Archived: Marquis Court (Windsor House) Care Home

Marquis Court (Windsor House) Care Home is a nursing home providing personal and nursing care to up to 52 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 34 people using the service (although 1 person was in hospital at the time of our visit). People would normally live in bedrooms spread across 3 floors; however, the lower-level floor was closed at the time of our inspection as the home was not full and to concentrate staff on the ground and upper floor.

People’s experience of using this service and what we found

Quality assurance systems in place were not always effective at identifying concerns or areas for improvement. The provider had failed to implement and sustain improvements. There had been numerous management changes in the home which may have impacted the provider’s ability to make improvements. There was mixed feedback from relatives about communication. Medicines were not always safely managed. This had been an ongoing concern in the home, so lessons had not always been learned when things had gone wrong. The home required redecoration and work was ongoing to achieve this. People had access to other health professionals, but improvements were needed to the systems in place to monitor this.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service had not always supported this practice. Action was taken in response to this following our feedback.

People were protected from harm as there were detailed care plans and risk assessments in place and staff knew people well. People were protected as infection control measures were in place. There were enough staff to respond to people’s needs; however, we did receive mixed feedback about the staffing levels. Staff were recruited safely. People were safeguarded from abuse. People were supported to have enough food and drinks of their choice and in line with their needs. People were supported by staff who had training and support to be effective in their role. Relatives and staff felt positive about the registered manager and felt they could report concerns, if needed. The registered manager understood their duty of candour. The home worked in partnership with other organisations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 April 2022) and there were continued breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement overall for the last 3 consecutive inspections. The well-led key question has been rated less than good for the last 7 consecutive inspections.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This inspection started with us looking at the Key Questions safe and well-led which contained those requirements.

When we inspected, we found there was also a concern with supporting people in line with the Mental Capacity Act 2005 so we widened the scope of the inspection to also include the effective key question.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see all of the sections of this report for the details of this. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marquis Court (Windsor House) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines management, checking consent and quality assurance systems in place at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Marquis Court (Windsor House) Care Home provides personal and nursing care for up to 52 people aged 65 and over across three separate floors, each of which has separate adapted facilities. At the time of the inspection 44 people were living at the home.

People’s experience of using this service and what we found

We found that Infection prevention and control measures in place were not protecting people from the risk of cross infection. Guidance from external infection prevention and control professionals was not being followed. Plans had not been put in place following a previous COVID-19 outbreak within the home.

People's risks were not always assessed and managed safely. Some of the processes in place to assess the quality and safety of the service were not always effective in identifying and addressing shortfalls. These issues were also identified at the time of the last inspection of the home and improvement had not been made to make the home safer.

The provider had systems in place to audit and monitor the quality of the service provided but these had, been ineffective and changes had not been actioned to improve the service. Risks had not always been identified or actions not taken to reduce risks after incidents. As a result, people had been placed at risk of harm. People who displayed behaviours that challenged, were not being consistently supported because there were no clear guidelines to help staff to keep people (and themselves) safe.

Care plans had not been updated to reflect people’s care and support needs following incidents where harm has occurred. The provider was in the process of adopting new processes across the service to improve the quality of care people received but these had not yet been embedded.

Overall there were sufficient numbers of staff to meet people's needs. However, the home used a high number of agency staff and when staffing had dropped below identified staffing levels it impacted upon the service people received.

Staff had received safeguarding training and were confident they could recognise and report abuse to keep people safe. Medicines management had improved and medicines were now being stored safely.

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 Requires Improvement (published 15 July 2021).

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We had also been made aware by the local authority of a COVID-19 outbreak within the home.

This report only covers our findings in relation to the Key Questions of Safe and Well-Led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will therefore continue to monitor the service and the warning notice issued in June 2021 will remain in place. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to set out what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Marquis Court (Windsor House) Care Home provides personal and nursing care for 43 people at the time of the inspection. Marquis Court (Windsor House) Care Home can accommodate up to 52 people aged 65 and over across three separate floors, each of which has separate adapted facilities.

People’s experience of using this service and what we found

People’s risks were not always assessed and managed safely. Medicines were not always stored safely. Some of the processes in place to assess the quality and safety of the service were not always effective in identifying and addressing shortfalls.

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; however, the policies and systems in the service did not always support this practice.

Staff had received safeguarding training and knew what actions to take to protect people from the risk of abuse. There were sufficient numbers of staff to meet people’s needs.

Infection and prevention control practices were in place and were effective in reducing the risk of the spread of infection.

The provider was in the process of adopting new ways of improving the practices across the service to improve the quality of care people received.

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. Last report published (25 September 2019)

Why we inspected

We received concerns in relation to people not receiving adequate care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well- led sections of this full report. Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marquis Court (Windsor House) Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 (safe care and treatment) and Regulation 17 (governance) at this inspection.

We have issued the provider with a warning notice. We will check the provider is taking action to comply with the legal requirements set out in the warning notice.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Marquis Court (Windsor House) Care Home is a nursing home providing personal and nursing care to 42 older adults. Care is provided on three floors. Some of the people are living with dementia. The service can support up to 52 people.

People’s experience of using this service and what we found

Some of the audits in place were not always effective in identifying inconsistences or areas where improvements were needed. Staff felt supported and listened to. Feedback was sought from people and relatives who used the service. There was a manager in place who understood their responsibility with regards to their registration.

The care people received was safe. Individual risk to people were considered and regularly reviewed. There were safeguarding procedures in place and these were followed. Medicines were managed in a safe way. There were enough staff available for people who were effectively deployed around the home. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

The care that people received was effective. 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 support this practice. Staff received training to ensure they had the skills to support people safely. People had access to healthcare professionals when needed. People enjoyed the meals provided and they were offered a choice. The environment was adapted to meet people’s needs.

People were supported in a kind and caring way by staff they were happy with. People were encouraged to remain independent, offered choices and their privacy and dignity was maintained.

People received care that was responsive to their needs. Staff knew people well and they received care based on their assessed needs. People’s preferences were taken in to account. People had the opportunity to participate in activities they enjoyed. Complaints were listened to, taken seriously and acted on.

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 Requires Improvement. (19 November 2018)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding’s. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

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.

At this inspection we found improvements had been made, but more were needed and the service remains rated as Requires Improvement.

Marquis Court (Windsor House) is a Residential 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.

Marquis Court (Windsor House) accommodates up to 52 people in one adapted building. At the time of the inspection there were 44 people using the service.

There was a manager in post at the time of our inspection, they had recently been appointed and had not yet completed their registration application, but plans were in place to do this. 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.

Staff were not always available to support people when they needed help. This meant people did not always receive support which was caring. Governance systems were not always effective in identifying concerns and driving improvements whilst some improvements had been made following our last inspection, more were needed.

Peoples medicines were administered as prescribed. Risks to people were assessed and planned for to keep people safe. Staff were safely recruited. People were protected from the risk of cross infection and safeguarded from abuse. The provider learned when things went wrong.

Staff were supported in their role and had access to an induction and training. People were supported to live in an environment which was suitable to meet their needs. People could choose their meals and were supported to eat and drink. People were supported to maintain their health and well-being.

People had choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice.

People had their privacy and dignity protected. People were supported to make choices and staff promoted people’s independence. Peoples communication needs were assessed and planned for.

Peoples preferences were understood by staff. People had access to a range of activities. People were clear about how to make a complaint and these were responded to. There was nobody receiving end of life care at the service so this was not considered during the inspection.

Notifications were submitted as required and the manager understood their responsibilities. People and their relatives were engaged in the service and felt able to approach the manager.

The location has previously been rated as Requires Improvement. At this inspection the provider had made improvements to those areas, but other areas were found to require improvement. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

This inspection took place on 4 May 2017 and was unannounced.

At our last inspection on 22 November 2016, we rated the home as requires improvement overall and asked the provider to make improvements to ensure people were consistently protected from the risk of avoidable harm and to have the opportunity to take part in activities to promote their wellbeing and reduce social isolation. At this inspection, we found some improvements had been made but further action was still needed.

Marquis Court (Windsor House) is registered to provide nursing and personal care for up to 52 people. The accommodation is arranged in three units, Tivoli, Chase and Heath. At the time of our inspection, 34 people were living at the home, some of whom were living with dementia.

There was a registered manager at the service. 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.

People received their medicines as needed but improvements were still needed to ensure that medicines were consistently managed in a safe way and that effective checks and audits were in place to continually monitor this.

Risks to people’s health and wellbeing were assessed and managed and staff understood the actions they should take to minimise any identified risks. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing and staffing levels were kept under review to ensure they continued to meet people’s changing needs.

The registered manager and staff understood their responsibilities to support people to make their own decisions as much as possible. Where people lacked the capacity to make decisions for themselves, decisions were made in people’s best interests which followed legal guidance. Where people were being restricted of their liberty in their best interests, the registered manager had applied for the required legal approval.

People felt safe living at the home and staff understood their responsibilities to protect people from the risk of abuse. Staff received training so they had the skills and knowledge to provide the care people needed. People were encouraged to eat and drink enough to maintain a healthy diet and were able to access the support of other health professionals to maintain their day to day health needs. People were encouraged to keep in contact with family and friends and visitors were able to visit without restriction. Relatives felt involved in people’s care and were kept informed of any changes.

Staff had caring relationships with people and respected their privacy and dignity. Staff knew people well and people received personalised care. People’s care was regularly reviewed to ensure it continued to meet their needs. Improvements had been made and people were offered opportunities to take part in social activities that met their individual needs.

The provider and registered manager carried out checks to monitor and improve the quality of the service people received. People and their relatives were asked for their views on the service and were positive about the improvements being made by the provider. People felt able to raise concerns and complaints and were confident they would be responded to. Staff felt valued and supported by the provider and registered manager.

This inspection took place on 22 November 2016 and was unannounced.

At our last inspection in September 2015, we rated the home as Requires Improvement overall and asked the provider to make improvements to ensure people received their care as planned. We received an action plan from the provider which said the improvements would be made by the end of December 2016. At this inspection, we found some improvements had been made but further action was still needed. We also found improvements were needed in the management and safe storage of people’s medicines and the checks carried out to monitor the quality and safety of the service.

Marquis Court (Windsor House) is registered to provide nursing and personal care for up to 52 people, some of whom were living with dementia. The accommodation is arranged in three units, Tivoli, Chase and Heath. On Heath unit, a number of people were living with advanced dementia. At the time of our inspection, 43 people were living at the home.

There was no registered manager at the service. 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. There was an acting manager who had started working at the service on 26 September 2016, who was in the process of registering with us.

At the last inspection, staff did not always follow risk management plans to ensure people received their care as planned. At this inspection we found action was still needed to ensure risk management plans consistently detailed the actions staff should take to minimise any identified risks associated with people’s care. We had recommended the provider reviewed the way staff were deployed to ensure people received timely support. At this inspection, we found there were sufficient, suitably recruited staff to meet people’s needs at all times.

Whilst we saw people received their medicines when needed, improvements were needed to ensure people’s medicines were accurately recorded and stored safely. The provider had systems in place to monitor the quality and safety of the service. The acting manager had identified the improvements needed but had not been able to implement these during the short time they had been working at the service.

Staff were trained to meet people’s needs but improvements were needed to ensure they were consistently supported in their role. People’s nutritional needs and preferences were met but the recording of people’s weights needed to improve to ensure prompt action could be taken when their needs changed. Improvements were still needed to ensure everyone living at the home had the opportunity to take part in activities and social events that met their individual needs and promoted their wellbeing.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns or complaints, they felt able to raise them with the staff and management team. Staff understood their responsibilities to protect people from the risk of abuse. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People’s care was reviewed and their relatives were kept informed of any changes and were encouraged to visit the home whenever they wished. People told us they accessed the support of other health professionals when needed.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Where people were restricted of their liberty in their best interests, for example to keep them safe, this was authorised in accordance with the legal requirements.

The acting manager had started to develop an open and transparent culture at the home which encouraged people, their relatives and the staff to give their views on how things could be improved.

We considered our inspection findings to answer the questions we always ask;

Is the service safe?

Systems were in place to make sure that the premises were safe and secure. The required health and safety checks and servicing were completed.

The home had proper procedures in place in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. Staff were aware of their responsibilities to respect people's rights and to keep people safe.

The home had a risk management system in place and acted upon any incidents or accidents. It worked closely with other agencies to promote people's safety. We had concerns about the diversity of people's needs on one of the units and how the risks to people were managed. We have asked the provider to take action to address this.

Is the service effective?

People's health and care needs were assessed. People’s nutritional, personal care and mobility needs were identified in their plans of care. Monthly reviews of care were completed to make sure that care remained appropriate. Some people needed additional support to manage their behaviour. These plans would benefit from being more comprehensive and including the specific actions staff should take to respond to any incidents.

People that needed specialised diets were provided with them. People were supported to eat and drink. Gaps in some food and fluid charts meant that the amount of food and drink people consumed was not always accurately monitored.

Some signage was in place to help people to know their way around the home. The provider told us that other changes were planned to make the accommodation better for the people that lived there.

Is the service caring?

People were supported by staff that showed them respect and promoted their dignity. Most relatives were pleased with the care provided. One relative said: “I have peace of mind when I leave that they will be well looked after”.

Plans of care included some information about people’s previous lifestyle and individual needs.

Relatives involved with the service had the opportunity to complete an annual satisfaction survey. The home had relatives meetings and the manager took action to address any concerns.

Is the service responsive?

The service gave people the opportunity to take part in a number of activities. There continues to be scope for these to be further developed as we saw periods when people were sitting with little stimulation.

The service had a complaints procedure. This was made available to people. Few complaints had been received but we saw that when they were raised they were acted upon.

The service worked closely with health and social care staff to support people to manage their behaviour.

Is the service well led?

The service had a quality assurance system. A range of audits and checks were completed covering such areas as care planning and medication. Records we saw showed when shortfalls were identified they were acted upon. The service had a remedial action plan in place to improve the service to people.

People and relatives told us they were satisfied with their care. Some of our previous concerns had been addressed but improvements were still needed to make sure people received safe and appropriate care.

Staff had received training in identifying incidents of potential abuse and knew the actions to take if they had any concerns that abuse had occurred. The manager knew how to refer potential incidents for investigation.

The provider had improved the way that staff were recruited. All the required checks were completed.

We saw that care staff received the training and support to provide care to an acceptable standard. Over 90% of staff had completed training and all the care and nursing staff had met the manager to discuss their work.

Effective systems were in place to monitor and check the quality of care provided to people. Action plans were in place to address the shortfalls these checks identified.

Improvements had been made in the record keeping but further improvements were needed to make sure that the records provided up to date and accurate information.

Relatives we spoke with said they felt that the care had improved and they were happy with the care their relative received.

People's needs were assessed and plans of care were in place. People were supported to have their personal care needs met and access health care support. Records of care were not always properly completed to show that people received the care they needed.

People did not receive sufficient stimulation to promote their wellbeing. There were some activities available but some people sat for periods with nothing to do.

Care staff were not well supervised and trained. The home provided a range of training but a lot of staff were not up to date with their training. Supervision of care staff had recently been introduced.

The home sought the views of people and relatives that used the service. The home had a system in place to monitor and review the quality but this had not been consistently completed.

We spoke to three people who lived at the home and eight staff members. People we spoke with told us, "They are very good here you know", and "I do love the girls they are so good".

We saw that people were treated with respect and had their dignity promoted. People were given choices about their life in the home and their choices were respected.

We found that the home had made improvements which demonstrated that it was compliant with the regulation we assessed.