Archived: Marske Hall - Care Home with Nursing Physical Disabilities

We inspected Marske Hall on 18 June 2015 and 3 July 2015. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 3 July 2015.

Marske Hall provides personal and nursing care for up to 30 people with a physical disability. At the time of the inspection there were 27 people who used the service of which 12 people required personal care and 15 people required nursing care. Accommodation is provided over two floors. All bedrooms are for single occupancy and have a separate toilet and sink. Some of the bedrooms have a wet room and one has a bath. Communal areas include a large lounge, dining room, activities room, gym, conservatory and atrium. There is a large enclosed garden.

The home had a registered manager in place. 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 last inspection of the service on 8 and 14 July 2014 we found that care records were not always accurate or fit for purpose. The registered provider sent us an action plan telling us they would be compliant by 30 March 2015. We checked care records at this inspection and found that improvements had been made.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual person. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual performance development review.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. However at the time of the inspection 41 of the 81 staff were due for refresher training in first aid or emergency aid. This meant that on some occasions there wasn’t a staff member who was qualified to administer first aid should the need arise. We pointed out our concerns to the registered manager who immediately booked a further 15 staff on first aid training in July 2015. The registered manager confirmed to us after the inspection that now further staff had received training there was now always a qualified person on duty to provide first aid. We were told that further first aid training had been booked for the remaining staff.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. Nutritional screening had been undertaken and people were weighed on a regular basis.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

We saw people’s care plans were person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people were involved in all aspects of their care plans.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that there was a plentiful supply of activities and outings and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.

There were systems in place to monitor and improve the quality of the service provided. However the current tool used by the registered provider to identify trends and patterns for accidents and incidents was not always effective . At the time of the inspection accidents and incidents were not a common occurrence.

We saw there were a range of audits carried out both by the registered manager . We saw where issues had been identified; action plans with agreed timescales were followed to address them promptly. We also saw the views of the people using the service were regularly sought and used to make changes.