Archived: Marlborough House Nursing Home

Updated 26 February 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13 and 14 November 2014 and was unannounced.

There were two inspectors in the inspection team and they both visited on each date. We met and spoke with all 36 people living at the home. Because a small number of the people were living with dementia we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with five visiting relatives, and two visiting representatives of the CCG (Clinical Commissioning Group) during the inspection. We also spoke with the acting manager, the deputy manager and six staff.

We looked at seven people’s care and support records, all 36 people’s medication administration records and other documents about how the service was managed. These included staffing records, audits, meeting minutes, maintenance records and quality assurance records.

Before our inspection, we reviewed the information we held about the service. This included the information about incidents the provider had notified us of. We also contacted one commissioner and eight health care professionals involved with people to obtain their views.

Following the inspection, the acting manager sent us information we asked for about policies and procedures, staff recruitment, and staff training.

Updated 26 February 2015

The inspection was unannounced on 13 and 14 November 2014. Marlborough House Nursing Home is a nursing home for 52 older people with complex health needs, some of whom are living with dementia. At the time of the inspection 36 people were living at the home.

We inspected Marlborough House Nursing Home on 1 September 2014. Following this inspection we issued three warning notices for breaches in the regulations. This was because people's privacy, dignity and independence were not always respected, people’s care and welfare needs were not planned for and met and people were not supported to eat or drink sufficient amounts for their needs. We had previously asked the provider to take action to meet these regulations following the inspection on 17 June 2014. We told the provider they had to take action to meet these warning notices by 31 October 2014. These warning notices were not met at this inspection.

In addition to this we asked the provider to take action to make improvements to cleanliness and infection control in the home and people’s care records which we had found contained inaccuracies, inconsistencies and omissions.

Following the inspections that we carried out in June and September 2014, the provider sent us an action plan to tell us the improvements they were going to make. The action plan stated that all actions would be complete by 1 October 2014. During this inspection we looked to see if these improvements detailed in the action plan had been completed. We found that there were still a number of shortfalls.

We found four repeated breaches and six new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. In addition we identified a breach of the Care Quality Commission (Registration) Regulations 2009. At this inspection we found they had failed to make improvements. We have taken enforcement action against Marlborough House Nursing Home to protect the health, safety and welfare of people using this service.

Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. You can see the enforcement action we have taken at the back of the full version of this report.

There was no registered manager in post and the acting manager had not yet applied to be registered. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff did not always treat people with dignity and respect or promote their independence. Staff knew people’s basic care needs and some personal information about them. We saw some sensitive and caring interactions between some staff and people.

Not all staff were sure how they should respond to, and report any allegations of abuse or how to raise concerns as a whistle-blower. The provider had not notified us of any allegations of abuse that were being investigated by the local authority.

People’s medicines were not safely managed, stored, recorded or administered. This was because some people did not have their medicines as prescribed and staff did not have clear instructions when they needed to give people ‘as needed’ medicines. This placed some people at risk of harm and not receiving the treatment they needed.

Any risks to people’s safety were not consistently assessed and managed to minimise risks. For example, medical emergencies had not been risk assessed and planned for so staff knew what action to take.

People’s needs were not reassessed when their circumstances changed and care plans were not updated or did not include all the information staff needed to be able to care for people. People did not always receive the care and treatment they needed and this placed them at risk of harm or neglect. Their health care needs were not always met because the healthcare support they needed was not delivered.

People’s need for social stimulation, occupation and activities was not consistently met.

Some people, who needed support to eat and drink, did not get the help they needed so they could do this safely and receive the food and drink they needed to keep them well.

There were not always enough staff to respond quickly to people’s requests for care and support and for people to get up when they wanted. There were also delays in answering call bells.

Staff did not have the right skills and knowledge to provide personalised care for people who had specialist nursing needs such as epilepsy, diabetes and the use of end of life medicines. This was because they did not have the right training, regular support and development sessions with their manager.

Staff did not understand about making decisions in people’s best interests and whether there were any restrictions placed on people who were being deprived of their liberty.

Staff were not always recruited safely to make sure they were suitable to work with adults at risk.

Some areas of the home were not clean, there were unpleasant odours in two of the bedrooms. People were at risk from unlocked rooms with hazards in them and the lack of robust infection control measures.

The systems and culture of the home did not ensure the service was well-led. This was because people, relatives and staff were not routinely involved or consulted about the development of the home. The management of the home was reactive rather than proactive. When we identified shortfalls and risks to people they were addressed. However, the quality monitoring systems in place had not identified the shortfalls we found for people or drive improvement in the quality of care or service provided.