The Care Quality Commission
  • Care Home
  • Care home

Mary House

Overall: Requires improvement read more about inspection ratings

Mary House, Martha Trust, 490 The Ridge, Hastings, East Sussex, TN34 2RY (01424) 757960

Provided and run by:
Martha Trust

All Inspections

18 May 2023

During an inspection looking at part of the service

About the service

Mary House is a care home providing personal and nursing care to up to 15 people. The service provides support to people with complex learning disabilities, autistic people, and people with physical disabilities. At the time of our inspection there were 14 people using the service.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support:

Risks to people were not always managed safely. Medicines were prepared in advance of giving them and not signed by the staff member who had given them. Medicines that were prescribed on an as required basis were not always managed safely. There was limited oversight to ensure some people had enough to drink throughout the whole day.

The systems in place ensured that people were protected from abuse and improper treatment. Mary House was kept clean. Although there were high staff vacancies the service used regular agency staff who knew people well. 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.

Right Care:

Although records of activities were basic and lacking in detail, we observed that staff worked with people in a person-centred way to involve them as far as possible in all activities. The number and range of activities had increased since our last inspection, and people were going out more to places of interest. Staff were caring in their approach and people responded warmly to them. We saw people smiling and responding with happy faces when staff spoke with them. Staff ensured people’s privacy and dignity was always maintained.

Right Culture:

Systems to monitor the quality of records in relation to staff recruitment, daily records and incident reporting were not effective as they had not identified the matters we raised. The management of medicines was not effective, but the service had recognised this and was seeking advice and support and actively trying to improve in this area.

We received mixed feedback from parents and professionals. Most felt that the service had made significant improvements and were on track to improve further. Although all recognised the improvements, further work was needed to improve communication, to be more accessible and to work together in people’s best interests.

Staff felt supported by the management team. All staff had attended a supervision meeting and staff meetings were held to give staff the opportunity to share their views on the running of the service. Staff morale had improved since our last inspection and all staff spoken with felt positive about working at 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 17 December 2022) and there were breaches of regulation. We served the provider Warning Notices under Section 29 of the Health and Social Care Act 2008. The notices required the provider to become complaint with breaches relating to person centred care and governance.

Why we inspected

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

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 coronavirus 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 requires improvement.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified continuing breaches in relation to safety and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

25 October 2022

During an inspection looking at part of the service

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

About the service

Mary House is a care home providing personal and nursing care to up to 15 people. The service provides support to people with complex learning disabilities, autistic people and people with physical disabilities. At the time of our inspection there were 14 people using the service.

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

Right Support:

The model of care and setting did not always maximise people’s choice, control and independence. There were not always enough staff to provide people with person centred care. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were not always offered choices effectively and how people spent their time was sometimes dependent on staff availability. Medicines were not always managed safely and improvements were needed to ensure processes for people receiving their medicines were robust and effective. People living at the home each had unique and complex health needs and staff knew people and understood risks to people.

Right Care:

The care people received was not always person-centred and did not always promote people’s dignity, privacy and human rights. Staff did not always use people’s preferred methods of communication. The provider had not fully considered people’s needs and wishes in the planning and deployment of staff. This had led to some institutional practices. Records did not demonstrate that people were receiving appropriate care and support. Due to inconsistencies in record keeping, the provider could not be assured that people were receiving adequate support with food and fluids. Records did not show that people were being supported in the least restrictive way possible.

Right Culture:

People were not always supported to lead confident, inclusive and empowered lives. Audits were not robust to identify concerns or areas for improvement. There were tensions between some relatives and the management team. Relatives did not always feel comfortable to raise concerns. Staff told us morale was low and insufficient staffing impacted on their ability to provide person centred care. People were supported by kind and caring staff. Staff spoke positively about people.

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 30 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We received concerns in relation to the management of the service and support people received. As a result, we undertook a focused inspection to review the key questions of safe, effective responsive and well-led only. 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 changed from good to requires improvement based on the findings of this inspection.

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 Mary House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, person-centred care, consent, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

12 July 2018

During a routine inspection

This inspection was carried out on 12 and 20 July 2018 and was unannounced. At the last inspection, the service was rated ‘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 on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Mary House is a ‘care 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. The service provides accommodation and personal care for up to 13 people living with a learning disability. There were 13 people living at the service at the time of our inspection.

The care service has 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 using the service can live as ordinary a life as any citizen.

People continued to be supported to have choice and control over aspects of their lives, and staff supported people in the least restrictive way possible. People were able to maintain contact with those people that were important to them and were able to participate in a range of activities.

People were safe and positive risk taking was encouraged. Risk assessment and risk management practices were robust. As far as possible, people were protected from harm and abuse. Staff knew how to recognise the signs of abuse and what they should do if they thought someone was a risk. People were supported to eat and drink enough, and specialist dietary needs were met. People were able to access the healthcare they needed to remain well and their medicines were safely managed.

People experienced care that met their needs, and were supported by kind, caring staff. People had their privacy and dignity respected, and staff knew what to do to make sure people’s independence was promoted. People experienced person centred care and had their care needs regularly assessed, with all of the relevant people involved.

Staff were supported with training, supervision and appraisals to make sure they had the skills they needed to provide good quality care. Specialist training had been arranged where needed, for example, supporting people with behaviour that may cause themselves or others anxiety.

People were asked for their consent before any care was given and staff made sure they always acted in people’s best interests. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be deprived of their liberty for their own safety or unable to make informed choices about their care.

The registered manager had notified the CQC of events that were reportable. The rating of ‘Good’ was displayed at the service and on the provider’s website. The service has met all the fundamental standards and the registered manager and staff have maintained a good service. Further information is in the detailed findings below.

4 August 2016

During a routine inspection

The Inspection took place on 4th and 5th August 2016 and was unannounced.

Mary house is a purpose built care home registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for a maximum of 13 people with profound learning and physical disabilities. At the time of our visit there were 11 people living in the home. At the time of our inspection there was a registered manager at the home. 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.

Audits to monitor the quality of service were effective. They identified actions to improve the service where needed and these were carried out.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. People told us that staff asked their permission before they provided care. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

Risks to people’s safety had been assessed and actions taken to protect people from the risk of harm. The provider also had systems in place to reduce the risk of people experiencing abuse. When concerns were raised, the provider had investigated these thoroughly and action had been taken to protect people when necessary.

Medicines were managed safely and people had access to their medicines when they needed them. However, medicines were not clearly audited when counting stock from one month to the next. We have made a recommendation about the procedure for stock checking all medicines.

Staff were trained and there were enough staff with the right skills and knowledge to provide people with the care and assistance they needed. They knew the people they cared for well and treated them with kindness, compassion, dignity and respect. Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s special dietary needs were clearly documented and staff ensured these needs were met.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff sitting and talking with people as equals. People could have visitors from family and friends whenever they wanted.

People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. People led full and varied lives and were supported with a variety of activities often with one to one support.

Support plans ensured people received the support they needed in the way they wanted. People’s health needs were well managed by staff so that they received the treatment and medicines they needed. Staff responded effectively to people’s needs and people were treated with respect. Staff interacted with people very positively and people responded well to staff.

The culture of the service was open and person focused. The registered manager provided clear leadership to the staff team and was an active presence in the home.

20 and 21 July 2015

During a routine inspection

Mary House provides residential and nursing care for up to 13 people with profound and multiple learning disabilities. As a result of their disabilities people require support with all aspects of care including eating and drinking and with moving and handling. People were unable to communicate verbally and some used vocal sounds or body language and facial expressions to make their needs known. The building was purpose-built to meet people’s needs. A hydro pool was on site with access to appropriately designed changing rooms to meet people’s needs. A hydro pool is a pool used for water exercise and other therapy treatments. Facilities included an art room, a music room and a sensory room. At the time of our inspection there were 12 people living at the home.

We inspected Mary House on 19 and 23 December 2014 and identified a range of concerns. We took enforcement action and asked the provider to make improvements in staffing levels, care and welfare, equipment and in the monitoring of the service. Improvements were also required to be made in the management of medicines, nutrition, dignity and respect, complaints, records, staff training and infection control. The provider has written an action plan to address these improvements within a required time frame.

We inspected again on 06 May 2015 because we had received concerns about people’s safety. At the time of this inspection, the timescales to meet our regulations had not yet expired. This inspection therefore focused on the concerns and checked whether some of the improvements had been carried out in regard to people’s safety. At this inspection we found that improvements and compliance had been achieved in infection control, the management of medicines, records and recruitment. However further requirements were identified about the lack of sufficient staff with the right skills and knowledge and a lack of appropriate safeguarding procedures to ensure restraint was only used when absolutely necessary.

This inspection on the 20 July 2015 was to check whether appropriate action had been taken to implement improvements identified at our inspection in December 2014. We found that progress have been made although in some areas some improvements were still to be implemented. Although the timescales to meet our regulations had not yet expired in regard to the inspection of 06 May 2015, we found that the two further requirements identified at that inspection had already been fulfilled.

There was not a manager in post who had applied to become registered with the Care Quality Commission (CQC) at the time of our visit. A registered manager is a person who has registered with the CQC 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. A newly recruited manager had not yet started their duties in the service.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

All fire protection equipment was serviced and maintained.

People’s bedrooms were personalised to reflect their individual tastes and personalities.

Staff knew each person well and understood how to meet their support needs. A relative told us, “We find that staff are more alert about and respond better than a few months ago to individual needs”.

Essential staff training was up to date and additional training was scheduled to take place shortly. Staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal. This ensured they were supporting people to the expected standards.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements. However further applications that needed to be made were in the process of being completed.

Staff sought and obtained people’s consent before they helped them.

The service provided meals that were in sufficient quantity and met people’s needs and preference. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect.

People and their relatives were involved in their day to day care. People’s care plans were reviewed with the participation of relatives who were invited to attend the reviews and contribute.

Clear information about the home, the facilities, and how to complain was provided to people and visitors.

People were able to spend private time in quiet areas when they chose to. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed monthly and updated when their needs changed.

People were involved in the planning of activities. A broad range of suitable activities and outings was available.

The service took account of relatives’ feedback, comments and suggestions. People’s views were sought and acted on. Satisfaction questionnaires were sent to people’s relatives or legal representatives, and the results were analysed and acted on. Staff told us they felt valued under the registered manager’s leadership.

The acting manager notified the Care Quality Commission of any significant events that affected people or the service. The provider, directors and acting manager kept up to date with any changes in legislation that may affect the service. They carried out audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

6 May 2015

During an inspection looking at part of the service

Mary House provides nursing and personal care and accommodation for up to 13 young adults with profound and multiple learning disabilities. There were 12 people living at the home during the inspection they required assistance with all aspect of their care, including washing, dressing, eating and drinking and moving around the home. People were unable to communicate verbally and used body language, facial expressions and some vocal sounds to make their needs known.

We inspected Mary House on 10 and 23 December 2014 and identified a range of concerns. We gave the provider a list of actions to take to meet the regulations.

Although the timescales to meet our regulations have not yet expired. We received concerns about people’s safety and undertook a focused inspection on 6 May 2015 to look into these concerns. This report only covers our finding in relation to these concerns.

There was no registered manager in place at the time of this inspection and the home was being managed by senior staff from the charity, Martha Trust, and the deputy manager or the home. A registered manager is a person who has registered with the Care Quality Commission to manage a service. Like registered providers, they are registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associate Regulations about how the service is run.

The trust managers said they had advertised for a manager for the home and they had interviewed some people, but they had not found a suitable applicant. A relative told us they had been involved in the interview and said “We haven’t found the right person yet.”

There were not enough staff with the right skills and knowledge working in the home and safeguarding procedures did not ensure that restraint was only used when absolutely necessary.

Medicines were managed safely and systems for the control of infection were in place to protect people.

Risk assessments for pressure sores had been completed and systems were in place to reduce the risk.

Robust recruitment procedures were in place to ensure only people suitable to work at the home were employed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

19/12/2014 and 23/12/2014

During a routine inspection

Mary House provides residential and nursing care for up to 13 people, with profound and multiple learning disabilities. As a result of their disabilities people required support with all aspects of care including eating and drinking and with moving and handling. People were unable to communicate verbally and some used vocal sounds or facial expressions to make their needs known. The building was purpose built to meet people’s needs. A hydro pool was on site with access to appropriately designed changing rooms to meet people’s needs. A hydro pool is a pool used for water exercise and other therapy treatments. Facilities included an art room, a music room and a sensory room. At the time of our inspection there were 12 people living at the home.

At the last inspection on 28 April 2014 we asked the provider to take action to make improvements in records. After that inspection we received information about concerns relating to the home. We carried out this unannounced inspection on 19 and 23 of December 2014 to check that improvements had been made, to follow up on the concerns received and to determine a rating for the home. At this inspection we found insufficient progress had been made in relation to records and we also identified a number of additional concerns. This is reflected in the enforcement actions we have taken which can be seen at the back of this report.

A registered manager was in post but was on temporary leave at the time of inspection. In the interim, the director of care services for the organisation had taken on the role of manager and the deputy manager had also taken on additional duties. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

People’s safety was compromised in a number of ways. Minimum staff levels were provided most days. However, a number of people received additional funding for one to one support and these hours were rarely provided. There were a lack of protocols for the management of topical creams and this increased the risks of creams being applied inappropriately. The systems for monitoring cleanliness were inadequate and did not protect people from the risk of infection. Care plans did not fully reflect people’s complex needs and incident and accident records were not always evaluated to consider if risk assessments were sufficiently detailed to support staff in reducing the number of incidents.

A number of people had equipment that was ill fitting and no longer met their needs. This included wheelchairs, standing frame and walking frames. Whilst progress had being made in recent weeks to arrange for some people’s equipment needs to be reassessed, this was a slow process and the home had not been proactive in pushing this forward. There was a lack of timely referral to healthcare professionals to assist staff in meeting people’s complex needs, for example in relation to oral hygiene and maintaining oral skills. Due to the turnover in the staff team significant gaps were seen in relation to staff training. There was limited evidence that sufficient staff had appropriate specialist training to meet people’s complex needs.

People’s relatives told us that they had no problem raising concerns with the management of the home. However, they said that actions taken to address matters were not always sustained. There were no systems in place to document actions taken in respect of informal complaints. Activity programmes were not varied and there was limited evidence that people were offered meaningful occupation.

The systems to monitor the quality of the home were not effective. When shortfalls were identified there was minimal evidence that the shortfalls were followed up to ensure matters were addressed.

We observed practices that showed that people’s dignity was not always respected. However, we also observed very positive interactions, for example a staff member giving lots reassurance to a person whilst they were assisted with their mobility. A visiting therapist told us staff were, “Wonderful, I can’t praise them enough. It’s spacious and staff are attentive and kind.” One relative told us, “Staff are dedicated, we have no concerns about the care given.” Relatives told us that if their relative was unwell staff were in touch regularly to give them an update.

We found a number of breaches of the regulations. This includes a continuous breach in relation to records we found at our last inspection. You can see what action we told the provider to take at the back of the full version of the report.

28 April 2014

During a routine inspection

Mary House provides accommodation with personal and nursing care for up to 12 people with learning and physical disabilities. At the time of the inspection there were 12 people living at Mary House. None of the people who were living at the service were able to speak with us but we did speak with some relatives.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We found the service was meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were recognised, respected and promoted.

Relatives spoke positively about the staff and their kindness. One relative said, “There is a very positive, enthusiastic team spirit” and a “great sense of fun”, which helped create a “warm and loving environment.” Relatives felt there were “lots of positives” about the service although some felt there were some areas that could be improved, such as communication.

The service was not always safe and improvements were needed. The majority of risks associated with people’s care and support had been identified and guidance about good practice was in place to reduce these risks and keep people safe. People were treated with dignity and respect. Staff understood the importance of supporting people to make their own decisions where possible. People received their medicines when they should and safely. 

People’s needs had been assessed. Relatives and staffs knowledge of people had been used to develop care plans. Care plans detailed people’s known preferences, choices and independence skills. The service had recently introduced an “active support” programme, to encourage further development of interaction and independence skills. People had sufficient quantities of food and drink and any special dietary needs were catered for.

People were treated with kindness and respect. Relatives told us people’s preferred name was always used by staff and this was recorded in their care plan.

People were encouraged to make their own day to day decisions about their care and support. Where people were unable to make complex decisions for themselves, such as whether to have hospital or dental treatment, the service had considered the person’s capacity under the Mental Capacity Act 2005. Records showed a person’s relatives and health care professionals had been involved in the best interest decision making process for that person. People had opportunities to undertake activities both within the service and in the local community.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law with the provider. The registered manager provided good leadership and support to the staff. Relatives had opportunities to feedback about the service provided, but some felt communication with management could be better. The senior management team had systems in place to monitor the quality of the service, so that people received care and support that met their needs.

We found there was a breach of Regulation 20 of the Health and Social Act 2008 (Regulated Activities) Regulations 2010.

6 November 2013

During an inspection looking at part of the service

We carried out this inspection to follow up on a compliance action made in December 2012 and April 2013 and a second compliance action made in April 2013.

We used a number of different methods including SOFI to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We observed staff interacting positively with people and providing person centred care.

We found that care plans clearly documented the needs of people and how they should be met. Where appropriate, specialist advice and support was obtained.

Records demonstrated that staff received appropriate training and supervision to perform their respective roles.

24 April 2013

During a routine inspection

We carried out this inspection to follow up on compliance actions made in December 2012 and to inspect additional outcomes.

We used a number of different methods including SOFI to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We observed staff interacting positively with people and providing person centred care.

We found that care plans clearly documented the needs of people and how they should be met. However, it was not always clear from record keeping that people's needs were appropriately met. Where appropriate, specialist advice and support was obtained. People's representatives were involved in decisions about their relative's care and treatment.

Records did not fully demonstrate that all staff had received appropriate training to perform their role. There were systems in place to monitor the quality of the care provided and this was being developed further to ensure they were more effective.

31 December 2012

During a routine inspection

We used a number of different methods including SOFI to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We observed some staff interacting positively with people and providing person centred care. However, some care practices indicated that people's dignity was not always respected.

We found that care plans clearly documented the needs of people and how they should be met. Where appropriate, specialist advice and support was obtained. People's representatives were involved in decisions about their relative's care and treatment.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse.

25 May 2012

During an inspection in response to concerns

We asked parents for their views on their child's care. They told us, 'We've been told we can't discuss anything with the carers because they're concerned things might be taken the wrong way. I don't know fully what she's doing. We've been given a programme, but it's not tailored for her. My wife feels our daughter needs her own individual programme'.

Another said 'If my child is unwell I need to know. This doesn't always happen'.

'The rooms and the home are immaculate, but there's never a manager around at weekends ' this is when people visit, and when we need to speak with someone, no-one gets back to you for ages'.

We asked parents about the activities available, they told us 'I've asked for a timetable of activities, but they've refused'.

One parent said 'I was led to believe that it would always be a female dealing with my daughter's personal care, but I challenged this after seeing a man assist her'.