Marina Lodge

Marina Lodge is a residential care home providing personal care to younger adults with mental health needs. The service can support up to 11 people. At the time of this inspection there were 10 people living at the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

The service didn’t always provide care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. External fire exits were blocked, there were insufficient bins to dispose of used PPE and a communal bathroom was not clean.

Staff supported people with their medicines in a way that promoted their independence. The use of as and when required medicines were not always appropriately recorded to include why it had been given and if it had been effective.

The service supported people to have the maximum possible choice, control and independence to promote control over their own lives. However, records did not evidence that people were encouraged to achieve their aspirations and goals.

Right Care

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Staff assessed risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture

The quality assurance processes in place were not effective and failed to identify and address shortfalls in a timely manner.

Best practice guidance was not always followed which impacted people’s privacy and dignity.

Staff turnover was low, which supported people to receive consistent care from staff who knew them well. Safe recruitment processes were not always followed.

The provider worked well in partnership with other health and social care organisations, which helped to improve people’s wellbeing. However, they were not actively involved in engagement groups or forums organised by the local authority which aim to improve care services in the local area and share best practice.

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

Rating at last inspection

The last rating for this service was good (published 29 November 2019).

Why we inspected

We received concerns in relation to the quality of care being provided and the providers oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to environmental risks, cleanliness , recruitment of staff and quality assurance processes at this inspection.

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Marina Lodge is a care home providing accommodation and personal care for up to 11 younger people requiring support with their mental health. At the time of the inspection there were seven people using the service.

The service has communal space and bedroom accommodation over two floors. A garden and courtyard were situated to the rear of the property with seating that people had access to use.

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

People told us they felt safe and that staff supported them well. The provider had robust recruitment checks in place to employ suitable staff. Staff were available to provide care and support when needed, in a timely way. People's medicines were managed safely.

Staff received training which provided them with the knowledge and skills needed to carry out their roles. Staff told us they felt supported and received regular supervisions and appraisals to support them.

People had choice and control of their lives and the staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People engaged in regular activities with staff and other people living at the service. Staff supported some people to access the community and attend activities or events outside the service.

Staff described people’s individual needs which were detailed in their care plans. These were regularly updated to reflect any changes in people’s needs. People told us staff treated them with dignity, respect and understood their needs. People described staff as, “Kind and caring” and, “Excellent, easy to get on with.”

The service was managed well and demonstrated positive outcomes for people. The registered manager was hands on and regularly assessed the quality of care provided to people. People and staff had opportunities to voice suggestions to improve the service which the provider had taken on board and actioned.

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

Rating at last inspection

The last rating for this service was good (published April 2017).

Why we inspected

This was a planned inspection based on the previous rating. 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.

Marina Lodge provides care and accommodation for up to 11 people with enduring mental health needs. On the day of our inspection there were eight people using the service.

The service had a registered manager in place. 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.

We last inspected the service in November 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Marina Lodge. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The registered provider had an effective complaints procedure in place and people who used the service were aware of how to make a complaint.

Staff felt supported by the management team. People who used the service, visitors and staff were regularly consulted about the quality of the service.

We found that up to date information was held on an individual's file informing staff how they wanted to be treated when they were ill. We found that staff had all completed training in the Mental Capacity Act 2005 (MCA). We observed that staff treated people with dignity and respect at all times during our visit.

People who used the service told us that staff worked with them to achieve their goals. One person was working towards independence and a clear plan had been implemented with their involvement. Several people told us the staff were "Great" and "They always take time to listen"

We saw that each person had a care plan. Each plan was reviewed at an interval determined by the support required by the individual. People were involved in their own care plan and had clearly signed each time it had been reviewed.

We saw that the medication procedures had been changed to ensure people were not at risk of receiving the wrong medication. Staff told us they now administered the medication to each individual in the office, observing that they took the medicine and then filling in the record. The provider had also obtained a controlled drugs (CD) cabinet and a proper CD register. This meant these drugs could be stored securely and an accurate record could be maintained if they were used.

We found that people were involved in developing their own care plans and that the home sought their consent to their care and treatment. We saw that the home assessed people's capacity to make decisions. However they had not identified what action they could take when someone did not have the capacity to consent. In one instance they had recorded a relative as having the responsibility to make decisions on behalf of the person receiving support without any legal documentation to support this claim.

The plans did not contain any information about any procedures that staff should follow in the case of a foreseeable emergency situation arising.

We saw that the home assessed people's care needs and developed care plans which were reviewed, with risk assessments in place. This meant that people received the care they needed.

The home did not handle medication in a way that protected people's health and safety.

The home monitored the quality of its service through surveys and internal systems so that improvements could be identified and put in place

We spoke to a social care and health care professional and they both said that the support people received allowed them to become more independent. They felt the people they were involved with benefitted from the semi - structured environment provided at Marina Lodge.

Staff told us that the manager was supportive of them and provided them with regular supervision. They said that they worked with people who used the services and encouraged them to be independent. Staff could not tell us what they would do if someone reported abuse to them. Staff also told us they tried to ensure that people's dignity and human rights were respected throughout the care planning process.