Archived: Markfield Court

We looked at a number of records including people's personal records, medication records, staff records and records in relation to the management of the service. This is a summary of what we found and more detailed evidence can be found in the full report.

Is the service safe?

People we spoke with told us they were listened to, treated with respect and felt their care needs were being met. People had been asked for their consent regarding the care and treatment that was being delivered.

However, there was a limited understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Nobody using the service was under a DoLS authorisation at the time of our inspection and we found this legislation had not been considered as part of people's care planning. The implementation of the MCA was inconsistent and confusing which meant that where people lacked the capacity to consent their legal rights may not have been upheld. We have asked the provider to make improvements in this area.

As part of our inspection we looked at a number of people's individual risk assessments. We found that risk assessments recorded the potential risks to people and any action that should be taken to minimise the risk. Risk assessments had been regularly reviewed and updated to take into account people's changing needs. In addition, the provider had audits and checks in place to ensure that incidents and accidents in the home were reviewed and responded to.

People were cared for in a safe, clean and hygienic environment. There was an ongoing refurbishment programme which had recently included re-fitting bathrooms to ensure they were fit for purpose.

The provider had appropriate arrangements in place for the management of medication and medicines were stored safely.

Is the service effective?

We spoke with people who used the service and the majority were satisfied with the delivery of their care. One person told us 'I'm very happy here, everyone is kind and always there to help me'.

People's needs had been comprehensively assessed and care plans were up to date and contained accurate information. Care plans contained sufficient information about how staff should meet people's needs to ensure their safety and welfare.

People were supported to maintain good health by on-going monitoring and referral to appropriate health professionals when necessary.

Staff had a good understanding of the needs of people who used the service and were able to describe people's needs and how they should be met. This was consistent with what was contained in people's care plans.

Is the service caring?

People were supported by kind and attentive staff. Staff showed consideration for people's individual needs and people who used the service were very complimentary about the staff team describing them as hardworking and friendly.

Staff had time to talk with people in between carrying out their other duties and our observations showed that staff were patient and respectful in their approaches. The two relatives we spoke with spoke highly of the staff team and told us that staff had promoted their relatives well-being and always maintained their privacy and dignity.

Is the service responsive?

Consideration had been given to supporting people to engage in activities and we saw this was the case during our inspection. There was a programme of activities in place and staff available to support people to go into the community as well as a minibus for transportation.

Care plans recorded people's preferences, choices and wishes in how they would like their care and support to be delivered. Relatives we spoke with felt involved in what was happening at the home and told us that staff were good at communicating any issues.

The service gathered people's views in a number of ways including questionnaires and residents meetings. The service had an appropriate complaints policy and responded to concerns and complaints effectively. Staff, people who used the service and their relatives were all confident that any concerns, complaints or issues would be properly responded to by the service.

Is the service well-led?

The service did not have a registered manager in post at the time of our inspection. This is a condition of the services registration with CQC. There was an acting manager in post who was being supported by project managers.

People we spoke with felt the manager and staff team were approachable and they were able to speak to them about any problems or concerns.

We found that there were sufficient numbers of staff available to meet the needs of the people who used the service. The service continued to use agency staff but more permanent staff had been recruited. The skill mix of the staff team had been considered when allocating staff on the rota.

There was a system in place to monitor the quality of service being received which included audits and checks. This included monitoring of falls and other incidents in the home. This meant that the risks associated with the delivery of care had been monitored and responded to.

Medicines were not always administered reliably. Storage arrangements were adequate but medicines that required refrigeration were not stored safely. Systems intended to record the receipt and administration of medicines did not work reliably.

Improvements had been made to some parts of the building. However, some of the bedrooms were unsuitable for the people who used them.

People sometimes found the care they received was unreliable. This was due to the high use of temporary staff and because there were insufficient staff available during the evenings and at night.

People were asked to confirm their agreement with the arrangements for their care and support. One person told us that they knew the content of their care plan and had agreed to it,' I can't see to read it but they explained it to me so I could let them know it was right. I am happy because they are doing things how I like them.'

The people we spoke with told us that they were satisfied with the care and support they received, and their requests for assistance were usually responded to promptly enough. One told us, 'Staff are very nice, they sort you out if you get muddled about something.'

People told us that their medicines were given reliably. One person explained to us, 'I get my tablets at a regular time. I have so many it takes ages.'

Staff participated in training at regular intervals to help keep their skills and knowledge up to date.

People had opportunities to share their views about the service. We saw notes of a recent residents meeting which discussed issues relating to meals, staffing and the planned building work. Concerns raised at a previous meeting had been addressed. One of the people we spoke with told us that they attended these meetings, 'We have residents meetings sometimes. We iron out our differences.'

Improvements had been made to some areas of the building and maintenace requests were responded to promptly. People using the service told us they were satisfied with the standard of decoration and cleanliness in the home.

People we spoke with told us that they were satisfied with the care and support they received. They felt staff looked after them well, treated them respectfully and understood their needs. Some people expressed concerns that staff appeared very busy and at times they had to wait for their requests for assistance to be responded to. We shared this concern as at times there were insufficient staff to ensure people's needs were properly supported.

Some improvements had been made to the building and extensive work was due to commence on the exterior and top floor of the building. Despite this we found that the provider was failing to adequately maintain all areas of the building.

People appreciated the range of leisure and social activities that were provided, whether they participated in group activities or benefitted from one to one time with the activities staff.