Archived: Marlborough House Nursing Home

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

Care was not always planned to meet people's needs. We found that some people living in the home had PRN (as required) pain relief. We asked a member of staff about pain assessments and when they were used. They told us they would use them at end of life but not otherwise. However, some people at the home had cognitive impairment, and this did not follow guidelines to support people who might have pain but were unable to express this easily. This meant that people who may not be able to express verbally that they were in pain may not have been adequately supported.

We looked in the kitchen and looked at the kitchen cleaning records. We saw that there were records for daily, weekly and monthly cleaning tasks. We found that the records were largely incomplete. For example, we looked at the cleaning schedule for 18 to 24 August 2014 and saw that the hot trolley, cabinets and breakfast trolley had not been cleaned. We discussed this with the relief chef and kitchen assistant who told us that they did not have time to complete these tasks. This meant that provider had not ensured that there were effective systems in place to reduce the risk and spread of infection.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. We saw that the provider conducted a variety of tests to ensure that the premises were safe and systems were working effectively. These included monthly tests for the fire alarm system, call bell, emergency lighting and fire exits. We noted that Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) testing, had taken place on 14 July 2014. Following our inspection the provider wrote to us confirming that the home's lifts were last serviced in March 2014.

Is the service caring?

People's privacy, dignity and independence were not always respected. We noted that one of the bathrooms on the first floor was cluttered and contained a hoist, sling, broken specialist chair, pressure relieving cushion and dirty flannel. This meant that people would have been impeded when trying to use the bathroom and did not promote their independence.

Is the service responsive?

We saw records that showed people had full access to external professionals. One person told us that they had recently seen the GP due to their leg becoming swollen. Another person had been seen by a physiotherapist because they had special seating requirements. This was recorded clearly in the person's records and on the wall of their room there were the same pictures that showed staff exactly what they needed to do to ensure the person's safety and comfort.

Is the service effective?

Where a person was unable to make decisions independently, 'best interest' processes had been followed in line with the Mental Capacity Act 2005. Records showed that mental capacity assessments had been completed for people who lived in the home. Best interest decisions had been made for areas such as the use of bedrails, repositioning and personal care.

People were not all supported to eat or drink sufficient amounts for their needs. At 10:00, we observed a member of staff give one person a hot drink. The person did not appear to understand or attempt to drink. We checked this drink at intervals until 15:00 and found the same drink, that was cold, had not been drunk. This meant they had not had a drink for five hours and were not protected against the risks of inadequate hydration.

Is the service well led?

We spoke with five people and two visitors during our inspection. People told us that they received good care and support that met their needs. One person told us, "It's fine here really, the staff are good, help me to shower every morning. Since you last came they have installed a new shower. It's much better now, the maintenance man is good."

At the time of our inspection there were 36 people accommodated at the home.

We spoke with 12 people who lived at the home, relatives who were visiting one person and with five members of staff.

We considered all the evidence we had gathered under the outcomes we inspected. We use the information to answer five questions we always ask;

' Is this service safe?

' Is the service responsive?

' Is a service caring?

' Is this service effective?

' Is this service will led?

This is a summary of what we found.

Is there service safe ?

People and their relatives told us that on the whole they or their relatives were safe but some aspects of care delivery were of concern. We were told that people had to wait a long time for call bells to be answered, which could put people at some risk.

We found that the laundry area was small with not enough shelving provided. Bathrooms were uninviting and in need of refurbishment.

Following the inspection in response to our feedback, the provider increased the staffing levels at times of peak demand.

Generally, we found that people's needs had been assessed with care plans put in place so that people's needs were being met.

At the time of our inspection there was no one living at the home who was deprived of their liberty as authorised by the Court Of Protection, or by a Supervisory body under the Deprivation Of Liberty Safeguards. The manager was aware of a recent Supreme Court ruling that widen the criteria for an application to deprive a person of their liberty and applications were being made for those people who now fell under the new criteria.

Is the service responsive ?

People's needs had been assessed and care plans put in place to support people. We saw examples of where action had been taken, such as people being referred to the tissue viability nurse for advice in treating wounds.

The home co-operated and advocated on behalf of a person who wished to move to another placement.

During our inspection we identified shortfalls in staffing levels, and the environment.

Complaints had been responded to with action taken to address issues identified.

Is a service caring?

People told us that the staff were kind and caring although at times they were very busy and sometimes did not have the time to fully support people.

Is this service effective?

Mental capacity assessments had not been recorded where 'best interest' decisions had been made on behalf of people who lacked mental capacity.

Fresh fruit and snacks were available in between meals for people at risk of not eating enough .

Some people had poor food and fluid intake which could contribute to poor health outcomes . One person said that they did not get enough to eat in the evenings and often felt hungry at this time.

Is this service well led?

The manager has been employed since November 2013 and is currently in the process of being registered as manager for the service. Two team leaders and the clinical the head of care are to be appointed to provide better leadership to the care and nursing staff.

We found there were quality assurance systems in place that identified areas for improvement. The manager demonstrated keenness to make improvements and had affected some changes before the report had been drafted.

Accidents and incidents were analysed to prevent re-occurrence.

Complaints had been responded to with action taken to address issues identified.

We carried out this unannounced inspection on the 14 February 2014, to follow up on compliance actions made at the last inspection of the home in August 2013. We spoke to nine people living at the home, two relatives, four members of staff and the manager.

People living at Marlborough House were generally positive about their experience of living at the home. No one had any complaints or concerns about how the home was run and managed. A visitor told us that they had "happy" about the care provided for their relative.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were protected from the risks of inadequate nutrition and dehydration.

People were cared for in a clean, hygienic environment.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People that we spoke with were generally positive about the way the home was run and managed. People told us that staff were "kind" and the food was good and there were organised activities to keep them occupied. However one person told us that when they used their call bell, they would regularly have to wait long periods of time to be assisted with personal care.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found that care plans did not always reflect people's needs and had not always been drawn up with their involvement.

There were some systems in place to reduce the risk and spread of infection. However people were not always cared for in a clean, hygienic environment.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

People living at Marlborough House were very positive about their experience of living at the home and no one had any complaints or concerns about how the home was run and managed.

They told us that they had good relationships with the staff, who were described as caring. They told us that the home was kept clean and warm. They told us that the standard of food was good and there were activities arranged to keep people occupied.

People told us that they were involved in decisions about how they were looked after and that they could choose when they got up and when they went to bed. They told us that they could also choose to participate in activities or not.

We found that records were up to date, accurate and stored securely.

We examined the care records of four people living at the home. The plans detailed what a person was able to do for themselves and where they required support. People's plans were routinely reviewed and updated when required.

People we spoke with told us that they were satisfied with the care they received. They told us that the staff knew how to care for them, that their assessed needs were met and that the staff were kind and respectful of their privacy and dignity.

They told us that their call bells were answered appropriately and the food was good.

We saw staff engaged and encouraged with people living in the home. However, we also observed staff ignoring people when they requested assistance with personal care.

We saw that appropriate checks were undertaken before staff began work.

We found that the provider did not have appropriate arrangements in place to manage medicines.

We saw that accurate and appropriate records were not always maintained by the home.