Simon Marks Court

Simon Marks Court is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 40 people. Simon Marks Court is purpose built and accommodates people across four units.

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

People were not always safe. Risks to individuals such as behaviours that challenged and pressure sores were not always assessed and appropriately managed. Improvements were needed to make sure medicines were managed safely. The provider made sure people lived in a safe, clean environment and appropriate fire safety measures were in place. There were enough staff to keep people safe although some people felt the staffing arrangements did not always enable staff to spend quality time with them. Recruitment practices were robust and ensured staff were suitable to work at Simon Marks Court. The service followed safeguarding procedures and dealt with abuse and allegations of abuse properly.

Management systems were not implemented consistently and effectively. The provider's auditing and monitoring had not highlighted issues that were raised at the inspection. Some records could not be located and others which were still relevant had been archived. The management team were responsive to the inspection findings; they took appropriate action when issues were highlighted and when we completed day two of the site visit some positive changes had been introduced. They had a clear vison of how they wanted to develop and improve the service. People had opportunities to share their views about the service and the service had received several compliments about people’s experience of Simon Marks Court.

Staff were supported in their role. They received appropriate induction, training and regular updates. People had plenty to eat and drink and were offered a choice of meals. Meal times were well organised although the main dining room was sometimes noisy, and space was limited; the provider was in the process of opening another dining area. 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. People were comfortable in their surroundings. The service was decorated and furnished to a good standard and suitable to meet people’s needs.

People were treated well and enjoyed living at Simon Marks Court. They were tidy in appearance and looked well cared for. Staff were proud to work at the service and confident people received good care. They understood how to promote people’s privacy, dignity and independence.

People’s routines were person centred care, for example, people chose when to get up and go to bed. People’s care and support needs were usually identified in their care records. Staff were familiar with people’s needs. However, they sometimes relied on communication from other staff rather than reading care plans. The service was developing and improving social opportunities and activities. Systems were in place to deal with concerns and complaints.

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 December 2018) and there were multiple 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 in some areas, but the provider was still in breach of two regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the safe and well-led key question sections of this full report. You can see what action we have asked the provider to take at the end of this full 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 also 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.

Simon Marks Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Simon Marks Court is a care home for older people and people living with dementia, owned by Anchor Trust a registered charity. The home caters for up to 40 people over the age of 65. Simon Marks Court is purpose built and situated in a cul-de-sac facing other sheltered accommodation. There are good parking facilities and there is a ramp to the front door providing level access.

There was a registered manager in post 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.

Some areas of the home and people’s records were not safe. For example, a door leading to a set of steep stairs was unlocked and people’s personal emergency evacuation plans were not detailed. Records for the management of medicine were not robust.

People’s mealtime experience was not positive. We observed, at times, the meal service was chaotic and task orientated. Where staff recorded people’s diet and fluid intake, improvements needed to be made to ensure the records were accurate and detailed. Systems and processes for monitoring the quality of the care provision required strengthening.

People and relatives knew how to complain. Complaints were appropriately dealt with and responded to by the registered manager. However, not all the documentation was in the complaints file, which made it difficult to establish an evidence trail and we noted one person’s complaint had not been recorded or addressed. The registered manager told us they would address this.

The home was warm, with a friendly atmosphere. Comments from people and relatives confirmed staff provided good care. Staff, treated people with dignity and respect. We saw positive interaction between staff and the people they supported. People received support to access other healthcare professionals. There was a range of activities provided at the home, although, the provision of activities had changed to adopt a whole team approach, which was still being embedded.

Staff had received training in safeguarding people from the risk of harm or abuse and understood their responsibilities in reporting any concerns. There were sufficient numbers of staff deployed in the home and feedback from people and staff confirmed this. Recruitment of staff was managed safely. Staff completed induction and there was a training programme in place. Timely staff supervisions and appraisals were carried out; staff said they felt supported by the management team.

Building, health and safety and fire equipment checks were completed. There were systems in place to reduce the risk and spread of infection. Communal areas of the home were comfortably furnished and people were familiar with the layout of the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did support this practice. Mental Capacity Assessments and Deprivation of Liberty Safeguards were appropriately managed.

People’s care plans mostly contained individual information regarding peoples wishes. The registered manager told us there was no one living at Simon Marks Court at the time of our inspection who was approaching the end of their life. People’s end of life wishes were recorded in their care plans. Feedback on the service provision from people who lived at the home and staff was mainly positive.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to some areas of safety, mealtime experience and governance and some records. You can see what action we told the provider to take at the back of the full version of the report.

Simon Marks Court is a care home for older people and people living with dementia, owned by Anchor Trust a registered charity. The home provides care and support for up to 40 people. Simon Marks Court is purpose built and is situated in a cul-de-sac facing sheltered accommodation. Accommodation is situated over two floors with lift access. There are lounge and dining areas with bedrooms having en-suite facilities. There is good parking facilities and a ramp to the front door providing level access.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

People said there were enough staff to meet their or their family member’s needs.

There were systems in place to record accidents and incidents and monitor for any patterns or trends.

The premises and equipment were well maintained to ensure people’s safety.However we did point out a couple of areas in the home that needed attending to which the registered manager completed on the day of inspection.

People told us they felt safe and well looked after at the home. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Staff were recruited appropriately in order to ensure they were suitable to work within the home. They were provided with training to develop their knowledge and skills. However some staff had not received regular supervisions or appraisals in 2015.

There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were, in the main, made in their best interests.

People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. People’s choices and preferences were respected and they were supported to make their own decisions whenever they could do so.

Overall people told us they enjoyed the food and got the support they needed with meals.

There were systems in place to ensure complaints and concerns were fully investigated. People had the opportunity to say what they thought about the service and the feedback gave the provider an opportunity for learning and improvement.

People were not put at risk because systems for monitoring quality were effective. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

The registered manager was supportive of people who lived in the home and the staff who worked there. They listened to what people had to say and took action to address any issues they had. Staff told us they felt supported by the registered manager.

We looked at three people's care plans and found that they included clear instructions to enable staff to carry out effective care. All aspects of people's personal and health care needs had been assessed, and were reviewed on a monthly basis. Care was planned and delivered in a way that ensured people's safety and welfare. An assessment of any risk had been recorded with actions documented as to how the identified risk was to be managed.

We found that when people required care and treatment from another provider, such as a doctor or hospital, the provider obtained these services in a timely way. A record of all healthcare intervention was kept in the person's file.

We inspected medication storage and administration procedures in the home. We found that medicine trolleys and storage cupboards were secure, clean and well-organised. We found that all medicines were dispensed by well-trained staff who undertook regular updates to maintain their competency.

All areas of the home that we saw were clean and fresh. Several people who lived at the home commented on the high standards of cleanliness. One person said "they keep everywhere spotlessly clean."

The provider had a recently reviewed complaints policy for ensuring that complaints were recorded and fully investigated.

The home had appointed a new activities coordinator and a group activity was observed on the day of the visit. It was observed that people had choice about what they had to eat and that there was a folder in the dining room where people's comment about the food was written.

Staff were observed treating people with respect and dignity when moving them into the dining room. One person was observed being encouraged to get out of a chair herself which helped to maintain her independence.

New management have been appointed to the home since the last inspection and staff said that they were now much clearer as to how they should work and also said that morale had also improved. They also said that staff numbers had improved. A number of staff were observed supporting the activities co coordinator with the group activity.