We carried out a review of the data available to us about Marie Louise House Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Marie Louise House Nursing Home, you can give feedback on this service.
Marie Louise House Nursing Home is a nursing care home providing personal and nursing care to up to 51 older people. The home consists of three separate floors with their own shared spaces, including lounges and activity spaces. One of the floors offered specialised care and support to people living with dementia and they had their own area of the garden which they could access safely. At the time of our inspection there were 30 people using the service.
People’s experience of using this service and what we found
People and their relatives told us they felt safe and liked living at the home. People knew who they could talk to if they had any worries or concerns. There were appropriate policies and systems in place to protect people from abuse. Staff knew how to recognise abuse and protect people.
Risks to people were recorded in their care plans. Staff demonstrated their knowledge of people and how to support them to manage their individual risks. The safety of the environment, and of equipment within it, was monitored through regular checks.
We were assured that the provider effectively managed or prevented infection outbreaks. People told us they were able to contact their family members and friends when they wanted to. The provider facilitated visits to people living in the home in accordance with government guidance.
People and staff told us there were enough staff to meet people’s needs. We observed safe staffing levels throughout the inspection and staff appeared unhurried and responsive to people. Safe recruitment processes were in place.
People received the correct medicines at the right time. Staff followed systems and processes to safely administer, record and store medicines. People received care and support which met their needs.
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.
People and their relatives were positive about the quality of care and support people received. People, and those important to them, worked with the management team and staff to develop and improve the service. There were a number of systems and processes in place for monitoring the quality of care. These were used to plan improvements. Where issues were identified remedial action was taken. Staff felt respected, supported and valued.
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 29 September 2020).
Why we inspected We carried out an unannounced inspection of this service in relation to the Key Questions Safe, Effective and Well-led on 18 and 20 August 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve safe care and treatment.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. 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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
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 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 Marie Louise House Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Marie Louise House Nursing Home is a service providing care and support for up to 51 older people. The home is located in Romsey.
People’s experience of using the service
Medicine administration was not always carried out safely or in line with best practice guidance.
Falls were not always investigated appropriately and records relating to falls were not always documented robustly.
We could not be assured the deployment of staff was safe or suitable to regularly engage people in meaningful activity.
Whilst the provider had good arrangements in place to assess the risk of COVID-19, further improvement was required to promote social distancing.
Although management had taken action from our feedback, further improvement was required to ensure all staff had received up to date training in respect of infection prevention and control.
Records relating to care and treatment required improvement to ensure documents were accurate and reflected the care provided.
The provider had effective procedures in place to safeguard people from possible abuse.
Lessons had been learned from previous incidents and new learning tools had been put in place to improve the quality of care provided.
People consistently told us they received pain medicine when they needed it.
People told us they received good quality meals and were encouraged to choose what they wanted.
Staff worked effectively with external healthcare professionals who were complimentary about the service and the clinical treatment provided.
Support, supervision and competency assessments were carried out frequently and staff told us they could access support when they needed it.
The management team of the service were open, honest and had worked hard to develop robust systems to ensure people remained safe.
The interim manager and the quality lead were aware of areas where the home required improvements. Governance systems were effective in identifying this.
Rating at last inspection
We previously inspected the service on 28 and 29 March 2018 and rated the service good.
Why we inspected
The inspection was prompted in part due to concerns received about catheter care, falls management, pain management, nutrition and hydration. A decision was made for us to inspect and examine those risks.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Marie Louise 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.
Marie Louise House is a purpose built care home with nursing. The home is a Catholic foundation which regards spiritual welfare to be equally important to physical care. However, people of all faiths were welcome at the home. The home is owned by the Daughters of Wisdom, a Catholic religious order, and managed on their behalf by the Healthcare Management Trust (HMT), a not for profit organisation, and their board of Trustees. The home is registered to accommodate up to 51 people and at the time of the inspection there were 46 people using the service. The home comprises of three units. The Nightingale Unit provides care for up to 10 people who are living with dementia and have associated health and social care needs. The Kingfisher and Skylark Units each provide care to 18 people who require either residential or nursing care.
The service had a registered manager. 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 and associated Regulations about how the service is run.
Overall medicines were managed safely. The registered manager was arranging for additional training to support improvement with record keeping in relation to medicines.
There were a range of systems and processes in place to identify and manage risks to people’s wellbeing and to the environment.
Staff had received training in safeguarding adults, and were aware of their responsibilities with regards to keeping people safe from harm.
There were suitable numbers of staff deployed to meet people’s needs.
The home was clean and staff were observed to be using appropriate personal protective equipment (PPE).
Accidents and incidents were investigated and action taken to reduce the risk of further harm.
Care plans provided a record of people’s individual needs and staff were provided with opportunities to develop their skills and knowledge and performed their role effectively.
Staff worked in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were applied appropriately.
People were supported to have enough to eat and drink.
The premises were purpose built and their design and layout met the needs of people using the service. A programme of refurbishment was underway.
Where necessary a range of healthcare professionals including GPs, dentists and speech and language therapists, had been involved in planning people’s support to ensure their health care needs were met.
People were cared for by kind and compassionate staff and were treated with dignity and respect.
Feedback showed that staff provided effective and compassionate care to people reaching the end of their life.
Improvements had been made to develop the activities programme provided and action was being taken to extend the activities provision to include weekends.
Communication was provided in ways which met people’s individual needs and technology was used to support people to maintain choice and control as to how aspects of their care were delivered.
People and relatives told us they were confident they could raise concerns or complaints and that these would be dealt with.
The service was well led. Staff were positive about the leadership of the service and felt well supported in their roles. Staff morale was good and staff worked well as a team to meet people’s needs.
There were robust systems in place to monitor and improve quality and safety within the service. The provider sought feedback from people, their relatives and from staff and used this to continually improve the service.
This inspection took place on 30 November and 1 December 2015 and was unannounced.
Marie Louise House is a purpose built nursing home which opened in 2005. The home is owned by The Daughters of Wisdom, a religious order, and managed on their behalf by the Healthcare Management Trust and their board of Trustees. The Sisters from Abbey House convent work closely with the home providing pastoral support to the residents and their relatives. At the time of our inspection there were 45 people living at the home. The home is arranged over three floors. The Nightingale unit on the ground floor provides care for up to 10 people living with dementia some of whom were also physically frail and needed assistance with all aspects of their personal care and mobility. The Skylark and Kingfisher units provide general nursing care for up to 36 people.
Marie Louise House had a registered manager. 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 and associated Regulations about how the service is run. The registered manager was new to the service having only been appointed in September 2015.
At our last full inspection in November 2014, we asked the provider to take action to ensure they were; acting in line with the principles of the Mental Capacity Act (MCA) 2005, providing person centred care and managing people’s medicines safely. We found that staffing levels needed to improve and that the systems in place for assessing and monitoring the quality of the service also needed to improve. The provider sent us an action plan which described the actions they were going to take to make the required improvements. This inspection checked to see whether the required improvements had been made to ensure that the home was meeting these and other essential standards.
Improvements were being made which meant that there was an increasingly stable staff team available to meet people’s needs. Whilst some staff felt that there could at times be insufficient staff, people told us their needs were usually met in a timely manner.
Action had been taken to ensure that, where people lacked the mental capacity to make decisions staff were more effectively applying the principles of the Mental Capacity Act 2005. This supported staff to act and make decisions in which were in the person’s best interests.
The provider and new registered manager were taking action to strengthen the systems in place to identify, assess and manage risks relating to the safety of people and of the quality of the service. There was an increasingly robust quality assurance system in place.
People and their relatives were positive about the care and support they received. Staff knew people well and understood how to meet their individual needs in a person centred way. However, people’s records did not consistently contain sufficient information about their needs and how these should be met.
The activities programme would benefit from further development to ensure its meets the needs of each person using the service including those living with dementia. We have made a recommendation regarding this.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were either in place or had been applied for.
Staff had received training in safeguarding adults and had a good understanding of the signs of abuse and neglect. Staff had clear guidance about what they must do if they suspected abuse was taking place.
Recruitment practices were safe and relevant checks had been completed before staff worked unsupervised. These measures helped to ensure that only suitable staff were employed to support people.
Staff had developed effective working relationships with a number of healthcare professionals to ensure that people received co-ordinated care, treatment and support.
People told us they were cared for by kind and caring staff who respected their choices, their privacy and dignity and encouraged them to retain their independence.
People were actively supported to maintain their religious and spiritual beliefs and this was fundamental to each person’s wellbeing and the overall quality of their care. The home had close links with the Daughters of Wisdom living in the adjacent convent who provided pastoral support to people.
People told us they were able to raise any issues or concerns and felt these would be dealt with promptly.
Staff had an increasing confidence in the new registered manager to listen to their concerns and make improvements.. However, the relationship between some of the staff members was at times disharmonious and we were concerned that this could impact upon the care people received. The registered manager was aware of the need to work with the staff team to build relationships and a more productive culture and was already taking action to address this.
People and their relatives spoke positively about the registered manager and about the leadership of the home. The engagement and involvement of people and their relatives was encouraged, their feedback was being used to drive improvements.
We carried out an unannounced comprehensive inspection of this service on 24 and 25 November 2014. Breaches of legal requirements were found and we issued a warning notice for a breach in relation to the maintenance of proper records. The provider was required to meet the regulation by 16 February 2015.
As a result we undertook an unannounced focused inspection on 10 April 2015 to follow up on whether action had been taken to meet the requirements of the warning notice. You can read a summary of our findings from both of these inspections below.
Comprehensive inspection of 24 and 25 November 2014.
This inspection took place on 24 and 25 November 2014 and was unannounced. At the last inspection in June 2014, we asked the provider to take action in relation to how people consented to their care and treatment, the care and welfare of people, how workers were supported, how the safety and quality of the service was monitored and the maintenance of records. The provider sent us an action plan which described the actions they were going to take to make the required improvements. Whilst at this inspection, we found some improvements had been made; further action was required to ensure that the home was meeting these and other essential standards.
Marie Louise House is a purpose built nursing home which opened in 2005. The home is owned by The Daughters of Wisdom, a religious order, and managed on their behalf by the Healthcare Management Trust. The Sisters from Abbey House convent work closely with the home providing pastoral support to the residents and their relatives. At the time of our inspection there were 45 people living at the home. The home is arranged over three floors. The Nightingale unit on the ground floor provides care for up to 10 people living with dementia some of whom were also physically frail and needed assistance with all aspects of their personal care and mobility. The Skylark and Kingfisher units provide general nursing care for up to 36 people.
Marie Louise House has not had a registered manager since June 2014. 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 and associated Regulations about how the service is run. A new manager was appointed in October 2014. They plan to make an application to be appointed the registered manager, although this has not yet been submitted.
Staffing levels required improvement. People told us that they had to wait for support and assistance. Target staffing levels were not always met and agency staff were required on a regular basis which meant staff struggled to meet people’s needs in a consistent manner.
The management of medicines required improvement. Records contained insufficient information to ensure the consistent administration of medicines to people. Medicines were not always administered safely.
Mental capacity assessments were not being undertaken with due regard to the MCA 2005. When a person lacked capacity to make decisions about their care, we were not always able to see that appropriate best interests consultations had been undertaken.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager had submitted an application for one person’s DoLS appropriately. However, they were not fully aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. There was a risk therefore that some people might have their liberty or choices restricted without the proper authorisations being in place.
People’s wishes and choices were not always listened to. Improvements were needed to ensure that all staff understood how to respond and interact with people in a manner that demonstrated to the person that they mattered and that their wishes and choices are valued.
People did not always have a detailed plan of care which ensured staff could meet their needs. People were not always receiving care in line with their care plan and people did not always receive care when they needed it.
People’s records did not always contain enough information about their needs to ensure that staff were able to deliver responsive care. Some records were not completed accurately.
Improvements were needed in relation to how the provider and manager identified, assessed and managed risks relating to the safety of people and of the quality of the service. We identified concerns in a number of areas including medicines management, the suitability and accuracy of records and staffing levels which showed that there was a lack of robust quality assurance systems in place.
Despite our findings people did however tell us they felt safe living at Marie Louise House. Most staff had received training in safeguarding adults and had a good understanding of the signs of abuse and neglect and were aware of what to do if they suspected abuse was taking place.
Safe recruitment practices were followed which made sure that only suitable staff were employed to care for people in the home.
Most people told us that they received effective care from staff who had the skills to support them. Some staff had not completed all of the training relevant to their role. However staff seemed to have a good understanding of their role and responsibilities.
There was an effective working relationship with a number of health care professionals to ensure that people received co-ordinated care, treatment and support including memory nurses supporting those living with dementia and respiratory nurses working alongside those with breathing difficulties.
People were actively supported to maintain their religious and spiritual beliefs and this was fundamental to each person’s wellbeing and the overall quality of their care. The home had close links with the Daughters of Wisdom living in the adjacent convent who provided pastoral support to people.
People knew how to make a complaint and information about the complaints procedure was displayed within the home and included in the service user guide, including how to raise concerns with the Care Quality Commission.
People said they had no concerns about the leadership of the home. We found that the manager was still getting to know the home, the people living there and the staff, but was also actively working to develop their understanding of what the home did well and the areas it needed to improve on.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which now corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
Focused inspection 10 April 2015.
At our inspection in November 2014, the provider was issued with a warning notice as they had failed to ensure they maintained an accurate record of the care and treatment received by each person. The provider was required to meet the regulation by 16 February 2015.
As a result we undertook an unannounced focused inspection on 10 April 2015 to check whether action had been taken to meet the requirements of the warning notice.
We found that the provider had taken sufficient action to meet the requirements of the warning notice. Overall we found that people’s care plans were more detailed and were being reviewed regularly. It was evident the provider was taking action to personalise and improve the level of detail contained within people’s care plans. People’s care and monitoring records were being more consistently maintained and more accurately reflected the care and support they received.
We did find that some people’s care plans could be improved still further, for example, two of the diabetic care plans we viewed required additional information to ensure staff were able to provide an appropriate response should the person experience low blood sugar levels as well as high blood sugar levels. One person’s pain plan did not include details of the signs or behaviours which might indicate that they were in pain. Since the inspection, the provider has sent us updated care plans which address these omissions.
Measures had been put in place to drive on-going improvements of the records of people’s care and treatment. The provider had arranged for the home to have additional support from its Director of Clinical Operations, Audit and Compliance Manager and managers from other homes run by the provider. Detailed audits were being undertaken of each care plan and these highlighted clearly where improvements were still needed. Staff had received training in care planning to enhance their skills and knowledge and they were being encouraged to take accountability for, and to be part of, the work underway to improve people’s records.
We will undertake another unannounced inspection to check on all other outstanding legal breaches identified for this home.
This inspection took place on 24 and 25 November 2014 and was unannounced. At the last inspection in June 2014, we asked the provider to take action in relation to how people consented to their care and treatment, the care and welfare of people, how workers were supported, how the safety and quality of the service was monitored and the maintenance of records. The provider sent us an action plan which described the actions they were going to take to make the required improvements. Whilst at this inspection, we found some improvements had been made; further action was required to ensure that the home was meeting these and other essential standards.
Marie Louise House is a purpose built nursing home which opened in 2005. The home is owned by The Daughters of Wisdom, a religious order, and managed on their behalf by the Healthcare Management Trust. The Sisters from Abbey House convent work closely with the home providing pastoral support to the residents and their relatives. At the time of our inspection there were 45 people living at the home. The home is arranged over three floors. The Nightingale unit on the ground floor provides care for up to 10 people living with dementia some of whom were also physically frail and needed assistance with all aspects of their personal care and mobility. The Skylark and Kingfisher units provide general nursing care for up to 36 people.
Marie Louise House has not had a registered manager since June 2014. 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 and associated Regulations about how the service is run. A new manager was appointed in October 2014. They plan to make an application to be appointed the registered manager, although this has not yet been submitted.
Staffing levels required improvement. People told us that they had to wait for support and assistance. Target staffing levels were not always met and agency staff were required on a regular basis which meant staff struggled to meet people’s needs in a consistent manner.
The management of medicines required improvement. Records contained insufficient information to ensure the consistent administration of medicines to people. Medicines were not always administered safely.
Mental capacity assessments were not being undertaken with due regard to the MCA 2005. When a person lacked capacity to make decisions about their care, we were not always able to see that appropriate best interests consultations had been undertaken.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager had submitted an application for one person’s DoLS appropriately. However, they were not fully aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. There was a risk therefore that some people might have their liberty or choices restricted without the proper authorisations being in place.
People’s wishes and choices were not always listened to. Improvements were needed to ensure that all staff understood how to respond and interact with people in a manner that demonstrated to the person that they mattered and that their wishes and choices are valued.
People did not always have a detailed plan of care which ensured staff could meet their needs. People were not always receiving care in line with their care plan and people did not always receive care when they needed it.
People’s records did not always contain enough information about their needs to ensure that staff were able to deliver responsive care. Some records were not completed accurately.
Improvements were needed in relation to how the provider and manager identified, assessed and managed risks relating to the safety of people and of the quality of the service. We identified concerns in a number of areas including medicines management, the suitability and accuracy of records and staffing levels which showed that there was a lack of robust quality assurance systems in place.
Despite our findings people did however tell us they felt safe living at Marie Louise House. Most staff had received training in safeguarding adults and had a good understanding of the signs of abuse and neglect and were aware of what to do if they suspected abuse was taking place.
Safe recruitment practices were followed which made sure that only suitable staff were employed to care for people in the home.
Most people told us that they received effective care from staff who had the skills to support them. Some staff had not completed all of the training relevant to their role. However staff seemed to have a good understanding of their role and responsibilities.
There was an effective working relationship with a number of health care professionals to ensure that people received co-ordinated care, treatment and support including memory nurses supporting those living with dementia and respiratory nurses working alongside those with breathing difficulties.
People were actively supported to maintain their religious and spiritual beliefs and this was fundamental to each person’s wellbeing and the overall quality of their care. The home had close links with the Daughters of Wisdom living in the adjacent convent who provided pastoral support to people.
People knew how to make a complaint and information about the complaints procedure was displayed within the home and included in the service user guide, including how to raise concerns with the Care Quality Commission.
People said they had no concerns about the leadership of the home. We found that the manager was still getting to know the home, the people living there and the staff, but was also actively working to develop their understanding of what the home did well and the areas it needed to improve on.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which now corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
At the time of our inspection there were 45 people living at Marie Louise House Nursing Home. The home is arranged over three floors. The Nightingale unit on the ground floor provides care for up to 10 people living with dementia and associated nursing needs. The Skylark and Kingfisher Units provide general nursing care for up to 36 people. During the inspection we spoke with 17 people who use the service. Where people were unable to speak with us due to their complex needs, we used other methods to help us understand their experiences including observation of their support. We spoke with a number of staff including the head of care, two nurses, three senior care workers, two care workers and two agency staff and one bank care worker. We also spoke with one relative who was visiting the home. We reviewed nine people's care and support plans and other relevant records.
We gathered evidence against the outcomes we inspected to help us answer our five key questions.
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well led?
Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.
Is the service safe?
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the service was currently subject to a DoLS, we found that overall staff lacked knowledge about DoLS within the context of the service and we saw training records which showed that only two staff had received training about the safeguards.
Overall the home was adequately staffed, however, staff told us that at times they felt there were not always a good mix of experienced or skilled staff alongside less experienced or agency staff. The head of care has told us that recruitment is ongoing and that the provider is committed to ensuring that the home is appropriately staffed at all times by care workers who are familiar with people's needs.
We found that some people's care records contained incomplete monitoring charts which meant that accurate monitoring of their needs would be difficult. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the maintenance of accurate and appropriate records to ensure that people are fully protected against the risks of unsafe or inappropriate care.
Is the service effective?
Where people had capacity to consent, they were asked for their consent before they received any care and staff acted in accordance with their wishes. However, where people did not have capacity to consent to their care and treatment, we found that mental capacity assessments were not always being carried out in line with the Mental Capacity Act (MCA) 2005. We have asked the provider to tell us what they are going to do to meet the requirements of the law and ensure that staff act in accordance with the requirements of the Mental Capacity Act 2005.
Staff did not have all of the training relevant to their role and therefore there was a risk that they would not be able to deliver care and treatments safely and to an appropriate standard. Staff had not received regular supervision in line with the frequency required by the service. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting workers to develop and improve their skills.
We saw that people's care plan documentation included information about the care and support people needed. Staff we spoke with were informed about people's needs and were able to tell us about the care they provided. However, this information was not always consistent with that recorded in people's support plans. Assessments did not always provide sufficient information about how risks to some people's health and wellbeing were to be managed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that people are protected against the risks of receiving care that is inappropriate or unsafe, by means of the proper planning and delivery of care to meet people's needs.
Is the service caring?
People were supported by kind and attentive staff. Staff treated people with dignity and respect and we saw care being delivered in an unhurried and sensitive manner. One person told us, 'I'm very happy, I have no complaints, the staff are so kind'. Another person said, 'It's lovely here, everybody is so kind'. A relative told us, 'Its excellent care, I can't fault it'..I would be very happy to be here'.
People's preferences, likes and dislikes had been recorded and we saw that support was provided in accordance with peoples wishes.
Is the service responsive?
We saw records which indicated that some people had sustained injuries including skin tears and bruising as a result of moving and handling due to poor technique. We found that the service had responded to these concerns by making arrangements for staff to receive further training in this area.
We saw that where people needed to have their medication at specific times in order for this to be effective, the service had made arrangements for alarms to be purchased that would prompt the nursing staff to administer the medication in a timely manner.
The service had measures in place to review people's needs on a regular basis. However we found that care plans were not always updated to reflect changes in people's needs.
Is the service well led?
The provider had a business continuity and major incident plan, the purpose of which was to set out the procedures for dealing with emergencies and the steps that would be taken to mitigate the risks to people who use the service.
There were arrangements in place to ensure that people who use the service, their representatives and staff were asked their views about their care and the service provided. We saw that where the need for improvement was identified, the service was taking action to address this.
Systems were in place to ensure that the service learnt from incidents and accidents, comments and complaints.
The service had some quality assurance systems in place to assess the quality of the service and identify where improvements could be made. However these systems had not been fully effective in monitoring the quality and safety of the service people received. For example, some of the care records at the home were not clear or incomplete. These issues had not been identified through the audit process. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having effective systems in place to regularly assess and monitor all aspects of the quality of the service.
In this report the name of a registered manager (Joanne Croft) appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. At the time of our inspection the provider did not have a registered manager in post as they had left this post during the week prior to the inspection. We were advised that the provider had plans to recruit to this position. As an interim measure, the service was being managed by the head of care supported by the provider.
The manager was able to demonstrate that the service had carried out a needs analysis and risk assessment as a basis for deciding sufficient staffing levels. We saw that information from care reviews was used to contribute to deciding appropriate staffing levels
The matron told us that the home was currently working towards the Gold Standards Framework (GSF) training programme. This is a systematic evidence based approach optimising the care for people nearing the end of life.
During our inspection we visited all three units of the home, and spent time in each unit talking with people living in the home, relatives and staff members. We checked eight care plans and observed how staff interacted and cared for residents.
During the day we spoke with seven people living in the home. We talked with three relatives, and with seven staff as well as members of the management team. These included staff with different roles, including nurses, care staff, the head chef and staff who organise activities for residents.
People living in the home and relatives spoke positively about the standards of care. However, some relatives and staff did not think there were enough staff for some of the units.
Comments from people living in the home included: "staff are excellent", "the home is well run" and "staff are extremely caring, giving that little bit extra".