Marquis Court (Windsor House) Care Home

Updated 8 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an assistant inspector. An Expert by Experience made telephone calls to relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Marquis Court (Windsor House) Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Marquis Court (Windsor House) Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. However, we were informed following the inspection the registered manager left their role.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We also asked Healthwatch for feedback, although they did not have anything to share. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service. We also spoke with 14 relatives, some who we met while we were visiting the service and others we spoke with over the phone. We also spoke with 6 staff, including care staff, an activities coordinator, nurses, and the registered manager. We also spoke with 3 regional managers. We made observations in communal areas to observe interactions between people and staff and the care and support offered.

We reviewed a range of records. We looked at 8 people’s care records and multiple medicines and daily care records. We looked at 4 staff files and 4 agency staff profiles to check recruitment processes. A variety of records relating to the management of the service, including policies and procedures, building safety records and audits were also reviewed.

Updated 8 August 2023

About the service

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.