The Care Quality Commission
  • Care Home
  • Care home

Archived: Marsden House

Whitchurch, Ross On Wye, Herefordshire, HR9 6DJ (01600) 890869

Provided and run by:
Mr Graham Fillery

All Inspections

27 November 2013

During an inspection in response to concerns

We last inspected Marsden House in May 2013. The report had not been published when in July 2013 we received concerns from a whistle blower. A whistle blower is someone who worked, or had worked, for the service. The concerns were investigated by the local authority under their duty to safeguard vulnerable adults. They found that some allegations were true and others were not. This information led us to delay publication of our report about the inspection in May 2013.

As part of their investigation, the local authority carried out a full contract monitoring audit in October 2013. They also arranged for an infection prevention and control audit to be carried out by Herefordshire Clinical Commissioning Group. Both of these audits found that the service was not meeting all the standards they were measured against. We carried out this inspection to see if the provider had made improvements following the safeguarding investigation and was operating the service in an effective way that protected people using the service.

There were ten people living at the home when we inspected, although one was in hospital. We found that people were at risk of serious injury. This was because the provider had not ensured that professional advice about how to safely transfer people who required assistance had been followed. After the inspection, we raised safeguarding alerts with the local authority for two people to help protect them from the risk of harm.

We found that the provider had not acted on professional advice given by infection control specialist nurses. The lack of action to improve arrangements to manage hygiene and cross infection meant people continued to be at risk of contracting an infection.

We found that the provider's quality monitoring systems had not been effective in ensuring that appropriate processes were followed when staff were recruited, inducted, trained and supervised to enable them to deliver care safely.

We found the provider did not have a system in place that made sure people who used the service were supplied with adequate heating.

The provider had not fulfilled the legal requirement to have a registered manager running the service since the service was registered under the Health and Social Care Act in September 2011.

15 May 2013

During an inspection looking at part of the service

During this inspection we checked to see if improvements had been made in the four outcome areas where shortfalls had been found at our inspection in October 2012. We also looked at staff recruitment as records had not been available in October 2012. We found that the provider had put their action plan into practice and made improvements.

We found that people received a caring service. People told us they liked the staff who gave them the care and support they needed. They felt safe living at the home and could raise any concerns. One person said, "The care is good and most of the staff are very good'. We saw that people had been helped to look their best. There were limited activities provided particularly for people living with dementia. Each person had a care plan and these had been improved since our last visit. These were being reviewed regularly. Risk areas such as weight lose were being monitored.

Suitable checks had been carried out on new staff and systems to support and train staff were in place. The range of training provided had been increased. This meant that staff were better equipped to provide safe care based on current best practice.

Significant improvements had been made to fire detection and prevention systems and to risks such as hot water so that people were much safer. Health and safety management systems had been improved. The provider assured us that he would monitor these closely and ensure they were effective.

31 October 2012

During a routine inspection

Many of the people who were living at Marsden House were living with some degree of dementia and so were not able to comment directly on the care and support provided. We spent time in communal areas such as the lounge, so that we could see how staff supported people. We also spoke with people in their own rooms and with staff and the manager.

People were positive about the home. One person said, 'It is lovely here, they are very nice and the food is good'. Most people had been supported to look their best. We saw that staff took time to listen to people and offer them choices. They knocked before they went into people's bedrooms. People told us that they felt safe living at the home. Relatives told us they would feel able to raise any concerns with the manager.

Staff were attentive and caring, but some care plans and risk assessments were not up to date. This meant that staff may not have had the information they needed to provide the correct care and meet people's individual needs. Suitable systems were in place to support people with their medicines.

There had been some core and refresher training provided for staff but some essential training had not been done. The provider did not have effective systems in place to manage health and safety risks or to assess and monitor the quality of the service.

Serious shortfalls were found in fire safety arrangements and how other hazards to vulnerable people were managed.

7 June 2012

During an inspection looking at part of the service

We visited Marsden House because during our inspection on 8 November 2011 we identified concerns about how the staff looked after medicines for the people who lived there.

We spoke with three of the 13 people who lived at Marsden House, two of whose records we had looked at. As well as the 13 permanent residents another person was staying for respite care. The three people we spoke with all had some difficulty communicating, possibly related to a dementia type illness. This meant that we were unable to find out their views on how the care staff looked after their medicines.

At this inspection the safe handling of medicines was assessed by a pharmacist inspector and a compliance inspector. We wanted to see if the action plan the provider gave us following our inspection in November 2011 had led to appropriate arrangements being put in place. We looked at the storage of medicines and a sample of three people's medicine records. We met six of the care staff working during the morning and afternoon shifts. Two senior carers assisted us with the inspection.

After the inspection we contacted a community services manager for department of mental health for older people at the 2gether NHS Foundation Trust Herefordshire involved in the treatment of one of the people who lived at the home.

We found that the arrangements had been improved in areas such as staff training in medicines and the safe keeping of medicines. We looked at three people's available medicines and their Medicine Administration Record charts (MAR charts). We found that appropriate arrangements were in place for recording when prescribed medicines had been administered.

We looked at one person's care plan and MAR charts and spoke to two senior carers. We found that this person had run out of one of their prescribed medicines in March 2012 and the relevant health professionals had not been told for 28 days. We found that there was a further delay of three weeks while health professionals reassessed the person's needs and made a decision about future treatment. During these three weeks the provider issued written instructions to care staff to start administering this medication again by using a supply held in the home prescribed to another person. The provider did this without the permission of a health professional.

The patient information leaflet supplied with the medicine by the manufacturer stated, 'If you miss more than three days of applying Exelon Patch, call your healthcare provider before putting on another patch'. The provider instructed care staff to cut the medication patches in half and apply half a patch each day. The manufacturer's safety instructions state in bold 'The patch should not be cut or folded sharply'.

After three days the medication was stopped again. A senior carer told us this was because some staff had raised concerns and thought what they had been instructed to do was not safe. We asked if there was a record of who made this decision but this carer told us there was not. This carer told us the relative of the person concerned was told the supply of patches had run out, but not that another person's patches had been used for three days. The manager of the health professional involved in this person's treatment confirmed their department had been told at a visit that the supply had run out 28 days previously, but that they had not been told that another person's patches had been used for three days. They told us that they would not have approved the use of someone else's medicine.

These events meant that the provider had failed to protect people in the care of Marsden House against the risks associated with the unsafe use and management of medicines. This was because the provider had not made appropriate arrangements for the obtaining and safe administering of medicines. As a result, this service user went without their prescribed medication for a period of 54 days and was administered another person's medicines for three of these days in an unsafe way and without the permission of a health professional.

2 November 2011

During an inspection in response to concerns

We visited Marsden House because we had previously identified some concerns about the home. These included some concerns about how care was provided and the management of the home.

We spent time in the communal areas of the home to see how people spent their time and were being cared for. We spoke with people living at the home, their visitors, and staff. We also spoke to some health care professionals who visit the home regularly. One person who lived at the home told us 'it's a good place to live, they do look after us well' and a visitor said 'the atmosphere is very nice'. A local GP told us 'the staff are very caring' and 'I don't have any concerns about the home'.

We saw that staff were attentive and caring, but the care plans and risk assessments did not give staff all the necessary information about the care each person needed.

The provider did not have effective systems in place to ensure that people were protected from the risk of abuse or neglect. Staff lacked knowledge of local and national guidance and had not been trained in the protection of vulnerable adults.

Medication was not being managed safely at the home. Records were not accurate and staff had not been trained adequately.

The provider did not have effective systems in place to ensure that staff recruitment was managed safely. The relevant checks were not always carried out to reduce the risk of unsuitable staff being employed.

The provider was not providing staff with the training and supervision they needed to develop their skills and knowledge in essential aspects of their roles as care workers.

The provider was failing to ensure that effective systems were in place to assess and monitor the quality of the service. Risks were not always identified and managed safely.

The provider had not always notified us as he should have done about important events at the home.