Markham House

Updated 30 August 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Markham 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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to the inspection visit we gathered information from several sources. We also looked at the information received about the service from notifications sent to the Care Quality Commission by the registered manager. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service. We spoke with five staff including support workers, deputy manager and the registered manager. We looked at documentation relating to two people who used the service and information relating to the management of the service. We spoke with three professionals who regularly visit the service.

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

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 30 August 2019

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.