Archived: Marley Court Nursing Home Limited

Marley Court Nursing Home Limited (Marley Court) is a residential care home providing nursing and personal care for up to 46 adults. At the time of our inspection there were 43 people living at the home.

We found the following examples of good practice.

There were policies, procedures and a range of information available, which provided staff with clear guidance about good infection control practices, including the management of COVID-19 and visiting arrangements during the pandemic.

Government guidance was being followed in relation to isolation criteria and testing programmes for service users, staff, community professionals and visitors. We spoke with two family members who were visiting at the time of our inspection and three relatives by telephone. They all told us an appointment system was in place and that it was necessary for them to demonstrate negative COVID-19 testing prior to their visit. They described the booking in procedure, which was an electronic system located in the entrance hall and which the inspector used on arrival to the home. This recorded all necessary details on the home’s computerised system, such as temperature checks, COVID-19 test results and times of visits.

Family members and friends were able to visit their relative’s in their private accommodation or in the communal areas of the home. The management team continued to monitor the visiting arrangements. We observed relatives and staff wearing face masks and relatives told us they were encouraged to use hand sanitiser.

All employees and service users were fully vaccinated and visiting professionals needed to demonstrate vaccination status prior to being allowed access to the home. Most staff had completed specific training in relation to infection control and the management of COVID-19.

There were nine domestic staff employed at the home. On the day of our visit four were on duty. We spoke with three of them, who confirmed they had enough equipment and domestic products, which helped to promote good infection control practices. Cleaning schedules were in place. The environment was clean and hygienic throughout and fully stocked PPE stations were provided in the entrance hall and on both floors of the home. Staff we spoke with confirmed there were enough supplies of PPE which was easily accessible by all staff at all times of the day and night. We saw staff wearing PPE correctly.

The management team continued to monitor the management of COVID-19 through an effective auditing process and action plans were developed in response to any improvements needed. The manager told us good support was provided by external organisations, which helped the service to promote good infection control practices.

Marley Court nursing home provides personal care and accommodation for up to 49 people, some of whom are living with dementia. When we inspected there were 42 people living in the home. Accommodation is provided over two floors with lift access.

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

People received good quality care from staff who had been recruited safely and had received training; which helped ensure they were able to meet people's needs.

People's care and support needs were kept under review and plans of care were updated in a timely way. This helped ensure people's safety and wellbeing. A new electronic care record system alerted care staff to support needs when they were due. This helped improve the timeliness of care.

People were protected from the risk of infection by staff who had received enhanced training to manage the impact of the Covid 19 pandemic.

Management oversight of the quality of care and care records had improved. Relatives of people living in the home told us they were confident in the new manager and identified recent improvements.

Rating at last inspection and update: The last rating for this service was requires improvement (published April 2019). At this inspection we found enough improvement had been made.

Why we inspected

We undertook this focused inspection to check whether the provider had made the necessary improvements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

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

People's experience of using this service:

The service met the characteristics of requires improvement in two of the five key questions. Therefore, our overall rating for this service remains requires improvement.

At the last inspection we found two breaches of legislation relating to recruitment and care plans not always reflecting people's needs and the service was rated as requires improvement.

At this inspection we found improvements had been made to recruitment processes. We also found that improvements had been made to assessments and care plans, but some documentation contained inconsistencies and some written records were difficult to read. We recommended that the provider ensured records were always clearly and consistently recorded. There was also a lack of information documented around how often some people required positional changes. We recommended that the provider sought guidance to ensure systems around recording related to pressure care were in line with best practice.

We found issues with infection control in the laundry. This was addressed as a concern with the provider and was dealt with immediately on inspection. We found the rest of the home to be exceptionally clean and tidy.

People told us generally that staffing levels were appropriate and staff responded in a timely way to people's needs. However, we observed some people that required assistance with their meals on the first floor had to wait long periods for staff to become available. We raised this with the provider and they told us that they would look at the way they deployed staff over the lunchtime period.

Although people we spoke with told us they had no concerns about the service, we saw that complaints recorded were not always managed consistently.

There were also good practices within the service such as medicines, which were being managed safely. People liked living in the service and the home had a warm, friendly atmosphere. People told us they felt safe. They were protected from abuse and discrimination.

Staff told us they received a comprehensive induction and had the right skills and experience. People told us the food was very good at the service and felt the chef was very accommodating, offering lots of choices.

Staff had appropriate knowledge of the Mental Capacity Act (MCA) and appropriate Deprivation of Liberty Safeguards (DoLS) applications had been made. People told us the staff were very kind and thoughtful. We observed staff to be kind and caring. We saw they treated people with dignity and respect and were attentive to people’s needs.

People had access to a range of stimulating activities co-ordinated by a staff member who was passionate about her role.

People were consulted about their care and families were involved in reviews. We saw evidence that reviews took place monthly.

There were management changes taking place at the time of the inspection as the previous registered manager had just retired. Appropriate interim arrangements had been put in place and a new manager was due to start. Audits were taking place and the staff told us they felt well supported by the senior management who visited regularly.

Rating at last inspection: The service was inspected 19 and 20 September 2017. The service was rated requires improvement.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

At this inspection we found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to regulation 19, Fit and proper persons employed and regulation 9, Person-centred care. This was due to effective recruitment procedures not being followed and care plans not always reflecting people’s most recent needs.

Marley Court is a purpose built home, which is registered to provide personal and nursing care for up to 49 older people. Accommodation is offered in single and double rooms on two floors. There are lounge and dining areas on each floor. There is a patio area at the front, and gardens at the side of the home which are accessible to people using the service. Marley Court is situated on the main A6 road from Chorley to Adlington and has a large car park for staff and visitors to use. There were 45 people who lived at Marley Court during the two days of our inspection.

There was a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 who lived at the home told us they felt safe and that staff were caring and empathetic in their approach.

People’s medicines were managed safely. We observed people’s medicines being given in a sensitive and professional manner and people told us they received their medication on time. Safe storage and disposal arrangements were in place.

The home was observed to be clean, tidy and following a suitable infection control regime. Staff were trained in this area.

Staff were trained in a number of areas to assist them to undertake their duties effectively. Staff were also supported via formal supervision sessions and received an annual appraisal of their performance. Staff told us that they felt supported informally as well and could approach managers with any issues either work related or otherwise.

Appropriate recruitment practices were not always followed to ensure that staff were of suitable character and had the necessary competence, skills and experience needed to carry out their duties safely and effectively. The registered manager had begun to address the issues prior to the inspection process being completed.

People told us that staff were respectful and professional in their approach and listened to their concerns. We observed many positive interactions between staff and people during our inspection.

It was evident that staff knew people well and were able to describe people’s preferred routines, likes and dislikes. Care planning information supported this.

Effective and well planned end of life and palliative care was in place for people when they needed it. We received positive feedback from the local hospice and found evidence to show a positive working relationship was in place between the home and the local hospice service.

We found the home to have an effective and appropriate complaints procedure in place. People told us they felt comfortable raising concerns or issues with the service directly. Information was available for people and visitors with regard to the home’s complaints procedure however no-one we spoke with was aware of the formal policy.

Although people we spoke with were not aware of the home’s formal complaints policy the home had an appropriate complaints policy on display and contained within the ‘service user guide’. People and relatives told us they felt comfortable raising issues with the management team or staff and that they felt any issues would be listened to an acted upon.

People’s care plans did not always reflect their current needs and some of the information within them was contradictory. This meant that people’s care plans were not always person centred. Some of the issues were due to the restrictions of the electronic care planning system in use however other issues noted had not been picked up when care plans were reviewed.

We made a recommendation regarding the number of access points staff had to access the electronic care planning system as this was an issues brought up by staff and was observed to be an issue at points during the inspection.

The culture within the home was positive. We observed this to be the case over the two days inspection period and people, staff and relatives confirmed this to be the case when we spoke with them.

The home had a suite of effective policies and procedures in place that were up to date. Staff were aware of them and knew how to access them.

You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we looked around the home,looked at people's care records, staff files and how people's medicines were administered, stored and recorded. We spoke with ten members of staff and two people who lived at the home.

We found that people using the service were not safe because they were not protected against the risks associated with use and management of medicines. People did not always receive their medicines at the times they needed them or in a safe way.

We saw evidence that a number of issues raised at the previous inspection had been addressed in relation to how staff were supported. However staff morale was very low and the majority of staff we spoke with confirmed this. Some staff also told us that whilst they felt able to raise issues with managers at the home that their concerns were rarely acted upon.

People's personal records were accurate, fit for purpose and securely maintained. Other records required to be kept were maintained and held securely.

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

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We found that the service was unsafe because people were not fully protected against the risks associated with use and management of medicines.

Medicines were stored at too high a temperature so there was a risk they might be unsafe to use.

Is the service effective?

We saw from looking at care plans that people's needs were assessed and care and support was delivered in line with their individual needs. We found appropriate risk assessments were in place and regularly reviewed. People's weight was monitored and any variations noted and we saw that people's blood pressure, temperature and heart rate were also monitored.

Staff we spoke to told us they felt supported to undertake their role effectively but this had not always been the case. One staff member told us, "I feel supported, If I need any help I just ask a senior member of the team". However it was evident that no structured supervision sessions or appraisals had been taking place for a number of months. There was little in the way of recorded supervisions and no appraisals were found within staff files. This was confirmed when discussing the issues with the management team. We were told that this was in the process of being addressed.

Is the service caring?

We spoke with five people who lived at the home and one visiting relative. All the people we spoke with were happy with the care they or their relatives were receiving at Marley Court Nursing Home. One of the people who lived at the home we spoke with said, "I depend on staff for everything and get everything that I need. I feel very fortunate to be here, I'm lucky as I have all my faculties. I hear people that don't and staff are very good with them". Other people who lived at the home told us; "I'm happy here" and "I'm well looked after". The one relative we spoke to said, "We are definitely very happy with the care here. We are kept well informed and all the staff are very friendly and very helpful".

Is the service responsive?

We spoke to four members of staff. All were clear what to do in the event of an emergency at the home such as fire or if a person living at the home had fallen. We saw that people had Personal Emergency Evacuation Plans (PEEPS) in place as well as hospital passports that travelled with people when taken into hospital or when attending medical appointments.

Is the service well led?

We saw examples of recent audits taking place. The week prior to our inspection the homes head office had been in to carry out an audit of staff files. The acting manager was awaiting the results of the audit. The home were undertaking a training audit to ensure that all staff were appropriately trained. Shortly prior to our inspection the home had also undertaken a full medication audit which had highlighted some issues.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with the staff and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service was not safe because people were not protected against the risks associated with the unsafe use and management of medicines.

People were not always given their medicines as prescribed which placed their health at risk of harm. The records about the management of medicines did not show that medicines were handled safely. We saw that medicines were not always stored safely.

Is the service well led?

We looked at the information the provider had sent us in January 2014 in response to the compliance action we made after our Inspection in November 2013. We found that none of the actions outlined in the letter had been put into force or had been maintained effectively. The provider had failed to protect people against the risks associated with the unsafe use and management of medicines. This raised concerns about the leadership within the organisation.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to safeguard those living at the home.

We found that some medicines records were not completed properly and that some medication was not stored or administered correctly.

Service users were safe and their health and welfare needs were met by staff who were fit, appropriately qualified and were physically and mentally able to do their job.

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

Overall, we found that medicines were managed in a safe way.

Overall we found medicines were not always safely handled and some improvements are needed.

Comments from residents included:

'I have dry itchy legs but staff don't apply my cream'

'They look after me well'

'My eye drops have not been put in for several days, they feel gritty and hurt'

'Staff are nice I like living here'

The home was divided into two units. The first floor was for people who had mainly nursing needs. Conversation with most residents on this floor was limited due to their health needs. We therefore spent much of the time in the lounge/dining area making observations of how people were being cared for. However residents and relatives we spoke with, said they were well cared for and praised the nursing and care staff for the support they received.

People told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs.

Residents said routines were relaxed and the standard of food was very good. They also said activities kept people entertained. One resident spoken with told us, "We have a special person for activities and she is fantastic. She keeps us on our toes.' Another resident said, 'We grow our own vegetables and bake in the afternoons I really enjoy that.'