The Marshes

We found the following examples of good practice.

The home was following government guidance in relation to visitors. Any visitors were requested to phone in advance and a risk assessment would be prepared. On arrival at the service all visitors would have their temperature taken and be asked to carry out a Lateral Flow Device (LFD) COVID -19 test before they could enter the home. Results were recorded. Visitors were asked to wear personal protective equipment (PPE) and advised to remain socially distant from people and staff.

There was a programme to ensure all staff were tested regularly. This was alongside daily temperature testing for everyone and observing people for any signs or symptoms of COVID -19.

The registered manager followed current guidance in relation to infection prevention and control. Cleaning schedules were clearly recorded. All touch points were cleaned three times daily. A new kitchen had been installed and work continued to complete painting in the dining room and corridors.

The home had recovered from an outbreak and had contingency plans in place should any person or staff come into contact with anyone with COVID -19 or test positive. The registered manager praised the staff team for their hard work throughout the outbreak and lockdown. All staff wore PPE and had received training on infection control, the putting on and taking off of PPE and hand washing.

Individual risk assessments had been written for people and staff to consider specific risks in relation to any underlying health conditions or specific considerations. Staff continued to receive regular supervision and support. The home worked flexibly to meet staff’s needs. For example, a staff member who had been off through COVID -19 had been able to come back on a phased return. All staff take breaks individually.

Where possible, people continued to be supported to maintain contact with relatives by telephone and through the use of technology. Indoor activities such as bowling were carried out and people enjoyed daily walks or drives locally.

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

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support. People were supported to make choices in all areas of daily living from choosing clothes to wear to what they wanted to do. There were regular opportunities to use local facilities and amenities and people had equipment that enabled them gain new skills and to increase their independence in whatever way they could.

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 supported this practice.

There were good recruitment procedures and enough staff on each shift to meet people’s needs. Staff understood what they needed to do to protect people from the risk of abuse. Incidents and accidents were well managed. People’s medicines were managed safely.

The organisation’s training programme ensured that staff were given regular opportunities to update their knowledge and skills and staff competency in areas of medicines and moving and handling were assessed on a regular basis. Supervision meetings were held regularly, and staff told us they felt very well supported by the management of the home.

People were supported to attend a range of health appointments, such as the GP or dentist and they also attended appointments for specialist advice and support when needed. People had enough to eat and drink, and menus were varied and well balanced. A visiting professional told us, “I have never felt that any patient has not been given the attention desired.”

Staff were passionate about the care they provided and demonstrated a caring and respectful approach with people. Most of the staff had worked in the home a long time and had a good understanding of people as individuals, their needs and interests. People needed support with communication and whilst they were not able to tell us their experiences, we observed that they were happy and content in their surroundings and relaxed with staff.

People were supported to take part in activities to meet their individual needs and wishes. This included trips to the local parks, theatres, cafes and restaurants, trips to places of interest and college. Entertainers provided musical entertainment and we observed one of these. This activity was lively and inclusive, and people were observed to really enjoy the activity.

The environment was well maintained. The bathroom and shower room had recently been refurbished. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks on equipment were all up to date.

Rating at last inspection: At the last inspection the service was rated good. (The last inspection was published 8 January 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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.

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.

Risks to people's health, safety and wellbeing had been assessed and plans were in place which instructed staff how to minimise any identified risks to keep people safe from harm or injury. However, risks assessments did not consistently embed, implement or follow nationally recognised tools and guidance such as the Malnutrition Universal Screening Tool (MUST). We have made a recommendation about risk assessments.

The registered manager and staff had received training and were knowledgeable about of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had been completed for the decision ‘does the individual have the capacity to make decisions about daily living whilst living at The Marshes.’ However, assessments of capacity were not decision specific and incorporated a wide range of decisions into one assessment. This is not in line with best practice requirements. We have made a recommendation about mental capacity assessments.

Staff told us they worked as part of a team, that the home was a good place to work and staff were committed to providing care that was centred on people's individual needs. There was a strong caring culture in the care and support team.

People received care and support that was responsive to their needs. Care plans provided detailed information about people so staff knew exactly how they wished to be supported. People were at the forefront of the service and encouraged to develop and maintain their independence. People participated in a wide and varied range of activities. Regular outings were organised and people were encouraged to pursue their interests and hobbies.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Staff had access to on-going training and supervision to ensure they had the skills and knowledge required to support people effectively. Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal. However, documentation did not consistently record the stock level carried forward from one month to another. We have made a recommendation about the monitoring and documentation of medicines.

Staff treated people as individuals with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. They approached people in a calm, friendly manner which people responded to positively. Relatives spoke highly of the service. One relative told us, “They couldn’t be in a better place.”

This was a follow up inspection to look at consent to care and treatment. We spoke with the new manager, area manager and two members of staff. The inspection was carried out by one inspector over two hours.

We considered all the evidence we had gathered and used the information to answer the question; Is the service effective? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service effective?

People who used the service had limited capacity to give their consent to care and treatment. We found that the provider acted in accordance with legal requirements where people lacked the capacity to make decisions for themselves.

Our inspection team was made up of one inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were systems in place to make sure people were protected against the risks associated with medicines. Medication was stored safely and there were clear records of administration. Staff had received training in the administration of medication and the use of controlled drugs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People who used the service had limited capacity to give their consent to care and treatment. We found that the provider had not always acted in accordance with legal requirements where people lacked the capacity to make decisions for themselves. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people receiving care.

Is the service caring?

People were supported by committed and caring staff. We observed that people appeared comfortable in the home and familiar with the staff that worked there. We saw that staff members spoke directly with people and supported them at an appropriate pace. One person told us they were happy and liked living there.

Is the service responsive?

People's needs were continually assessed. Records confirmed people's preferences, interests, goals and diverse needs had been recorded and support had been provided in accordance with people's wishes. People had regular review meetings with keyworkers to make sure that changes in needs were identified and action taken.

Is the service well-led?

Staff had a good understanding of their roles in the service and that they were supported by management. There were quality assurance processes in place to maintain standards in the service. We saw that staff and people who used the service were given opportunities to express their views.

Staff ensured that consent was obtained prior to providing care and support. Care plans provided comprehensive information about people's abilities and needs. However, interactions between staff and people on the day of inspection were minimal and care observed was task orientated.

Specialist advice and support was obtained to meet people's individual needs. There were safe systems in place for the management of medication.

The home had a robust recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.

We observed staff interacting positively with people. Where appropriate, specialist advice and support was obtained to meet people’s needs.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse. They also understood the home’s complaint procedure.