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Simon Marks Court Requires improvement

Reports


Inspection carried out on 28 November 2019

During a routine inspection

About the service

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 Some records could not be located and others which were still relevant had been archived.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

Inspection carried out on 14 November 2018

During a routine inspection

A comprehensive inspection of Simon Marks Court, took place on 14 and 15 November 2018. The inspection was unannounced on day one, but announced on day two as we needed to make sure the registered manager was available. At the last inspection in May 2016 the home was rated as ‘Good’.

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

Inspection carried out on 3 May 2016

During a routine inspection

The inspection took place over two days on 3 and 6 May 2016. Both days were unannounced, which meant the service did not know in advance we were coming. At the last inspection in April 2015 we found the provider met the regulations we looked at.

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.

Inspection carried out on 1 May 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 11 November 2014 at which a breach of legal requirements were found. This was because competency checks on training were not completed and supervisions were not completed in relation to Anchors policy. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on the 1 May 2015 to check they had followed their plan and to confirm they now met legal requirements. At our focused inspection on the 1 May 2015, we found the provider had followed their plan which they had told us would be completed by the January 2015, and legal requirements had been met.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for “Simon marks care home” on our website at www.cqc.org.uk’

Simon Marks Court provides accommodation for up to a 40 people who require support with their personal care. The home mainly provides support for older people over the age of 65.

The home’s manager had worked in this role since for only a few weeks. The area manger attended the service twice a week to support the manager of the home. The manager was in the process of registration. 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.

Staff had completed all mandatory training some which included equality and diversity, data protection, dementia awareness, moving and handling and safeguarding. All supervisions were in place in the home for staff.

Inspection carried out on 11 November 2014

During a routine inspection

This was an unannounced inspection carried out on the 11 November 2014. At the last inspection in December 2013 we found the provider met the regulations we looked at.

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.

At the time of this inspection the home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We did not see evidence that staff completed an induction when they started work. Staff training provided did not equip staff with the knowledge and skills to support people safely. There was no evidence staff knowledge and competency was checked following completion of specific training courses. Opportunity was not available for staff to attend regular supervision meetings. This is a breach of Regulation 23 (Supporting workers); Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans included risk assessments; however, care plans did not always contain sufficient and relevant information.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

We found people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines.

The home had policies and procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The temporary manager understood when an application should be made, and how to submit one. This meant people were safeguarded. However, the care plans we looked at did not show that people’s mental health and capacity needs had been assessed.

Suitable arrangements were in place and people were provided with a choice of suitable healthy food and drink ensuring their nutritional needs were met.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

We observed interactions between staff and people living in the home and staff were respectful to people when they were supporting them. Staff knew how to respect people’s privacy and dignity.

Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed. People were supported to attend meetings where they could express their views about the home.

A range of activities were provided both in-house and in the community. People were able to choose where they spent their time for example in a quiet lounge, outside or in a busier lounge area.

The management team investigated and responded to people’s complaints, according to the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the temporary manager and provider. We also saw refurbishment plans for the home to improve the environment.

We found the home was in breach of one of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 2 December 2013

During a routine inspection

Upon arrival at the home we saw a prominent notice on the door asking visitors to use the hand sanitizer gel available throughout the common circulation areas of the home.

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.

Inspection carried out on 20 November 2012

During a routine inspection

People said they can make decisions and are supported to make choices. One person said �I prefer living here to living at home I am better here than I have been for a long time�. People we spoke with when we visited the home told us that they thought the care their relatives were receiving was very good although one person was not aware that she could look at the care plan whenever she wanted.

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.

Inspection carried out on 17 March 2011

During a routine inspection

People said they can make decisions and are supported to make choices. One person said "You can get involved in things if you want to" Another said "I go to bed when I want, get up when I want, I�m happy here". People we spoke with when we visited the home told us they are kept informed about the care their relatives are receiving. However they are not sure who is in charge of the home, because they have been so many changes within the management. They also told us the home has an activities organiser but felt a lot of improvement could be made in relation to that post.

People told us their privacy and dignity is respected. Staff were discreet when supporting people with personal care. They said staff knock on doors before entering.

We spoke to some visitors. They told us they were happy with the care that is provided. One person said "The staff are helpful; I think people are getting good care although activities can be improved".

People said "We get plenty to eat" another said "The choices are quite good and they support me when needed".

People using the service did not raise any concerns about staffing and said they receive support from staff when they want it. One person said "I'm very happy they look after me well" another said "Staff are good". Visitors did not raise any concerns about staffing levels.

People told us they were concerned that the senior management of the company was not taking action quickly enough to sort out the management problems in the home. People said during our visit they had seen some stability since the acting manager started. However they were cautious because the management could all change again.

Reports under our old system of regulation (including those from before CQC was created)