Archived: Martins House

We carried out a comprehensive inspection at Martins House on 30 March 2017, this was unannounced. At this inspection we found that significant improvements had been made across the safe, effective, caring and responsive domains, although further improvement was still required in relation to the management of the service. Martins House is registered to provide accommodation and personal care for up 60 older people some of whom live with dementia. At the time of our inspection 28 people were living at the service.

Since our last inspection a new manager was appointed in August 2016 and had registered with the Care Quality Commission as they are required to do. A registered manager is a person who has registered with the Care Quality Commission (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.

People did not experience delays whilst waiting for their care to be provided, staff had sufficient time to carry out their tasks as the registered manager had recruited a significant number of staff to the home. They had reduced the number of temporary staff working in the home to zero hours prior to the inspection. People’s care plans had been developed to include more up to date information. However, these records still required work to ensure they included all the specific information about people's needs. Risks to people’s safety and wellbeing were positively managed with appropriate equipment in place to support people’s health needs. People were supported by staff who had undergone a robust recruitment process to ensure they were suitable to work with vulnerable people. People’s medicines were managed safely and people received their medicine as the prescriber intended.

People were supported by staff who were well trained and supported by effective leadership to develop their skills and provide effective care. Care staff received regular supervision of their conduct and practise. People's consent was sought however the service did not consistently work in accordance with MCA and DoLS legislation. People were happy with the food and drink provided to them and where people were at risk of weight loss, staff took appropriate the actions to support their welfare. People were supported by a range of health professionals who were positive about the improvements in the home.

Staff spoke and interacted with people in a kind and friendly manner, demonstrating a caring approach to meeting people’s individual needs. Staff ensured people’s dignity and privacy was maintained at all times and supported people's social needs. People felt able to raise a concern or complaint with staff who they felt would take appropriate action to resolve these. People were provided with regular opportunities to meet in order to discuss improvements in the home or be kept abreast of developments.

People did not always receive high quality care that was well led. People felt the service was well managed and that the management team were visible. Staff felt confident in approaching the registered manager and felt they were supportive of them. Governance systems in the home had been introduced and had improved in identifying areas of poor practise or risk to people, however these systems continued to be under review. People’s care records continued to require further development.

The inspection took place on 11 August 2016 and was unannounced.

Since our last inspection there had been significant changes within the senior management team and new ways of working at a senior level were being implemented with the further development of a service quality improvement team. The registered manager who previously worked at Martins House had been transferred to another home owned by the provider after our inspection in December 2015. At the time of our inspection a manager had been recruited who was due to commence employment on 15 August 2016. The home was also without a Deputy Manager and the provider was in the process of recruiting for both positions.

Martins House had two managers since the registered manager’s departure who had not registered with CQC and had both subsequently left the organisation. A registered manager is a person who has registered with the Care Quality Commission (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.

We inspected Martins House due to concerns raised with us by the local authority. These were related to people’s continence needs were not being met, care was not being provided safely and regularly reviewed, and there were concerns regarding the competency and deployment of staff to meet people’s needs. We found at this inspection breaches of Regulations 09, 10, 11, 12, 13, 14, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009. Following this inspection we took urgent action to suspend admissions to the home and sought urgent assurances from the Provider about how they would safely meet people’s needs.

At this inspection we found that there were numerous permanent staff vacancies and as a result there was a use of agency staff mainly at nights. This led to inconsistencies in the quality of care people received. People experienced delays in getting assistance and also receiving care when they needed it. People's continence needs were not met in a prompt manner as required. Risks to people’s health and well-being were not consistently identified and responded to positively. People’s medicines were not administered at the times indicated by the prescriber. The environment people lived in was not effectively maintained and cleaned.

Staff shortages and lack of skills of some of the staff working at the home had impacted on care delivery, maintenance of records, and the management of medicines and people's access to health care professionals. Staff told us they did not feel supported and had not received appropriate training to carry out their role. Staff morale in the home was low, and they told us they did not feel supported by the managers or the provider.

Permanent senior staff responsible for providing leadership on each of the floors of the home had limited support and training from the provider to be able to do this effectively. The training and development deficiencies had impacted on the care people received. People’s nutritional needs were not consistently met and monitored. People were not freely able to choose what they ate and people were not always referred promptly to the range of health professionals when their health deteriorated.

People's dignity and privacy was not protected by some staff and people were not cared for in a manner that promoted their wellbeing and personal hygiene. Some people were observed to be left in an undignified manner; however we also found that some staff interacted with people in a kind and friendly way. Some of the people we saw were comfortable in the presence of staff and close relationships had been formed.

We observed staff delivering care and support in a task orientated way and there was little interaction seen between people and staff. People’s social needs were not consistently met and there was little opportunities for them to pursue their hobbies and interests. People were unsure of where or to whom they were able to raise their concerns and complaints, and relatives told us that when they had recently raised complaints these had not been thoroughly responded to.

People did not always receive high quality care that was well led. The provider had not taken account of issues identified in other of their local homes recently to review and monitor the quality of care people received at Martins House. A service improvement plan recently developed was not sufficiently robust and did not identify many of the areas identified at this inspection. The provider had not sought to constantly monitor and review the quality and safety of care people received. Care records, and records relating to the management of the service were incomplete. Staff and relatives told us they felt the support from the provider was below of what they expected. The provider had not proactively engaged with people, relatives or staff to try to improve the service delivered. The provider had signed up to a complex care premium programme where they committed to improve staff training, moral and subsequently improve care to people however they failed to deliver on their commitment.

Following this inspection we took urgent enforcement action to restrict admissions to Martins House and imposed this condition immediately following the inspection. We also met with the provider to also seek urgent assurances that people's care needs would be met safely. We have reported our findings to the local authority, clinical commissioning group and local authority safeguarding team.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement are made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

We found that the improvements identified in the plan of actions had all been completed. The management had been effective in addressing the areas of concern. The standards of cleanliness had improved, as had the management of medicines and record keeping.

People told us that they were happy with the care they or their relative received. One person told us, "The staff are very nice. They do everything they can to help."

During our inspection on 24 September 2013 we looked at the files of five staff members. We saw that each of them had received one to one supervision meetings with the manager during June or July 2013.

On the day of our inspection the communal areas in the home looked clean and smelled fresh. However, when we looked at some of the bedrooms and en-suite facilities we noted that three of the rooms had very unpleasant odours. We also saw that the level of cleanliness in some areas of the home was not acceptable.

We carried out a reconciliation of the medication for four people who lived at the home. We found in two cases there were discrepancies between the amount of medicines held and the amount that the records showed should be in stock.

We saw that the manager, or their deputy, completed monthly audits on medication, infection control, health and safety and the kitchen.

We saw that people's care records had not been completed fully and care plans did not always reflect the care that was provided.

We observed that, in their different ways, people showed they were content living at this home and that they had good relationships with the staff. They showed that they felt safe, and were satisfied with the service being provided. We heard laughter and friendly banter between staff and people living there during our inspection.

Care records were inadequate and did not provide detailed information on how a person's care and support needs were to be met by staff. However, the staff we spoke with had all worked in the home for a number of years and knew the people well. We did note that people did not always receive the care and treatment they needed in a timely manner.

Staff understood how to protect people from abuse and what to do if they suspected any abuse had occurred. The provider had a complaints procedure and people were supported to make a complaint if they wanted to.

However, medicines were not managed well enough to ensure people received their medicines safely and as they were prescribed.