Archived: Marjorie Cobby House

Marjorie Cobby House is a residential care home for a maximum of 34 people. At the time of this inspection 14 people were staying at the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This is a bespoke service model operated by West Sussex County Council [WSCC] that focused on the rehabilitation needs of people following their discharge from hospital. Marjorie Cobby House provides a short term service and people can stay there for up to 12 weeks, depending on the service criteria. Respite and emergency short term care can also be accommodated. The service works in partnership with the NHS, social workers, local GP surgery and intermediate care team to support people to meet their objectives.

The home was well maintained and spacious, with small lounges and a large communal dining area. Kitchen areas are available for people to use to support with daily living skills and rehabilitation. There are pleasant outdoor seating areas. A large assisted bathroom is also offered to community physiotherapists to support people who live in the local community to receive a bath safely and enable them to receive rehabilitation support.

The service accommodates up to 34 people on short-term basis for rehabilitation support. The 34 beds were divided to reflect people’s different level of need and the level of support required by them to be able them to return to their home. There were ‘discharge to assess’ [D2A] beds, ‘community transfer beds’ [CTB] which were contracted by health commissioners and also standard ‘interim’ beds for those people with the lowest level of rehabilitation needs. People were admitted after an initial assessment was completed by a ‘trusted assessor’ who was a health professional based at the local hospital from where people would be discharged before moving to this service. We were told that the service had supported more than two hundred people to receive rehabilitation or to move onto more appropriate accommodation to meet their needs in the previous 12 months before this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service had not changed since our last inspection. Despite a safeguarding concern raised by the local social services safeguarding team, following a formal complaint that was raised, we found that the service responded to and managed risk to people appropriately. Following the safeguarding concern and after this inspection, the senior management team for this service had worked to change the structure of the service provided which meant that risks were further reduced. The ‘trusted assessor’ approach which had been used by the service to enable people to be discharged from hospital more quickly, had been stopped which enabled staff from the home to assess people’s needs instead of health professionals based at the hospital. This ensured that staff felt more confident about meeting the needs of people who were referred to stay at this rehabilitation service.

People were protected from abuse by trained staff who understood the reporting procedures when concerns may arise. Staff received appropriate training for their roles and were recruited safely which further protected people from the risks of abuse.

People had access to healthcare when they needed it. There was a regular presence of community health care professionals which included GP’s, community matrons and a paramedic practitioner, at the home. Community physiotherapists and occupational therapists also visited people at the service to support with improving daily living skills and mobility to enable people to confidently return home following an operation, fall or illness which had resulted in them spending a period of time in hospital.

Risks to people were assessed and managed. Accidents and incidents were recorded and monitored. The management team reviewed accidents and incidents for any trends and appropriate preventative measures were taken to reduce risk and avoid reoccurrences. There was a complaints process. A large number of positive compliments were seen during this inspection.

People’s medicines were managed safely and people were positively encouraged to maintain their independence with daily living skills which included self-administering their medication when safe to do so. People had a choice of food and dietary needs were maintained with healthy food and drink snacks which were always available.

The home was clean and well maintained and risks of infection were managed by appropriate use of protective equipment such as gloves and aprons when staff supported people with personal care or cleaning tasks.

During this inspection we were told that people at the service had the mental capacity to make decisions regarding their daily lives. The registered manager was aware of how to support people who may lack mental capacity and was able to describe previous occasions when they had provided appropriate support to people. People staying at Marjorie Cobby House 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 support this practice.

The service was well managed by an open and transparent management team. Daily handovers provided detailed information about people’s changing needs and support required to enable them to return home. The registered manager engaged very professionally and positively with the recent safeguarding concerns and shared regularly updated action plans with the Care Quality Commission [CQC] and social services of the progress against the actions noted.

The service was previously inspected on 29 February 2016 at which time no concerns were identified. At this inspection we found the service remained Good.

Further information is in the detailed findings below.

Marjorie Cobby House provides accommodation for up to 34 people who require personal care for short stays or rehabilitation. There were 13 people living on site at the time of our visit.

The registered provider of Marjorie Cobby House is West Sussex County Council. Marjorie Cobby House provides assessment and rehabilitation services to people to promote their daily living skills and independence.

People are referred to the service by the hospital, GP or local authority and generally stay for up to six weeks. Some people stay longer if their progress with rehabilitation requires more time.

Intensive therapy led rehabilitation is provided by care staff, physiotherapists and occupational therapists with the aim that people who use the service return to independent living or to residential services that can offer long term support.

The service is spread over two floors. Only the ground floor was in use at the time of our visit. On the ground floor, bedrooms were single occupancy and all bedrooms had ensuite bathrooms. Each bedroom had a lockable drawer for the storage of personal items. There was one large dining area, which connected to a conservatory, used for activities. In the dining room was a large refrigerator with a transparent door so that people could see in without having to open it and get cold, which was well stocked with fruit, yoghurts and jellies, different choices of squash and juice for people to help themselves to. There was a hairdresser’s room which was well equipped and there were three lounges on the ground floor.

At the time of our visit 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 2008 and associated Regulations about how the service is run. The registered manager was present throughout our visit.

We found that staff worked positively with community professionals such as learning disability nurses, social workers, dieticians, physiotherapists and speech and language therapists to ensure that people’s needs were met.

We found that people were protected against avoidable harm and abuse. Good systems were in place for reporting accidents and incidents and we found that the service was responsive to people's individual needs.

Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the provider's required staff training was up to date. This training was refreshed regularly to enable and ensure staff had retained and updated the skills and knowledge required to support people effectively. Staff told us that they felt supported and had received training to enable them to understand about the needs of the people they care for. People and their relatives felt the staff had the skills and knowledge to support people well.

There were sufficient numbers of staff on duty to keep people safe and to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting was employed.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely. Staff had completed safe management of medicines training and had their competency assessed annually by the senior staff. Staff were able to tell us about people's different medicines and why they were prescribed, together with any potential side effects.

People who used the service expressed satisfaction with their care and felt confident that staff understood their needs. Staff treated people with kindness, respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the service. This helped people maintain personal relationships with people that were important to them.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). We found that the service was working within the principles of the MCA 2005, and whether any conditions on authorisations to deprive a person of their liberty were being met. The registered manager told us that all people who used the service at the time of our visit were not subject to DoLS.

People were supported to maintain a healthy balanced diet through the provision of nutritious food and drink by staff who understood their dietary preferences that met their likes and dislikes. We observed communal mealtimes where people ate together. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks, while protecting them from harm and promoting their dignity.

We looked at care records and found good standards of person centred care planning. Records showed that people who lived at the service were assessed against risk on an individual basis. Care plans represented people's needs, preferences and life stories to enable staff to fully understand people's needs and wishes.

People, who used the service, and their relatives, were given the opportunity to share their views about how the service was run through monthly meetings and feedback surveys.

We found that the service was responsive to people's individual needs. The good level of person centred care meant that people could lead independent lifestyles, maintain relationships and be fully involved in the local community. People were encouraged to maintain their interests and hobbies and staff supported their personal preferences.

Quality assurance procedures identified where the service needed to make improvements and where issues had been identified the provider took action to continuously improve the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with three people who were staying at the service, two members of the management team and two staff supporting them. We also reviewed records relating to the management of the service. These included four people's care and health records, policies and procedures, staff training documentation and audit reports. We observed interactions between staff and people who received a service for two hours during the morning. At the time of our inspection there were four people staying at the service. Marjorie Cobby House was not accepting new admissions for three months. This was due to staffing and operational difficulties and to allow for continued refurbishment work to be completed.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection no one who received a service was subject to a DoLS. However, there were policies and procedures in place to guide staff and to uphold people's rights. People confirmed that there were no restrictions placed on them by the service. As one person explained, 'They gave me the combination to the door lock so I can go out whenever I want. I just let them know if I'm in or out for emergencies such as a fire'.

Is the service effective?

Since our last inspection the range and choice of activities available to people had increased. Activities included a range of board games, art and craft equipment, books and music. People told us that they were happy with the activities on offer. One person told us, 'There are so many things you can do. I went to Church yesterday'. Another person said, 'I went out for a cup of tea and a walk to the seafront with one of the staff yesterday. It was lovely'. This meant that people were provided with activities that stimulated and entertained them.

Is the service caring?

People were supported by kind and attentive staff. People that we spoke with confirmed this. One person told us, 'The staff are very helpful. I brought my own television in and they sorted out the plugs to make sure it was safe'.

Is the service responsive?

Since our last inspection the provider has reviewed the procedures that should be followed if people lack capacity to consent to their care and treatment. During our visit we observed that staff checked that people were happy with the support they received. People confirmed that there were no restrictions placed on them by the service. One person told us, 'The staff check that I am ok. They give me my independence, they don't overprotect. They are good like that. For example I had to go for a hospital appointment. They asked me if I wanted to go on their transport. I said no and that I would rather catch the bus. They respected my wishes'.

Is the service well-led?

Since our last inspection the provider had formally notified us that the registered manager was no longer managing the service. On the day of our inspection a manager from another service of the provider's was managing Marjorie Cobby House with support from a senior manager. We were given assurances that a permanent manager was being recruited who would submit an application to be the registered manager.

Since our last inspection systems had been reviewed and the views of people who have used the service obtained and used to make further improvements. We also found that structures and systems within the service were in the process of being reviewed to ensure all aspects of the service were routinely audited.

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. The summary is based on our observations during the inspection, discussions with ten people who were staying at the service, two members of the management team and four staff supporting them. We also reviewed records relating to the management of the service which included six people's care and health records, policies and procedures, accident records, staff training documentation and audit reports. We observed interactions between staff and people who received a service for two hours during the morning and at lunchtime. We also sat and observed part of a staff meeting. At the time of our inspection there were 14 people staying at the service. The service provided to people consisted of respite, interim care and rehabilitation.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection a manager told us that no one who received a service was subject to a DoLS.

At our previous inspection we raised concerns about the environment. The provider responded to these concerns. The service was in the process of being totally refurbished on the day of our inspection. As a result, at this inspection we found that people had been cared for in an environment which was generally safe and fit for use.

Is the service effective?

The service had assessment and care planning systems in place. However, we found that these had not ensured people received the care and support that they needed. People told us that generally they were happy with the care provided but that there was a lack of activities and stimulation. As one person explained, 'There is a total lack of things to do. I'm lucky because I am independent and can get out and about by myself.' Some people also told us that they needed more help to improve their mobility so that they could return to their own homes. For example, one person said, 'They help me to get dressed. They try getting me to stand up using the rail in the bathroom but I can only do this for a few minutes. I'm supposed to have exercises but they haven't done any yet.' A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The service had good systems in place for sharing information with other agencies that made sure people received the care and treatment they needed if they needed to visit a hospital or receive treatment from other professionals. People told us that they were happy with the support they received to access other health and social care services. For example, one person told us, 'They have arranged for me to have some care when I go back home.' Another person said, 'They arrange for the district nurse to come here and change my dressings, I've no complaints.'

Is the service caring?

People were supported by kind and attentive staff. People that we spoke with confirmed this. One person told us, 'The staff are lovely and friendly.' We saw that staff showed patience when they supported people.

Is the service responsive?

The service worked with other agencies and services to make sure people received their care in a joined up way.

We found that people's rights were not always upheld if they had changes in their mental ability to make decisions. This included the need to make a proper assessment of whether a person lacked capacity to decide whether or not to accept the care or treatment proposed, in line with the principles of the Mental Capacity Act. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The provider had formally notified us that the registered manager was absent from their post. On the day of our inspection a manager from another service of the provider's was managing Marjorie Cobby House with support from a senior manager. It was the first day that the acting manager had been in post at the service.

We saw there were quality monitoring systems in place. However, these were in parts fragmented and did not ensure that all aspects of service provision were monitored. Also, the service was unable to demonstrate that the views of people were routinely gathered and the findings used to improve the service people received. The managers acknowledged that work was needed to ensure people received a consistent and safe quality service. A compliance action has been set in relation to this and the provider must tell us how they plan to improve. Both managers demonstrated a commitment to making improvements to the quality of service provided to people.

People who use the service understood the care and treatment choices available to them. People expressed their views and were involved in making decisions about their care and treatment. Comments included "It's a good place", "We know we are here to recover" and "The occupational therapist (OT) comes to assess us for going home".

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. A planned refurbishment was not due to start untill the end of 2013 and the provider had not made any interim plans to improve the environment for people.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We were told by one person "The staff are very good they do their best for us". Other comments were "The staff are very considerate" and "staff come quickly when called".