manager at any time. They felt that they were able to raise any concerns and they would be listened to.

A range of quality audits and checks were completed regularly to ensure that good standards were maintained. Where any concerns were identified appropriate action was taken.

We saw that the staff were caring and respectful towards people and encouraged them to have fun and enjoy themselves. People were smiling and laughing with the care workers supporting them. The care records showed that people's care needs were assessed and contained detailed information to help make sure that they received the correct care. We saw that people took part in physical and social activities at the home and in the community. One relative described Martha House as, "A wonderful place". All the families we spoke with told us they were fully involved in their relative's care.

The arrangements for the management of people's medicines were well organised with clear systems to help make sure that people received their medicines as prescribed.

The staff team received training relevant to the needs of people who lived at Martha House. This was supplemented by a supervision system to support the development of the staff team. The service was in the process of reviewing and improving the training arrangements.

There was a complaints procedure displayed in the building where people could see it easily. The families and staff we spoke with told us they could raise concerns if they needed to and felt listened to.

We saw that the staff treated people as individuals and understood the importance of upholding their rights. Where people lacked capacity to make major decisions the appropriate steps were taken to take action in people's best interests.

People were supported to look their best and staff made sure people's health care needs were met. We saw that people took part in physical and social activities at the home and in the local community. Various therapists worked at the home to give people additional support to improve their health and wellbeing. Careful attention was given to people having a suitable diet and sufficient amounts to drink.

The service did the expected checks on new staff to make sure they were suitable people to work in care. Staffing levels were based on giving each person one to one support during the day. There had been a recent period when staffing levels had been difficult to maintain without staff working extra hours. Action was taken to deal with this and the service was about to achieve a full staff complement.

The service had gone through major changes recently including a change of manager. People told us this had been challenging but they believed that things were on the right track.