Marriott House and Lodge is registered to provide care and accommodation for 119 older persons with nursing, residential care and physical care needs. Accommodation is provided in two separate buildings. Marriott House provides care and support for people with nursing needs over three floors and Marriott Lodge provides residential care for people over four floors. There is a passenger lift in both buildings to provide access to people who have mobility issues. On the first day of our visit 54 people were living in Marriott House and 29 people were living in Marriott Lodge.
The home did not have a registered manager, the previous registered manager had left on 12 May 2017. 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.
A manager was in post but they had not applied to become registered with CQC. They told us that they were leaving and the second day of our visit coincided with their last day in post. The provider’s regional director was present during the inspection and told us that a new manager had been appointed and was due to start the week following the inspection.
At the last inspection on 4 and 5 August 2015 we had no concerns and the service was rated ‘Good’ overall. At this inspection we found three breaches of the regulations and other areas of practice that needed to improve.
There were not always enough staff to care for people safely. People and their relatives expressed concerns that people had to wait for their care needs to be met. One person said, “At times I have to wait for staff and when they do come they always appear rushed.” Another person commented, “Sometimes you wait over half an hour.” Call bell records confirmed that people regularly waited for longer than they should reasonably expect for staff to respond. This was identified as a breach of regulations. The provider took immediate action to increase staffing levels and improvements were noted on the second day of the inspection.
Most people and their relatives spoke highly of the staff and the care they received. One person said, “They are a very nice group of girls, I call them my grand-daughters.” However people’s dignity was not always protected because staff were not responding to call bells in a timely way. Some people told us that staff were not always kind and caring. One person said, “There are some good ones (staff), and some are not so good. They do what has to be done but don’t look beyond that.” A relative described how they had heard a staff member speaking 'sharply' to their relative. People and their relatives told us that most of the staff were kind and caring in their approach however not all interactions between staff and people were consistently positive. This was identified as a breach of the regulations.
The provider had a number of management systems and processes including audits, to monitor quality at the home. However, these had not always been effective in identifying shortfalls in the quality of the service. There was a lack of management oversight in some areas of practice which meant that the manager could not always be assured that risks to people were being effectively managed. This was identified as a breach of the regulations.
People were receiving their medicines safely but some PRN (as required) medicines were not always documented clearly. This put people at risk of receiving inappropriate doses of their medicines and was identified as an area of practice that needed to improve.
Risks to people were identified and care plans were regularly updated to guide staff in how to provide care safely. However, staff were not always following the care plans consistently. This meant that people were at risk of receiving inappropriate or unsafe care. This was identified as an area of practice that needed to improve.
There was a wide range of organised activities on offer for people at the home. However, whilst the activities programme was meeting some people’s needs, other people remained at risk of social isolation. Some people said they didn’t have enough to do, one person said, “The activities are very good but I don’t join in because it’s not my type of thing.” Meeting people’s need for social interaction and stimulation and supporting them to follow their interests is an area of practice that needs to improve.
People knew how to access the provider’s complaints system and the manager monitored all complaints. Some people told us that they did not feel confident to raise complaints because they were not sure how their concerns would be addressed. This was identified as an area of practice that needed to improve.
Staff demonstrated understanding of their responsibilities with regard to safeguarding people and knew who to speak to if they had any concerns. People said they felt safe living at the home, one person told us, “I always felt safe here from day one.” Incidents and accidents were being recorded and monitored to identify and address any patterns or trends.
People were having enough to eat and drink and they told us that they enjoyed the food on offer. Staff were knowledgeable about people’s dietary needs. Staff supported people to maintain their health and to access health care services when they needed to. One person said, “If you need the doctor they arrange it.” People and their relatives said that they had confidence in the skills and knowledge of the staff. Staff told us they received the training and support they needed. One staff member said, “I’m up to date with my training and I have asked to do additional training in End of Life Care because that’s a particular interest for me.” Staff had received training in the Mental Capacity Act and understood their responsibilities.
People were being supported to make decisions about their care. They told us that they felt their views were listened to. A relative told us, “I am here for a review today, they keep me fully involved.” Staff had a good understanding of how to protect people’s privacy. People told us that staff supported them to maintain their independence. One person said, “I like to be independent and do as much as I can for myself.” Staff demonstrated that they knew people well and provided care in a personalised way, respecting people’s wishes.
The provider sought the views of people and their relatives on the quality of the service and used this information to drive improvements. We were told that a refurbishment plan was in place to update areas of the home to give it the 'Wow factor.'
Staff had developed good links with the local community and staff told us that they had benefitted from additional training as a result. Staff spoke highly of the management of the home and described an open and supportive atmosphere. The regional director told us that the provider was committed to making improvements at the home.
You can see what actions we have asked the provider to take at the back of the full version of this report.