Background to this inspection
Updated
5 November 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on the 23 September 2015 and was unannounced. The inspection team consisted of one inspector and an inspection manager. This service was last inspected on 4 August 2014 and had no concerns.
We reviewed the provider information return (PIR) prior to this inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
Before the inspection we checked the information that we held about the service and the service provider. This included previous inspection reports and statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send us by law. We used all this information to decide which areas to focus on during our inspection.
During our inspection we spoke with six people living at the home and two relatives/visitors, five care staff, and the two assistant managers.
We reviewed records related to people’s care and other records related to the management of the home. These included the care records for three people, medicine administration records (MAR), three staff files, quality assurance audits, survey and questionnaire feedback forms and a selection of the services other records relating to the management of the home.
We observed care and support in the communal lounges and dining area during the day and spoke with people in their rooms. We spent time observing the lunchtime experience people had and observed the administering of medicines.
Updated
5 November 2015
Marlborough Lodge is a family run care home which provides accommodation and personal care for up 18 people, some of whom are living with dementia. The home specialises in dementia care. At the time of our inspection there were 17 people living in the home.
We inspected Marlborough Lodge on 23 September 2015, the inspection was unannounced. During our last inspection on 4 August 2014 we found the provider satisfied the legal requirements in the areas that we looked at.
There was a registered manager in post at the service; however they were on a long term absence. The deputy manager was acting up in the role of manager, and the two assistant managers were on duty at the time of our inspection. 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 told us they felt safe living at Marlborough Lodge and they were well cared for. The provider had systems in place to manage risk and protect people from abuse. Staff were aware of their responsibilities and knew how to identify if people were at risk of abuse and what actions they needed to take to ensure people were protected.
The home had a high number of staff at all times and they were highly committed to providing care that was centred on people’s individual needs. Staff described working in the home as one big family. Staff told us they had confidence in their manager and felt very supported in their roles.
Staff employed in the home had an attitude and values based interview which meant the manager was actively seeking to employ people with genuine caring abilities and skills to support people. This showed in the retention of staff who had worked for long periods of time at the home. This gave continuity to people and staff knew their needs well.
People were involved in a range of activities within the home and the local community. The home arranged for people to go on holiday and enabled people to make trips of personal meaning such as a visit to a cemetery on the anniversary of a loved one's death or to see their favourite football team play.
There were clear policies and procedures for the safe handling and administration of medicines. Where there had been medicine errors these had been dealt with in an efficient manner and learning from these situations was recorded and put into practice to make it safer.
CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The management team and staff had knowledge of the Mental Capacity Act 2005. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Documentation in people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the persons best interests.
The service had a strong commitment to supporting people and their relatives before and after death. The management team were determined that people should remain in the home being cared for by the staff they knew unless the home could not provide the level of care someone might need at end of life. Documentation that we looked at did not show that people’s end of life wishes were being reviewed, this meant that whilst good practice around end of life care was happening the records did not support this.
People were supported to access healthcare services to maintain and support good health. People were protected from the risks associated with nutrition and hydration. Where people were at risk, the home worked alongside the community dietician.Support plans were in place to monitor the health of these individuals. People told us they could choose what they wanted to eat and if they did not like what was on the menu they could ask for an alternative. There were snacks and drinks available throughout the day during our inspection.
People and their relatives spoke positively about the care and support they received. They said that if they had any concerns they could speak to either staff or the management team. They said they felt their concerns would be listened to and where required appropriate action taken. Systems were in place which continuously assessed and monitored the quality of the service. This included encouraging people to provide feedback on the services they or their relative received. The home had pictorial feedback forms to ensure those less able to verbally communicate could still provide opinions on the service they received.