The inspection took place on 1 and 3 May 2018. The first day of our inspection visit was unannounced.

Martha House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Martha House accommodates up to 14 people within one purpose-built building, and specialises in the care of people with learning and physical disabilities. At the time of our inspection visit, there were 13 people living at the home.

A registered manager was in post and present during our inspection. 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 our last inspection in December 2016 we rated the home as Good. At this inspection we found the service remained Good overall, although there were some areas where improvements were required

Discrepancies identified by staff during the home’s weekly medicines count had not always been investigated to confirm people had received their medicines as prescribed. The provider had failed to notify us of the authorisation of two people’s Deprivation of Liberty Safeguards applications, as required under their registration with CQC.

People were supported by staff who understood how to recognise and report any form of abuse or discrimination. The risks associated with people’s care and support needs had been assessed, recorded and plans implemented to manage these. Staffing levels meant people’s individual needs could be met safely. All prospective staff were subject to pre-employment checks to ensure they were suitable to support the people living at the home. Measures were in place to protect people from the risk of infection, including appropriate use of personal protective equipment (PPE) by staff.

People’s individual needs and requirements were assessed before they moved into the home. Staff received relevant training and ongoing support to ensure they had the skills and knowledge needed to work safely and effectively. People received encouragement and physical assistance to eat and drink, and any associated risks were managed. Staff helped people to access a range of healthcare services to ensure their health needs were monitored and met. People’s rights under the Mental Capacity Act 2005 were understood and promoted.

Staff had taken the time to get to know people well, and adopted a kind and caring approach towards their work. Staff and management encouraged people to express their views and be involved in decision-making that affected them. People were treated with dignity and respect.

People received consistent, personalised care that reflected their individual needs and requirements. The provider’s complaints procedure promoted good complaints handling.

The management team promoted open communication with people, their relatives and the community professionals involved in their care. Staff benefited from effective leadership and were clear what was expected of them. The provider took steps to involve people, their relatives and staff in the service, and welcomed their views.

This inspection was carried out on 8 December 2016 and was unannounced.

Martha House is a nursing home that is registered to provide accommodation for up to 14 people with complex learning disabilities. At the time of inspection there were 13 people living at Martha House.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 10 February 2016. Although a breach of legal requirements was not found we did have concerns about how the service was managed. We also had concerns about how medicines were administered. After the comprehensive inspection, the provider wrote to us to say what they would do to in relation to the concerns we had about the management of the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they had now addressed these concerns. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Martha House on our website at www.cqc.org.uk

After our last inspection we asked the registered persons to take action to ensure that medicines were administered safely. At this inspection we found that improvement had been made. The nurses who were responsible for administering medicines made sure that medicines were given in line with people’s prescriptions and by staff that had received appropriate training in medicines.

After our last inspection we asked the registered persons to take action to make improvements to the way management communicated with the staff. At this inspection we found that improvement had been made. Staff felt supported and more involved in the running of the service. Communication had improved and there were systems in place to keep the registered manager up to date with what was happening in the home and to identify any concerns early on. Feedback from the staff and relatives was gathered on a regular basis and any areas identified for action were acted upon.

After our last inspection we asked the registered persons to take action to make improvements to staff confidence and morale. At this inspection we found improvement had been made. Staff felt supported and could contact the registered manager at any time. They felt that they were able to raise any concerns and they would be listened to.

A range of quality audits and checks were completed regularly to ensure that good standards were maintained. Where any concerns were identified appropriate action was taken.

This inspection took place on 10 February 2016 and was unannounced.

Martha House is nursing home that is registered to provide accommodation for up to 14 people with complex learning disabilities. At the time of inspection there were 12 people living at Martha House and 2 beds used for respite care.

There was a registered manager in post. 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 and associated regulations about how the service is run.

There were quality assurance systems in place; however no action was taken when concerns or risks were identified. Staff did not feel they were able to raise any concerns with the manager. We had concerns in relation to how the service was managed.

People did not always receive their medicines safely. Some staff that gave medicines had not had the training to do this. Medicine records were not always signed by the person that actually gave the medicine. This increased the risk of mistakes happening.

People were kept safe from harm by staff who knew how to recognise and report any concerns about people’s safety. There were enough staff on duty to respond to people’s health needs at the times when they needed support.

People’s needs were met in a way that was kind and caring by staff. We found that staff knew about people’s needs and the care they provided was good. Care and support was always provided with dignity and respect for the person receiving it.

People were given support to make choices and decisions about their care and support. Where people could not make specific decisions themselves these were made in their best interests by people who knew them well.

People had the correct support to enable them to eat and drink. People’s specific dietary needs were catered for and people had a choice of freshly prepared nutritious food.

People were supported to access health and social care services to maintain and promote their health and well-being. Staff worked with other health professionals to make sure that people’s health needs continued to be met.

Staff did not start working with people until checks had been made to make sure they were suitable to support and care for the people living in the home.

People living at Martha House were not able to speak with us about their experiences of living at the home. We spent time in various parts of the building so that we could see how people spent their time and how the staff supported them.

We saw that the staff were caring and respectful towards people and encouraged them to have fun and enjoy themselves. People were smiling and laughing with the care workers supporting them. The care records showed that people's care needs were assessed and contained detailed information to help make sure that they received the correct care. We saw that people took part in physical and social activities at the home and in the community. One relative described Martha House as, "A wonderful place". All the families we spoke with told us they were fully involved in their relative's care.

The arrangements for the management of people's medicines were well organised with clear systems to help make sure that people received their medicines as prescribed.

The staff team received training relevant to the needs of people who lived at Martha House. This was supplemented by a supervision system to support the development of the staff team. The service was in the process of reviewing and improving the training arrangements.

There was a complaints procedure displayed in the building where people could see it easily. The families and staff we spoke with told us they could raise concerns if they needed to and felt listened to.

People living at Martha House were not able to speak with us about their experiences of living at the home. We spent time in various parts of the building so that we could see how people spent their time and how the staff supported them.

We saw that the staff treated people as individuals and understood the importance of upholding their rights. Where people lacked capacity to make major decisions the appropriate steps were taken to take action in people's best interests.

People were supported to look their best and staff made sure people's health care needs were met. We saw that people took part in physical and social activities at the home and in the local community. Various therapists worked at the home to give people additional support to improve their health and wellbeing. Careful attention was given to people having a suitable diet and sufficient amounts to drink.

The service did the expected checks on new staff to make sure they were suitable people to work in care. Staffing levels were based on giving each person one to one support during the day. There had been a recent period when staffing levels had been difficult to maintain without staff working extra hours. Action was taken to deal with this and the service was about to achieve a full staff complement.

The service had gone through major changes recently including a change of manager. People told us this had been challenging but they believed that things were on the right track.

The people who live at Martha House are not always able to communicate verbally, so we spent time observing how staff were supporting people and how they communicated with them. We saw that staff were working on a one to one basis with people, and were respectful and caring in their approach.

We spoke with parents who were visiting their children. They were very positive about the home and told us “this place is an example and a role model for others” and “they have incredibly good nursing here”.

We heard staff offering people choice in the activities they were involved in. Staff obviously knew each person very well and were able to tell us about people’s likes and dislikes.

People who live at Martha House were benefiting from the many activities which took place both within the home and in the local community. Parents told us that they appreciated the fact that many of the staff at Martha House were of similar age to the people who live there. They described the staff as “very sensitive to her needs” and said that “we feel part of the team” and “it’s never us and them”.