Marple Lodge Care Home

Marple Lodge is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 19 people.

Accommodation is provided across two floors which can be accessed via a stair-well and passenger lift. There are communal bathrooms, toilets and kitchen facilities as well as social, dining and garden areas that people can access.

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

Staff were aware of their responsibilities in safeguarding people from abuse. Risks were well managed. Care records gave clear guidance to staff on what needed to happen to keep people safe, whilst respecting peoples choices. Staff had received training to guide them on managing risks. Health and safety checks in the home had been carried out. There was a programme of regular maintenance to the building and servicing of equipment. Medicines were managed safely. Safe systems for recruitment 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. People's needs were assessed, and care was delivered in line with their preferences and choices. Staff received support, induction and training to ensure they had the skills to carry out their role.

People told us they were happy living at the home and were treated with respect. Staff knew people well and spoke about people in respectful and caring ways.

People were supported to access activities and people's spiritual wellbeing was promoted. The provider was thoughtful and compassionate about how they supported people receiving end of life care and worked in partnership with other professionals to ensure comfortable and considerate care was provided.

Staff were complimentary about the support they received from the assistant manager and the wider management team. The registered provider and assistant manager were committed to ensure continuous improvements were made at the service. The provider was passionate about further increasing the range of activities available and the home’s presence in the local community.

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 25 July 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated good and outstanding to test the reliability of our new monitoring approach.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Marple Lodge Care Home 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. The home is situated in Marple, Cheshire and is registered to provide accommodation for up to 19 people who require personal care and support. At the time of inspection 17 people were living at the home.

The home was last inspected in November 2016 when it was rated as requires improvement overall and in four domains, safe, effective, responsive and well-led. During that inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, need for consent, good governance and staffing, specifically the lack of training provided.

Following the inspection, the provider sent us an action plan which explained the improvements they intended to make to ensure the home met legal requirements and improved the key questions, safe, effective, responsive and well-led to at least good. This inspection was carried out

to check improvements had been made and review the homes rating.

At this inspection we found improvements had been made and the service was meeting all regulatory requirements, although we have made two recommendations in relation to capturing people or their legal representative’s involvement in care planning and reviews and the planning and documenting of activities.

The service had a registered manager. 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.

Since our last inspection, a new registered manager had commenced working at the home. They had started in November 2017 as acting manager, becoming registered with CQC in April 2018. The registered manager was supported by a deputy manager, who had worked at the home under the previous manager and so provided consistency.

Each person we spoke with told us they felt safe, and enjoyed living at Marple Lodge. Relatives were also complimentary about the standard of care provided. We saw staff had received training in safeguarding, which was refreshed in line with the providers policy and staff spoken with knew how to report concerns. The home had appropriate safeguarding policies and reporting procedures in place and had submitted notifications to the local authority and CQC as required.

We found the home to be clean with detailed cleaning checklists and appropriate infection control processes in place. Staff wore personal protective equipment (PPE) to prevent the spread of infection and toilets and bathrooms contained hand hygiene equipment and guidance.

Both people using the service and staff we spoke with told us enough staff were deployed to meet needs. The home used a system to determine safe staffing levels, which we saw tallied with the rotas. This system was regularly reviewed to ensure it was accurate and reflected the current needs of people living at the home.

We saw medicines were stored, handled and administered safely and effectively. All necessary documentation was in place and had been completed consistently. The home’s quality monitoring procedures, had highlighted any gaps or omissions in medicines documentation and steps had been taken to address this. Staff responsible for administering medicines had been trained and had their competency assessed.

Staff spoke positively about the support and training provided. We saw staff had completed an induction programme upon commencing employment and on-going training was provided, both e-learning and classroom based, to ensure skills and knowledge were up to date. Staff also confirmed they received regular supervision and annual appraisals, which along with the completion of quarterly team meetings, meant they were supported in their roles.

We found meal times to be a positive experience, with people being supported to eat where they chose. Staff engaged in conversation with people and encouraged them throughout the meal, providing support to those that required it as per their care plan. Food and fluid charts had been used where people had specific nutritional or hydration needs, with clear guidance in place for staff to follow.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect. It was apparent from our observations, staff knew the people they supported and had formed positive relationships. People told us they would feel comfortable raising any issues of concern with staff members.

All staff members we spoke with demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We saw the service was working within the principles of the MCA and had followed the correct procedures when making DoLS applications.

We looked at five care files in detail, all of which contained thorough and personalised information about the people who used the service and how they wished to be supported and cared for. Each file contained concise, yet detailed care plans and risk assessments, which helped ensure people’s needs were being met and their safety maintained. However, we did note people or their relative’s involvement in care planning and reviews had not been successfully captured.

We saw a varied activity programme was provided, with people’s likes and interests being catered for as much as possible. A record book was in place to capture details of activities completed and who had participated, however we found historically this had not been completed consistently.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily, weekly and monthly basis, depending on the area being assessed and covered a wide range of areas including medication, accidents and incidents, infection control and training.

Meetings had been held with staff members and people living at the home. Relatives opinions on the care provided had been sought via annual quality assurance questionnaires.

This inspection was carried out over three days on the 22, 23 and 24 November 2016. Our visit on 22 November 2016 was unannounced.

At the last inspection on 16 and 23 February 2016 we rated the service as Inadequate' which meant the service was in ‘special measures.’ At that inspection we identified ten regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to safeguarding, safe care and treatment, meeting nutritional and hydration needs, staffing, person-centred care, the need for consent, dignity and respect and good governance.

Following the inspection the provider sent us an action plan which stated the breaches would be addressed by May 2016. This inspection was to check improvements had been made and to review the ratings.

Marple Lodge Care Home is a care home that is registered to provide accommodation and personal care for up to 19 adults. On the three days of our inspection there were 15 people living at the home.

The home is situated in a quiet residential area of Marple, close to local amenities.

The home had a manager registered with the Care Quality Commission (CQC), who was present throughout the three days of inspection. A registered manager is a person who has registered with CQC 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.

During this inspection, we found significant improvements had been made and we observed staff giving positive and caring support to people. However, we also identified some areas where improvements were still required. The registered manager and the senior carer were responsive to our feedback and had started to take actions to make some of the required changes during our inspection.

During this inspection, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some medicines were not managed safely for example we found there was not always clear, detailed written directions for the use of medicines to enable staff to apply topical prescribed creams. We did a medicine count for a particular medicine for one person and we found discrepancies in the number of tablets that has been signed as given and the total number remaining in the box. This meant there was a risk that prescribed creams and medicines may not have been applied when required, which could have resulted in unnecessary discomfort for the person.

In addition we saw that the covert medication policy was not being appropriate adhered to for one person receiving their medication covertly. Covert medication is the administration of any medical treatment in a disguised form. This usually involves disguising medication for example by administering it in food and drink. As a result, the person is unknowingly taking medication.

From looking at the training record and speaking with staff, we found improvements had been to ensure staff were properly trained. However, we found there were still some gaps in staff training. For example, we found one cook and care staff who served meals and prepared drinks and snacks for people had not received food hygiene training. This meant that the registered provider had not ensured staff had the qualifications, competence, skills and experience to meet the needs of people receiving a service and that practices at the home reflected up to date best practice guidelines.

The registered manager told us that short-term plans of care were not implemented for individual short-term needs such as a chest or urinary tract infection. This meant there was a risk that the care need may not be appropriately met. However during the inspection we did not see anybody who required a short term plan of care and we were given assurances that these would be implemented as and when required.

Staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support. However we saw in four care files that a relative had signed the consent to care document without the legal authority to do so.

Since the last inspection, some systems had been improved to monitor the quality and safety of the service. However, we also saw there were no formal audits or reviews of accidents and incidents, complaints, care plans, staff recruitment files, staff training and general cleanliness and infection control within the home.

People were supported by a caring staff team and staff and relatives of people living at Marple Lodge told us they thought there were sufficient staff to safely meet people’s needs. However, we found there was not a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant the registered provider could not be sure that the staffing levels and skill mix of staff were sufficient to meet the assessed needs of people living at Marple Lodge Care Home. We made a recommendation that they implement the use of a staffing tool.

The home was clean and well maintained and we saw staff had access to personal protective (PPE) to help reduce the risk of cross infection.

We saw that since the last inspection appropriate safety checks were undertaken. For example water temperature testing, emergency lighting, fire safety cheeks and we saw people had a personal emergency evacuation procedure (PEEP’s) and portable appliance testing had all been undertaken However there was no clear system for documenting maintenance work required and then evidence that the work had been undertaken.

The service had good recruitment processes to ensure only suitable staff were employed.

Since the last inspection staff supervision and annual appraisals had been implemented to enable them to carry out the duties they are employed to perform.

Staff understood how to recognise and report abuse which helped make sure people were protected.

People had access to healthcare services and we saw specialist advice was sought in a timely manner. For example from the district nurse, dentist, optician and chiropodist and people were supported to attend hospital appointments as required.

Attention was paid to people’s diet and people were supported to eat and drink in a way that met their needs.

People received person-centred care and we saw privacy and dignity was respected.

The visitors we spoke with told us they thought their relatives were well cared for and looked after at Marple Lodge Care Home.

From our observations of staff interactions and conversation with people, we saw staff had good relationships with the people they were caring for and respected their privacy and dignity. The atmosphere felt friendly and homely.

There was a complaint notice on the back of people bedroom doors, on the notice board in the main reception and in the statement of purpose and service user guide and there was a system in place for receiving, handling and responding to concerns and complaints. One relative we spoke with told us they had never raised a complaint and said they could “never see why I ever would.”

The two healthcare professionals we spoke with told us they had no concerns for the people living at Marple Lodge Care Home and they said that they could see improvements since the new manager had taken up post.

Marple Lodge is registered to provide accommodation and personal care for up to 19 adults. On the two days of our inspection there were 16 people resident at Marple Lodge. Care was provided in either single or double rooms some with en-suite and there are communal bathrooms on both floors of the home.

The home had a registered manager and a manager who was intending to register. 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.

We identified 10 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There had been no routine checks of the building. There were no water temperature checks, fire tests had not been regularly carried out and emergency lighting checks had not been done since September 2015. The window restrictor in a first floor bedroom was broken and the window could be fully opened. There was equipment left by fire doors and in some areas the carpet was frayed. This meant the provider could not be sure the service was safe.

People's risk assessments were either missing or not fully completed. Medication records had some missing signatures. Some MAR's and care records did not contain a photograph of the person. This would make it difficult for new staff and agency staff to identify the person they were administering medication to. Some people's medication was not being administered as prescribed. One person had allergies to certain medication, which staff had not documented on their MAR’s, which meant they could be administered medication, which could cause them harm.

There were enough members of staff to keep people safe, although staff said an extra member of staff would enable them to spend more time with people. Staff training, supervisions and appraisals had not been completed for over a year.

There were two incidents recorded which should have been referred to the local authority under safeguarding which had not been done.

Mental capacity assessments had not been carried out. The provider had applied for Deprivation of Liberty Safeguards authorisations, which the local authority had granted. However, we found three we looked at had expired. This meant the provider was depriving people of their liberty illegally.

The records in the handover book showed that people had good access to physical healthcare; however, staff had not recorded this in people's care files. This meant it would be difficult to see people's healthcare history.

We saw good interaction between staff and people who used the service. It was clear from our observations that staff knew people well. Relatives told us staff were kind and they were happy with the care their loved one received. Staff maintained people's privacy and dignity. However, we found care records were kept in an unlocked cabinet in an unlocked office in the reception area of the home.

People's care records contained conflicting information. The new manager told us they were reviewing care plans as they had identified they were lacking in detail. We looked at the care plans of five people and found only one had been reviewed and updated. Staff told us there was no on-going assessment of peoples care. Staff had not consistently monitored people’s weights. We could not see referrals had been made to the GP or dietician where people had lost weight.

There were very few organised activities; the new manager was in the process of introducing a programme of activities.

The provider did not have a system in place to assess the quality of the service. There were no audits carried out. Monthly staff meetings took place; however, actions identified during the meetings were not followed up.

The provider had not complied with their duty to notify us of two safeguarding and one police incidents and deprivation of liberty safeguards authorisations.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, they will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying

the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

At the time of this inspection we were told that 15 people were accommodated in the home.

During this inspection we spoke with the manager and looked at records relating to assessing and monitoring the quality of service provision.

We considered the evidence collected under this outcome and addressed the following question, is the service well-led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service well-led?

Since the last inspection visit a new manager had been appointed and was in the process of implementing new systems to monitor the quality of the service and identify risk. This would help to ensure that people received a safe and effective service.

You can see our judgements on the front page of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people were treated with respect and dignity.

The environment was clean, tidy and hygienically clean.

For the outcome areas we looked at during this inspection visit we saw that staff had received appropriate training.

We saw that the chef undertook temperature testing of food prior to it being served to people to ensure it was served at a safe temperature. However we saw that there were some gaps and inaccuracies in the recording of the temperature testing.

Is the service effective?

People living at Marple Lodge Care Home had a care file that included assessments of needs and a plan of care to meet their individual needs. However it was of concern that one person's file could not be located during the course of this inspection visit.

The home was clean, tidy, free from offense odours and was nicely decorated and furnished.

Is the service caring?

The atmosphere in the home felt relaxed, pleasant and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and preferences. People were seen to be freely moving around the home and staff were kind and sensitive in their approach to people. We saw that staff responded promptly to peoples requests or need for assistance.

We observed that people looked well cared for and were appropriately dressed.

Some of the comments we received from people living at the home were: 'The staff are lovely, I can't fault them one bit' and 'they (the staff) are marvellous.'

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example we saw evidence of visits from the GP, the district nurse, the chiropodist and we saw that people attended hospital appointments. This meant that people using the service received co-ordinated care and support.

We saw that there was a complaint procedure and we were told that each person living at the home had been given a copy of in the service user guide. We were told that the home had not received any formal complaints but had an open door policy and were quick to respond to any issues or concerns people had. We were told that people living at the home and /or their visitors were actively encouraged to raise any issues they had.

Is the service well-led?

The provider told us that interviews were due to take place the week following our inspection visit for the position of manager for the service.

Some documents and files could not be located during the course of our inspection and the management of the home was disorganised and chaotic.

There was not an effective quality assurance system in place to assess and monitor the quality of the service provided. This meant that poor practices may not be quickly identified and people could be placed at risk..

All staff spoken with were positive about the standard of care provided at the home.

We found that each person had individual care records that identified their care needs.

We looked around the home and saw that the layout of the premises was safe and suitable for carrying out the regulated activity. The premises were maintained to high standard as was the d'cor and furnishings of the home.

People spoken with told us they were happy with the standard of food and drinks and snacks were available on request. However some improvements were needed in the care planning process and assessment of people who may be at risk of not receiving adequate nutrition and hydration. Some shortfalls were identified due to the lack of training for staff who were involved in food preparation.

We saw that staff were available in sufficient numbers to meet people's needs.

We sampled six care files and found them to be well maintained. Each file contained detailed assessments of personal care needs and risk assessments.

We observed that people looked comfortable and well cared for. When we spoke with three people who used the service comments included: "I have no complaints at all", "The staff here look after me very well" and "I am very happy here". We also spoke with two visitors during the inspection and they raised no issues at all about any aspect of the care provided.

We reviewed how medicines were managed in the home. We saw appropriate arrangements were in place in relation to obtaining, storage and disposal of medicines.

We found that Marple Lodge had appropriate systems in place to ensure that staff were recruited safely and effectively. We looked at a sample of six staff recruitment files and saw that they contained the required information, which included, two written references and proof of identity, all obtained before people began working at the home.

We found that complaints were managed appropriately. When we spoke with people who used the service, we were told: "I have no complaints at all, the staff here are very good", "I have nothing to complain about" and "I have never had any reason to complain, I am very happy".