This was an unannounced inspection and took place on the 26 June 2017. The inspection was planned in response to some concerns that had been shared with the Care Quality Commission.

The service provides care and support for up to seven people who may have a learning disability, a mental health condition or physical disabilities. Some people using the service displayed behaviours that were challenging to others and required interventions from staff to keep them and others safe. Some people could not speak with us due to their difficulty in communicating.

There is a registered manager at Marika House. 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; as does the provider.

The provider had outstanding arrangements in place to assess, monitor, analyse and learn from incidents where people’s behaviours challenged. Exceptional outcomes were achieved for people because the provider had gone the extra mile to implement excellent person centred training for staff which was specific to people’s individual health and social circumstances.

Staff received training appropriate to people’s needs and were regularly monitored by a senior member of staff to ensure they delivered effective care. Where people displayed physical behaviours that challenged others, staff responded appropriately by using redirection techniques and only used physical interventions as a last resort. Records showed the provider monitored incidents where physical interventions were used and had informed the local authority, behavioural support teams and healthcare professionals and the Care Quality Commission when these types of techniques were used.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and worked with advocacy agencies, healthcare professionals and family members to ensure decisions made in people’s best interests were reached and documented appropriately

People were not unlawfully deprived of their liberty without authorisation from the local authority. Staff were knowledgeable about the deprivation of liberty safeguards (DoLS) in place for people and accurately described the content detailed in people’s authorisations.

People were protected from possible harm. Staff were able to identify the different signs of abuse and were knowledgeable about the homes safeguarding processes and procedures. They consistently told us they would contact CQC and the local authority if they felt someone was at risk of abuse. Notifications sent to CQC and discussions with the local authority safeguarding team confirmed this.

Staff interacted with people and showed respect when they delivered care. Relatives and healthcare professionals consistently told us staff engaged with people effectively and encouraged people to participate in activities. People’s records documented their hobbies, interests and described what they enjoyed doing in their spare time.

Records showed staff supported people regularly to attend various health related appointments. Examples of these included visits to see the GP, hospital appointments and assessments with other organisations such as the community mental health team.

People received support that met their needs because staff regularly involved them in reviewing their care plans. Records showed reviews took place on a regular basis or when someone’s needs changed.

The service had an open culture where people told us they were encouraged to discuss what was important to them. We consistently observed positive interaction between staff and people.

This was an unannounced inspection.

The service provides care and support for up to five people who may have a learning disability, a mental health condition or physical disabilities. Some people using the service displayed behaviours that were challenging to others are required physical interventions from staff to keep them and others safe. Some people could not speak with us due to difficulty in communicating effectively.

There is a registered manager at Marika House. 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; as does the provider.

Record showed the provider monitored incidents where behaviours were and responded promptly by informing the local authority safeguarding team, the Care Quality Commission (CQC), behavioural support team and advocacy agencies.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and worked with advocacy agencies, healthcare professionals and family members to ensure decisions made in people’s best interests were appropriately documented.

People were not unlawfully deprived of their liberty without authorisation from the local authority. Staff were knowledgeable about the deprivation of liberty safeguards (DoLS) in place for people and accurately described the content detailed in people’s authorisations.

People were protected from possible harm. Staff were able to identify the different signs of abuse and were knowledgeable about the homes safeguarding processes and procedures. They consistently told us they would contact CQC and the local authority if they felt someone was at risk of abuse. Notifications sent to CQC and discussions with the local authority safeguarding team confirmed this.

Staff received training appropriate to people’s needs and were regularly monitored by a senior member of staff to ensure they delivered effective care. Where people displayed physical behaviours that challenged others, staff responded appropriately by using redirection techniques and only used restraint as a last resort. Records showed the provider had informed the local authority and healthcare professionals when this was applied. Records of physical restraint and challenging behaviours were used as part of people’s care reviews to consider the least restrictive intervention.

Staff interacted with people and showed respect when they delivered care. Relatives and healthcare professionals consistently told us staff engaged with people effectively and encouraged people to participate in activities. People’s records documented their hobbies, interests and described what they enjoyed doing in their spare time.

Records showed staff supported people regularly to attend various health related appointments. Examples of these included visits to see the GP, hospital appointments and assessments with other organisations such as the community mental health team.

People received support that met their needs because staff regularly involved them in reviewing their care plans. Records showed reviews took place on a regular basis or when someone’s needs changed.

The service had an open culture where people told us they were encouraged to discuss what was important to them. We consistently observed positive interaction between staff and people.

Records showed that people's care plans and behavioural risk assessments were regularly reviewed. Staff told us that the information in people's care plans was up to date, accurate and reflected people's needs. We spoke with a relative who said "The last review I went to had eight people there. Many professionals and I was pleased with the review".

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.

During our visit we inspected the storage and records of medicines held in the home. We saw that all medicines were stored in a locked cabinet. This meant that medicines were kept safely. A controlled drugs register was used for recording the administration of controlled drugs.

Appropriate checks were undertaken before care workers began work. We looked at the personnel records for four care workers. These confirmed that they had been interviewed, that references had been requested and that the provider had completed appropriate background checks before they started work at the home.

Records were kept securely and could be located promptly when needed. We spoke with five members of staff who all told us that people's care records were located safely in the office and told us that they could access the records when necessary.

People who lived at Marika House had complex needs and were not able to tell us what they thought about the care and support provided. We spent time in the home observing the support they received. We saw that members of staff were friendly and respectful. Members of staff knew how each person living at the home communicated. This meant there were positive interactions between staff and people living at the home, with the choices of people being respected. Members of staff were quick to respond if anyone appeared unhappy or distressed.