We carried out a review of the data available to us about Markham House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Markham House, you can give feedback on this service.
About the service
Markham House is a residential care home providing personal and nursing care to 13 people with an acquired brain injury. The focus of the care is rehabilitation, so people can become more independent. This style of care and support was designed to help people regain their independence by building cognitive and practical skills. Some of the accommodation was designed as flats and there were two bungalows at the location. At the time of our inspection 12 people were using the service.
People’s experience of using this service and what we found
The provider had a range of audits in place to monitor the service delivery. However, whilst issues raised during our inspection had previously been identified by the registered manager, they had not been resolved and there was no date for expected completion. Care was planned in a way that promoted people’s independence. Staff were committed in providing a high level of care to people who used the service. People who used the service had the opportunity to express their views.
Risks associated with people’s care and support had been identified and actions taken to minimise risks. Staff we spoke with confirmed they had received training in safeguarding and knew what action to take if they felt people were being abused. Staff confirmed that they had been safely recruited and had DBS check and references prior to commencing employment. Accidents and incidents were analysed, and trends and patterns were identified. Medicines were managed in a safe way; although the medication store room temperature was often recorded as being above the recommended temperature. However, the registered manager began to address this during our inspection.
We completed a tour of the home with the registered manager and found some areas of the home required attention. Some store rooms needed more shelves to prevent storage on floors and one store room required decluttering. The freezer required defrosting and the kitchen was in a poor state and required action. We discussed these issues with the registered manager who was aware of them and agreed to send confirmation of actions taken to address the issues.
Staff we spoke with did not always feel there were enough staff working with them to meet people’s individual needs. The registered manager was in the process of appointing more bank staff so more staff would be available.
People’s needs were assessed, and care was delivered in line with their preferences and choices. Staff received support, induction and training to ensure they had the skills to carry out their role. Staff were complimentary about the provider and felt they were very supported in their role. People were supported to eat and drink enough to maintain a healthy and balanced diet in line with their dietary requirements. People had access to healthcare professionals.
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.
Staff we spoke with told us how they respected people and ensured their privacy and dignity was maintained. People were involved in planning their care and were able to make decisions about the care and support they received. Staff enjoyed their role and were happy to know they had made a difference and supported people to meet their outcomes. Staff were keen to support people to be as independent as possible.
Care plans were organised and easy to follow detailing people’s needs and how these were to be met. People who used the service had access to a complaints procedure and were encouraged to make complaints where required. Complaints were followed up and responded to in line with the providers policy. People had access to various activities although this was limited due to the staffing issues.
We spoke with the registered manager who confirmed via email what actions had been agreed as a result of this inspection.
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 (report published 28 November 2016).
Why we inspected
This was a planned inspection based on the previous rating.
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.
There was a 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People told us they felt safe living at Markham House. When we spoke with relatives they confirmed their family members were safe. Staff had a good understanding of how to manage risk for individual people and also understood the various types of abuse. They knew how and when to report concerns and were confident those concerns would be followed up. People told us they were happy and relaxed with staff and we saw this throughout the day.
People's needs were assessed and their care plans provided staff with clear guidance about how people wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were reviewed and updated to reflect people's changing support needs while they were taking part in reablement. Reablement is a way of supporting people to help them gain skills they have lost through accident or illness. Reablement was monitored to help ensure people were receiving the right care and support as advised by specialist therapists. People could access health care when this was required.
People felt able to suggest changes to the service and felt any complaints would be listened to.
People received care and support from staff who were appropriately trained and confident to meet their individual needs. Medicines were managed safely. People were supported to make decisions in their best interests. However, not all documentation was in place which could have provided evidence for this. The registered manager and staff had an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards and consent to care and treatment was sought. Some activities required of the Mental Capacity Act were not documented, for example, best interest assessments were not carried in every case this was required.
People were supported to have sufficient to eat and drink and take an active part in shopping and arranging meals.
People enjoyed happy and supportive relationships with the staff who supported them and they told us they felt able to express their views and be involved in the decision making regarding their care. People's privacy and dignity was respected.
The service was well led and the registered manager was considered, by people and staff, to be an effective leader. People told us the registered manager was approachable and supported both people and staff. The registered manager and staff had a good understanding of their roles and responsibilities. High quality care was delivered in the service, although, this wasn't always documented with evidence which would have supported this outcome, for example quality audits.