Marion Lauder House

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

The recruitment of staff was not always safe as previous employment history was not always recorded and references were not always obtained from the most appropriate referees. Advocacy support had not been considered for one person when decisions were being made about their care and support.

The management of medicines was safe but further work was completed following the inspection to ensure medicines administered covertly were clearly recorded. Records in relation to fluid intake were not always accurately recorded. Quality monitoring processes had not highlighted the concerns found at this inspection.

People felt safe living at the home and told us staff were kind and caring. Internal and external health and safety monitoring of the home was regularly completed. Risks to people were identified and strategies implemented to reduce each risk. Infection control was well managed.

People received regular reviews from health and social care professionals. Relatives were regularly updated with information about their relations health. People received a healthy and nutritious diet. A programme of refurbishment was planned for the home. The home was fully accessible.

Staff promoted independence and we saw dignified interactions with people living at Marion Lauder House. Staffing levels were sufficient from our observations; however, we made a recommendation to review the staffing dependency tool to ensure it was suitable for the home. Staff received an induction, training and supervision. Staff felt supported by the manager.

There was a programme of activities in place, however, people from the nursing unit did not always take part. We made a recommendation; the provider reviewed the activity provision for people on the nursing unit. Care plans were in place and staff were aware of people’s needs. We made a recommendation; the provider ensures people, and their representatives are involved in reviewing their care records and advocacy support should be considered where people don't have any representation.

People and their relatives felt confident to raise any concerns they had with the manager or staff. Staff were aware of safeguarding processes. Relatives felt the manager was responsive. There had been a change in directors since the last inspection and an action plan was in place to highlight the improvements they wish to make and by when. We received positive feedback from professionals about the management and staff at the home.

People were mostly 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.

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 28 August 2021).

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 the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

We have identified a breach in relation to good governance.

We have made recommendations the provider should review the dependency tool used to calculate staffing levels, provision for activities for people in receipt of nursing care and for people’s representatives to be involved in reviews of care and advocacy support should be considered where people don't have any representation.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Marion Lauder Nursing Home is a care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 79 people.

The care home accommodates people across four units. One of the units specialises in providing residential care to people living with dementia.

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

Actions staff needed to take to reduce some risks were reflected in electronic care plans, but the system did not always accurately reflect the risks posed to people. Referrals were made to other health professionals, but these were not always done in a timely manner. Premises checks and all maintenance records were up to date. Required test and safety certificates were in place. Systems were in place to protect people from abuse and staffing levels ensured people received both shared and one to one care as deemed appropriate. Lessons had been learnt following a recent safeguarding incident. The provider had introduced more robust processes to be followed for the care and treatment of wounds.

Relatives we spoke with considered staff to be caring and compassionate and our observations supported this. Staff were aware of people's needs, promoted independence and took time to make sure people remained safe. Staff recognised the benefits of keeping people stimulated and entertained. Staff had used other skills during the pandemic to limit the contact with others outside the home and help protect people. Staff had helped people maintain important relationships with family and friends throughout the pandemic.

Systems and processes for audit and quality assurance were in place but had not identified the shortfalls we found with the electronic care planning system. The nominated individual was responsible for managing the service in the absence of the registered manager. Daily meetings with leads and heads of units were held to improve oversight of the service. Supervision of staff, especially new staff, was a priority for the provider.

Communication with relatives had not always been consistent. Families had appreciated the efforts of the home during the COVID-19 pandemic but felt communication during this time had suffered. The provider was open and transparent with stakeholders. The service was keen to re-establish partnerships with professionals that had lapsed during the COVID-19 pandemic.

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.

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 outstanding. (published 17 February 2020).

Why we inspected

We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about falls and wound care. A decision was made for us to inspect and examine those risks.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to mitigate the risks found on inspection and continues to work with relevant external professionals to help resolve them.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marion Lauder on our website at www.cqc.org.uk.

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 work alongside the provider and 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.

Marion Lauder House is a care home providing personal and nursing for 66 older and younger adults and people living with dementia, at the time of the inspection. The service can support up to 79 people.

The home consists of two floors providing care and support across four separate units.

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

The home was exceptionally well led. There was a continuous ethos of learning and improvement for the people, the staff and management of the home. Everyone we spoke with felt wholly supported by the management team. The provider and registered manager had complete oversight of the home and were at the forefront of it. The service supported research and progression of other health and social care services which resulted in positive outcomes for the people living at Marion Lauder House and other services.

Staff were extremely caring and ensured the care provided was person centred. Staff ensured people were cared for as they would have been in their own homes. People were supported to enjoy the things they previously had such as listening to their favourite music and all staff were fully aware of people’s needs and strived to support independence and wellbeing. People were treated as individuals and their individuality were valued and supported.

The provider had recognised that support with eating and drinking was paramount to ensuring people received a healthy and nutritious diet. This would enhance people’s health and well-being and the provider worked hard to achieve this. Staff were very positive about the varied training provided and were supported by external professionals and projects to enhance their knowledge. Links with health and social care professionals were positive and the right support was gained at the right time to ensure people remained fit and well. The environment was constantly being reviewed to ensure it remained suitable for the changing needs of people and the provider ensured it was decorated to people's current tastes.

Care plans were in place which captured people’s needs. Staff could accurately describe individuals plans of care and people were involved in developing and reviewing them along with people and their representatives. A range of activities were available and well attended across the home. Activities were person-centred and were held individually and in groups. All comments about activity provision was positive.

People were supported to remain at the home should they be at the end of their life. The home was six steps accredited which meant they provided truly person-centred and high-quality end of life care.

People were safely supported to live at the home. Risks were assessed, monitored and reviewed. Staff were aware of any risks and how to reduce them. Medicines were safely managed, and people received their medicines as prescribed. Staff were recruited safely.

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.

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

Rating at last inspection;

The last rating for this service was good (published 13 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

We last carried out an inspection at Marion Lauder House on 5 January 2016. We rated the service as requires improvement overall.

Marion Lauder House provides nursing and personal care and accommodation for up to 75 older people, some of whom are living with a diagnosis of dementia. There were 68 people living at Marion Lauder House at the time of this inspection.

The home accommodates people requiring nursing and residential care over two floors in three living units called Maple, Brookfield and Cherry. There is also a respite assessment unit that provides residential dementia care. At the time of our inspection the provider had recently renovated a bungalow in the grounds of the home and was using this for additional accommodation.

There was a registered manager in post at the time of this 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.

The registered manager had kept us informed of safeguarding incidents and other notifiable events which had occurred in the home in line with their statutory obligations. Staff were confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They knew what action to take to safeguard people from harm. All of the staff received regular training that provided them with the knowledge and skills to meet people’s individual needs in an effective manner.

People’s safety risks were identified, managed and reviewed and the staff understood how to keep people safe. There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety.

We looked at medication administration records (MARs) on the nursing unit and on the respite unit. Records on the nursing unit were complete and accurate. Nursing staff were recording initials when administered and using the key code on other occasions, for example when PRN medicines were not required or if medicines were refused and destroyed. The recording of medicines on the respite unit was confusing and not always accurate. The manager provided evidence that this had been addressed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made and was aware of the principles of the Mental Capacity Act 2005. Staff sought people’s consent before they provided care and support. However, some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. Where people had restrictions placed upon them to keep them safe, the staff ensured people’s rights to receive care that met their needs and preferences were protected.

The environment was designed to enable people to move freely around the area of the home where they lived. There were lounges and dining areas in each unit of the home and a large activity room in a separate area of the home. This room was used to provide day care for a number of clients but it was also accessible to people living in the home if they expressed a wish to do so. There was also access to secure garden spaces from lounges on the ground floor . The physical environment of the home had undergone positive change and we saw that the residential unit in particular was stimulating and interesting for people with dementia.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy. Mealtimes were pleasant experiences for people, and those who needed assistance were helped by staff in a discreet and calm manner.

People, relatives and other healthcare professionals involved with the service said that the support staff were caring. On the day of our visits we saw people looked well cared for. There was a relaxed atmosphere in the home. We saw staff engaging with people, speaking calmly and respectfully to people who used the service.

Care plans we looked at confirmed that a detailed assessment of needs had been undertaken by the registered manager or a nurse before people were admitted to the service. We reviewed whether the care plans were written in a person-centred way and judged that they were. People using the service and their relatives were consulted and involved in assessments, care planning and the development of the service.

The treatment of wounds was detailed and thorough and the home had worked hard in establishing the right links and professional support. We were confident that the home was responsive to changes in people’s skin and working well to reduce pressure sores.

Staff told us that they felt supported by the registered manager. Regular team meetings were also held and the service offered incentives for staff and had an employee of the month scheme. Staff were able to raise any issues or concerns at these meetings. Staff spoke highly of the management at the home.

There were systems in place to monitor accidents, incidents or safeguarding concerns within the home. The registered manager maintained a monthly record about the incidents which had occurred and what had been done in response. Appropriate action had been taken to address issues identified during these audits.

The company used various ways to obtain feedback from people using the service and their relatives so that the service could continuously improve. People were signposted to the suggestions box in reception. This showed us that the home was willing to consult with all stakeholders in the service and take on board what people said.

People who used the service said they were happy with the care provided. One person said, 'I am very happy here and the girls look after you well.' We observed staff speaking with people in a caring and respectful manner. One person was seen holding a staff member's hand. They told us, 'I like holding her hand, she's lovely.'

Relatives of the people who used the service said they were happy with the care provided. One person told us, 'The staff are nice people who always make you welcome'.

We observed the way lunch time was managed. People said they enjoyed the meals. People were supported with their meals as required. One of the people who used the service said, 'The meal was good, but it always is.'

Relatives said they had never heard any staff speak inappropriately to any of the people who used the service. One person said, 'I have absolutely no worries about my relative's safety, they are extremely well looked after.' One of the people who used the service said, 'The staff know what I like and they get it for you.' Another person told us, 'I just shout and someone always comes.'

We spoke with a relative of one of the people who used the service. They described the staff as 'supportive and caring'. They said they were very happy with the care and said their relative was always well dressed. The relative confirmed they were involved in the development of their care plan.

A plan was in place for each person which provided details of the care they needed. Staff consulted with health care professionals such as district nurses and people's GP for advice and guidance when necessary. This ensured people's physical care needs were met.

People's emotional care needs were met through a range of social activities.

Staff were trained on how to safeguard people from abuse. They were aware of the different types of abuse that could take place and the signs to look out for. None of the staff had any concerns about the safety and welfare of the people they looked after or the care practices of their colleagues.

The home's complaint procedure was available to the people who used the service and their relatives so they knew what to do if they were unhappy with the standard of care they received.