We carried out an unannounced inspection of Marsden Grange home on the 15 and 16 March 2016 and we contacted staff via telephone calls on the 17 March 2016. Marsden Grange care home is registered to provide accommodation, personal care and support for 40 people. Marsden Grange care home is set in its own grounds and is located in the area of Nelson in Lancashire. The accommodation consists of two separate buildings. One is the main house which accommodates 23 people and is set over two floors with single and twin bedrooms and a separate annex which is named as the pendle suite which accommodates 17 people and is set over one level. There is also a car park for visitors and staff. At the time of the inspection there were 36 people accommodated at the home.
The service was managed by 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.
The service was last inspected in April 2014 and was found compliant in all areas inspected.
During this inspection we found the provider to be in breach of two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. These breaches relate to the provider failing to provide staff with up to date refresher training in medicines management, not following best practice around the safe administration of medicines and not providing staff with frequent effective supervision sessions. You can see what action we told the provider to take at the back of the full version of this report.
We also spoke with the registered manager about the importance of allowing fire doors to close without obstruction in the case of a fire. The registered manager assured us she would install electric door closers as a matter of priority. These closers enable people to have their door open safely should they wish to.
People told us they felt safe living at the service. We received positive feedback about the service Marsden Grange provided. Relatives told us they felt secure in knowing their relatives were safely and effectively cared for by professional staff. Comments included, “The care could not be better. Staff really know what they are doing and I always observe good safe care towards my [relative], “I have nothing but good reports. I speak to other residents and their families and they all think it is wonderful here”. A visiting health professional told us how they thought “It was one of the better homes”.
We noted the service had contingency procedures and processes in place to maintain a safe environment for people using the service, visitors and staff. Environmental risk assessments covering areas such as use of stairs, and appliances were also evident.
People had care plans tailored to individual need with appropriate risk assessments covering areas around daily living, health and nutrition. Care plans contained PEEP (personal evacuation plans). All staff showed a good understanding of procedures to follow in the event of an emergency or fire.
We noted the service had robust policies and procedures in place to recognise and protect people for the risk of abuse. Staff displayed a good understanding around this and were aware of the various signs and indicators of abuse.
Over the two days of inspection we noted adequate staff presence. Staff told us they did not feel rushed in their daily duties. People using the service told us staff took time to sit and talk with them and look at photo albums. People also told us staff responded to them in a timely manner.
People were recruited safely and in line with current guidance. All staff had been subject to a DBS (Disclosure and Barring Service) check. The DBS carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults, to help employers make safer recruitment decisions.
People we spoke with and their relatives told us they felt the service was effective. People made positive comments about the staff team approach and attitude. One visitor said, “Its brilliant care. My [relative] is very happy here and they are very accommodating with my needs when I visit”.
The service had a thorough induction process. This ensures the competence of staff before undertaking their caring role. It also enable staff to familiarise themselves with policies and care files to enable them to effectively and safely support people using the service.
We found the service was working within the principles of the MCA (Mental capacity Act 2005). Processes were in place to support and encourage people to make their own decision and choices.
Bedrooms were personalised and people told us they were able to bring their own possessions from home including furniture.
Meals were adequately spaced and cooked from fresh produce which was delivered weekly by the local butcher and greengrocer. The registered manager told us no meat was frozen. We noted frequent refreshments and snacks being offered and people walking freely into the kitchen area to help themselves when desired.
Arrangements were in place to gather relevant information on people’s backgrounds, care requirements and medical diagnosis/ treatment before they used the service. People’s circumstances were kept under review and people and their relatives told us they were always involved in this process.
We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements. One health care professional referred to the registered manager as, “Innovative” with health care referrals.
We noted a good range of activities. People could freely leave the service to visit the local towns and access external hobbies. The registered manager told us that the people living at Marsden Grange were currently involved in a project alongside the National Institute for Health Research (NIHR),The Collaboration for Leadership in Applied Research and Care North West Coast (CLAHRC NWC), Lancashire County Council (LCC) and the East Lancashire Hospital NHS Trust (ELHT). This project was looking at using available evidence to inform professional practice change around the use of meaningful activity. This was done by engaging people living at the service with meaningful activity to increase wellbeing. People we spoke with told us they enjoyed being part of this and felt that their contribution was meaningful which gave them a true sense of worth and belonging.
Processes were in place to support people with any concerns or complaints. There was a formal system to manage, investigate and respond to all complaints and concerns. Regular residents and staff meeting were held. This gave an additional arena for people to collectively express concerns or dissatisfaction.
Over the two days of the inspection we noted positive staff interaction and engagement with people using the service. Staff addressed people in a respectful and caring manner. The service had a calm and warm atmosphere. We observed people enjoying each other’s company, singing, laughing and conversing.
We had positive feedback from people using the service, relatives and staff about the management team. People told us they were happy to approach management with any concerns or questions. One person told us “I don’t feel l am being ignored. The registered manager always listens to me”. We noted throughout the inspection that the registered manager was very accommodating to us and open and honest about the service. They provided us with all the information we required at the time of the visit.