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Inspection Summary


Overall summary & rating

Requires improvement

Updated 13 February 2019

The inspection took place on 3 and 4 December 2018. The first day of the inspection was unannounced, we told the provider we would be returning on the second day.

Martha House is a residential care home for up to 23 adults with a learning disability. There are two houses on the site Martha House and Frances House, both houses were included in this inspection and are registered with CQC under the name of Martha House. There were 13 people living in Martha house and 8 people in Frances house at the time of inspection. The houses were both single level. There is an activity centre on the site which included a hydrotherapy pool. Martha House is a ‘care home’. People in care homes receive accommodation and 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.

The care service had 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 can live as ordinary a life as any citizen.

At the last inspection on 5 and 6 October 2017 the service was rated overall as requires improvement. Following this we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive, effective and well-led to at least good. At this inspection we found that the rating remained requires improvement. This is the second consecutive time the service has been rated Requires Improvement.

There was no registered manager 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 time of the inspection the registered manager had left the service but had not yet de-registered. The service told us that the director of operations intended to register as the manager. However, the application had not been received at the time of the inspection.

At the previous inspection we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to assess all risks and did not have sufficient guidance for staff to follow to show how risks were mitigated when managing health conditions and health and safety. Also, the provider had failed to protect people from the unsafe management and administration of medicines. At this inspection we found that risks to people had been assessed. However, where mitigations were in place these were not always monitored. Care plans were updated but the service was in the process of transitioning from paper to electronic care plans and the paper records were not always up to date but were still being used by staff. There continued to be concerns relating to the safe management of medicines. Medicines were not checked in to the service quickly and were not always available when people needed them. Further improvements were needed to be made and the service remained in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the previous inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The systems in place to check the quality of the care being provided were not effective. Records were not accurate and up to date. At this inspection we found that whilst the electronic care plans were up to date the paper care plans were not and the service was still using both to provide care to people. There was a system of auditing in place, but these checks had not identified th

Inspection areas

Safe

Requires improvement

Updated 13 February 2019

The service was not consistently safe

Medicines were not always well managed.

Risks to people were assessed and there were mitigations in place but these were not always recorded appropriately or monitored.

People were protected from the risk of abuse.

The service was clean and improvements were being made to infection control.

There were enough appropriately recruited staff to keep people safe.

People were protected from the risks from the environment.

Where incidents had occurred these were investigated and acted upon.

Effective

Good

Updated 13 February 2019

The service was effective.

Peoples needs had been appropriately assessed and reviews of people’s needs and support were carried out as necessary.

Staff had the skills, knowledge and training they needed to support people. Staff were appropriately supervised.

People were provided with the appropriate support to eat and drink safely.

People had access to healthcare professionals when they needed them.

The building was appropriate to meet people’s needs.

The provider followed the principles of the Mental Capacity Act (2005).

Caring

Good

Updated 13 February 2019

The service was caring.

Staff were kind and caring and engaged with people in a meaningful way.

People were supported to express their views and were involved in decisions about their own care as far as possible.

Staff provided people with support to maintain their dignity and privacy.

Responsive

Good

Updated 13 February 2019

The service was responsive.

People's support plans were personalised and contained information on how people liked to be supported.

There was a complaints policy in place and people and their relatives knew how to complain if they chose to do so.

There were plans in place for the end of life which were continuing to be developed.

Well-led

Requires improvement

Updated 13 February 2019

The service was not consistently well led.

Audits had not always identified shortfalls in the service and action had not always been taken to address any concerns identified.

The management team were not always aware of their roles and responsibilities and notifiable incidents were not always reported to CQC.

Staff were happy in their role and felt well supported by the provider and that their views were listened to.

Relatives, staff and professionals were invited to feedback about the service. Communication in some areas had been a concern but the service was actively addressing this.

The service worked in partnership with other relevant organisations.