20 and 21 September 2015
During a routine inspection
This unannounced inspection took place on 21 and 22 September 2015.
Marley House is registered to accommodate up to 26 people who require nursing or personal care. On the day of our visit there were 16 people living in the home.
The service did not have a registered manager. There was a home manager who had been working in the home for four months. Their application to be registered manager had been submitted and was being processed. 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.
At our last inspection of Marley House in September 2013 we had concerns about how people received support for their individual care needs, the quality of record keeping and the recruitment of staff. There were breaches related to these regulations. We asked the provider to take action and they sent us a plan detailing they would make necessary improvements by the end of November 2013.At this inspection we found they had addressed actions related to how people received support for their individual care needs and recruitment. However during this inspection we found that concerns about the quality of record keeping had not been adequately addressed. The home was not able to demonstrate through their records, how they protected people from inappropriate or unsafe care. This meant there was a continued breach of this regulation.
Some people required creams to be applied as prescribed by their GP, during this inspection there were gaps in the recording of when cream was applied for two people.
The home had received input from health and social care services after one person developed a significant pressure sore. The provider put some actions into place to reduce the risk of further incidents. However we found that some care workers did not complete repositioning charts appropriately. This meant people were not being protected sufficiently from the risk of developing a pressure sore. Senior staff did not identify this through quality monitoring.
Improvements were needed to ensure regular checks were carried out by senior staff and actions taken to ensure staff have appropriate guidance to enable them to provide people with the right care and support.
We found the provider had made some improvements since our last inspection in September 2013. The provider had implemented appropriate recruitment checks and staff were recruited safely. Improvements had been made to how people with specific nutritional needs were supported.
During this inspection there were concerns the home did not always have sufficient staff with the right skills and experience to meet people’s needs. Some staff had left and some new staff had been recruited. Some new staff who had been recruited did not have previous experience in a care worker role. Seven members of staff, two relatives and a healthcare professional told us they were concerned about the home being “short staffed” and some staff not having the right skills and experience. There had been difficulties covering some shifts at short notice. The provider was aware of the problem and had taken actions to address it. They were actively recruiting and had booked agency staff to cover.
People were treated kindly and staff were caring and interacted warmly with people. People had their privacy and dignity respected. People were involved in decisions about their care and families told us they were happy with the home.
There were breaches of regulations which impacted on the quality of care that people experienced. You can see what action we have asked the provider to take at the back of the full version of the report.