Marple Dale Hall - The New Windsor

Marple Dale Hall – The New Windsor is a care home providing personal and nursing care for 57 people at the time of the inspection. The service can support up to 63 people. The service provides care to people living with dementia, physical disabilities and/or an acquired brain injury.

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

People felt safe and were happy with how they were supported. People’s needs and risks were assessed, and equipment used to support people to remain independent. Where things had gone wrong, work was completed to ensure lessons were learnt. Staff were recruited following safer recruitment methods and there were enough staff to meet people’s needs. The service was clean and tidy. Medicines were managed safely, however we recommend reviewing how people are supported to have their medicines crushed safely, and processes for recording the application of topical medicines such as creams.

People’s needs were assessed, and choices and preferences supported and respected by staff. Staff completed a variety of training and felt well supported in their role. We have made a recommendation about training in line with requirements. People were supported to access various healthcare input as needed and staff followed advice given. People were supported to eat and drink well, and mealtime experiences were pleasant. Feedback about the quality of food was mixed and ongoing work was being completed to improve this. 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.

A wide variety of systems were in place to ensure the quality and safety of the service and, where issues were identified, action was taken to address any shortfalls. People, relatives, and staff spoke positively about the management team and felt able to share feedback and raise concerns. The management team used a variety of processes to obtain feedback from people, families, and staff. The registered manager and staff were committed to ensuring positive experiences of care and people were supported to have improved outcomes.

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 13 July 2021) and we found 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We carried out an unannounced focused inspection of this service on 8 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, safe care and treatment and good governance at the service. 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, Effective and Well-led which contain those 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 Marple Dale Hall – The New Windsor on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation that the provider ensures all mandatory training in line with the requirements of regulation and best practice are available and being completed by staff as needed and the provider reviews how people are supported to have their medicines crushed safely, and processes for recording the application of topical medicines such as creams.

Follow up

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

Marple Dale Hall – The New Windsor is a care home providing personal and nursing care for 51 people at the time of the inspection. The service can support up to 63 people. The service provides care to people living with dementia, physical disabilities and/or an acquired brain injury.

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

We identified concerns about medicines, person-centred care and governance. These amounted to breaches of legislation. The provider and registered manager commenced immediate action to resolve the issues identified.

Staff did not always record the administration of medicines clearly and some medicines were out of date. The service followed safe recruitment practices and records contained the required documentation. There were arrangements for safeguarding people. Care workers had been provided with training on safeguarding people and knew what action to take if they were aware that people were being abused.

People did not always receive person-centred care. People told us they often had to wait for care. Care plans had been reviewed but contained conflicting information. Activities were taking place in parts of the building, but people cared for in bed were at risk of social isolation.

People were not supported to have maximum choice and control of their lives on the occasions they had to wait for care. However, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the services provided. However, audits had not identified the issues we found during the inspection. The management team were receptive to our feedback and started to make the required improvements immediately. They were committed to making improvements and ensuring effective systems were in place.

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 19 November 2019) and there were two 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 improvement had been made in relation to general monitoring of care and oral healthcare. However, the provider was still in breach of regulations in relation to governance and medicines management.

Why we inspected

The inspection was prompted in part due to concerns received about the management of people's care needs, staffing and medicines management. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

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

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Marple Dale Hall – The New Windsor on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to medicines management, person-centred care, and governance at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Marple Dale Hall – The New Windsor is a care home providing personal and nursing care for 61 people at the time of the inspection. The service can support up to 63 people. The service provides care to people living with dementia, physical disabilities and/or an acquired brain injury.

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

We identified concerns about safety, oral healthcare and governance. These amounted to breaches of legislation. The provider and registered manager commenced immediate action to resolve the issues identified.

Staff did not always administer topical medicines as prescribed and some medication care plans were out of date. People cared for in their bedrooms did not always have access to a call bell in case of emergency. Staff were recruited safely and people said staffing levels were sufficient to meet their needs. Monitoring documentation was not completed consistently. We have made a recommendation about documentation that monitors wellbeing and safety.

People did not always receive appropriate support with their oral healthcare. People’s food preferences were not always available to staff. People were complimentary about the range of food available and people who needed assistance to eat and drink were supported with sensitivity and patience. We have made a recommendation about improving quality for people cared for in their bedrooms.

Staff were caring. People told us they were happy and regarded the service as their home. People's privacy and dignity were maintained, and they were treated with respect, kindness and compassion. People were involved in discussions and decisions about their care.

Staff cared for people the way they preferred. However, these details were not always captured in people’s care plans. Formal complaints were recorded and responded to appropriately. People were supported with compassion as they came to the end of their lives.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the services provided. However, audits had not identified risks to people’s safety and wellbeing. The management team were receptive to our feedback and started to make the required improvements immediately. They were committed to making improvements and ensuring effective systems were in place.

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.

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

Rating at last inspection

The last rating for this service was good (published 04 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safety, healthcare and governance. 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 for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected the service on 8 and 9 September 2015, we rated the overall service as Requires Improvement. At that inspection we identified two regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to the management of medicines and staffing.

This inspection was to check satisfactory improvements had been made and to review the ratings.

We saw evidence to confirm that action required had been taken.

Marple Dale Hall-The New Windsor, is registered with the Care Quality Commission (CQC) to provide 24 hour nursing care and accommodation for up to 66 people with a wide variety of conditions and frailties. People are cared for in purpose built accommodation designed to meet the care and support needs of the people who live there. Accommodation is provided over two floors. The ground floor of the home provides specialist care for younger people who have a physical disability and those with an acquired brain injury or learning difficulties. The first floor of the home provides nursing care for older people with a wide variety of frailties and conditions and people living with dementia.

A registered manager was in place at the home. 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 who used the service and their relatives were complimentary and positive about the support provided and attitude of the staff team and management. People spoken with said, “We are happy with the service provided and overall our needs are being met.” Two relatives spoken with told us the nurses and care staff were extremely attentive and the care provided was always person centred.

People were supported by sufficient numbers of suitably trained staff. Care staff and nurses we spoke with told us they had undergone a thorough recruitment process and following their employee induction, training appropriate to the work they carried out was always available to them. Some staff were working towards a nationally recognised qualification in care such as a National Vocational Qualification (NVQ) in health and social care and the Care Certificate. This helped to make sure the care provided was safe and responsive to meet peoples identified needs.

Staff members received regular supervision to help make sure they were carrying out their duties safely and effectively.

Staff spoken with confirmed they had received safeguarding and whistle blowing training, and knew who to report concerns to if they suspected or witnessed abuse or poor practice.

Care records were in place which reflected peoples identified health care and support needs. Information about people’s dietary requirements, how people wanted to be supported, when support was required and how this was to be delivered was also included in the care records we examined.

We saw written evidence that people and their relatives were involved in the decision making process at the initial assessment stage and during their care needs review. Where people who used the service did not have the capacity to make their own decisions, the service ensured that decisions taken were in line with the principles of the Mental Capacity Act.

Systems to make sure the safekeeping and administration of medicines were followed monitored were in place and reviewed annually. Medicines were stored safely and administered only by registered nurses. Any specific requirements or risks in relation to people taking particular medicines were clearly documented.

Complaints, comments and compliments were encouraged by the provider and any feedback from people using the service or their relatives were addressed by the registered manager. People spoken with knew how to make a complaint and felt confident to approach any member of the staff team if they needed to.

The registered manager had systems in place to monitor the quality, including service user and relative surveys, to ascertain their views and opinions about their satisfaction of the service provided. Any feedback received was noted and used to make improvements to the service and the care and support being provided.

One of the family members we spoke with told us 'I have no complaints and I am comfortable with talking to the staff team if I have any concerns'.

We also spoke with the clinical nurse manager, customer services manager, activities organiser, and two of the nursing staff. They all told us that they were well supported by their immediate line managers. We also spoke with a visiting podiatrist who told us that the staff were very helpful.

We looked at five care files and two staff files. All the records were up to date. The care files contained information to assist the nurses and care workers in carrying out their duties. The training the staff received also ensured that the people who lived at The New Windsor were provided with care and support that met their needs.

We spoke with an officer of the Stockport Social Services Quality Assurance team who told us that they had received one concern over the past twelve months. We were told that it had been dealt with to everyones satisfaction.

We spoke with three people who used the service and comments included: "I feel happy here, the staff have really helped me gain a lot of independence", "I am included in my care plan review, I think the staff are very good in making sure, they do things to help you and do what's best for you" and "I am well supported, I feel that I have a choice and what I want is important".

Marple Dale The New Windsor had appropriate policy and procedure guidance in place which enabled staff to act apriority when any safeguarding incidents occurred. Staff had access to the local authority safeguarding team contact details.

We sampled a total of six personal files for nurses and care staff and found that each contained records of regular supervision. It was clear that roles and responsibilities had been discussed and that training undertaken or required, was well documented.

Marple Dale The New Windsor had appropriate systems in place to monitor the quality of the service provided.