OSJCT Marden Court

People’s experience of using this service:

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks.

We saw that further work was needed around the recording of behavioural incidents. Not everyone who displayed physical or verbally challenging behaviour had a care plan in place for staff to follow when supporting them.

People we spoke with told us they felt safe living at Marden Court and staff were available to help them.

We saw that where people had been identified as lacking capacity an assessment had been completed to ensure care was given in line with their wishes and in their best interests. The assessments had clear details recorded on how information was given to people in order for them to try and make a decision.

The service was calm and portrayed a homely environment. People were comfortable in the presence of staff and approached them easily for support, to chat or share a joke.

People had care plans in place that clearly explained how they would like to receive their care, treatment and support. People we spoke with were aware they had a care plan in place and where able contributed to discussions about their care.

The service continued to work towards improving care outcomes for people. An improvement plan was in place which set timeframes for areas that needed focus. The registered manager had implemented new ways of working and was looking forward to assessing the impact these had for people and staff.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 27 April 2018).

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

Follow up: We will monitor all intelligence received about the service to inform when the next inspection should take place.

The home was last inspected in February 2017 and we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was not meeting the requirements of the regulations relating to managing risks as a result of people’s challenging behaviours. At this inspection we found the registered manager had taken action necessary following the last inspection. However, other areas of the service had deteriorated and the provider had not ensured everyone received a consistently good service.

This inspection took place on 22 February 2018 and was unannounced. We returned on 26 February 2018 to complete the inspection.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

Action was not always taken to learn from mistakes in managing people’s medicines, to ensure similar mistakes were not repeated. We identified three incidents in which people did not receive the medicine they had been prescribed. Staff discovering the errors had reported it to the person’s GP, to check whether any further action was needed. On each occasion, the person suffered no ill effect from the missed dose and the GP instructed staff to administer subsequent doses as planned. Whilst action had been taken to ensure people were safe following these incidents, there had been no action to ensure staff had learned from the mistakes and the medicine management systems were suitable to meet people’s needs.

The management systems did not always identify the need to report certain incidents to CQC. Allegations of abuse had been reported to the safeguarding team at Wiltshire Council, but had not always been reported to us in a timely way. Once the provider became aware the allegations had not been reported to us, appropriate legal notifications were submitted. The provider had taken action to ensure all staff undertook additional training and knew their responsibilities to report incidents and allegations.

The registered manager and area manager acknowledged during the inspection that there were shortfalls in the management systems in the service. They reported this was being addressed through support for some senior staff to take on additional responsibilities, ensuring action could be taken if the registered manager was not at the service. The registered manager understood the improvements that were needed in the service and had worked with the area manager to develop plans to implement them.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for assistance. People told us they felt safe when receiving care and were involved in developing and reviewing their care plans.

There were sufficient staff available to provide the care people needed. Staff understood the needs of the people they were providing care for and had the knowledge and skills to meet their needs.

Staff received a thorough induction when they started working at the home. They demonstrated a good understanding of their role and responsibilities. Staff had completed training relevant to their role, which gave them the skills to meet their needs.

Staff were responsive to people’s needs and wishes. People had regular meetings to provide feedback about their care and there was an effective complaints procedure. People enjoyed the group social activities that were arranged.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.

A registered manager was in post when we inspected the service. 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 was present and approachable throughout our inspection.

Information around risks was not always available for staff to follow to ensure safe and effective care was given to people. This included appropriate assessments around behaviour that may challenge and pressure area care.

Infection control was not always managed appropriately to reduce the potential of risk. For example, two communal toilets were seen to be in an unclean condition. In addition the cleaning trolley was left unattended on two occasions with chemicals accessible to people.

People told us they felt safe living at Marden Court and were well looked after by kind staff who were available to help them. Comments included “I feel very safe. If I need anything at night they always arrive quickly”. Staff knew how to identify signs of abuse and their responsibilities in reporting and taking action around this.

We observed the mealtime experience for people which was unrushed and provided people with the appropriate support from staff that were available throughout. People told us they liked the food and were able to make choices about what they had to eat commenting “A good choice of food. A cooked meal every day” and “I have a bit of a job swallowing after being ill, I can’t manage hard food. The chef makes sure I have stuff I can eat”.

We saw that interactions between people and staff demonstrated person centred care was being given. People praised the staff describing them as kind, humorous and professional. Comments included “Staff are very caring, absolutely lovely”, “There is a very good atmosphere, you are not in the way but feel part of it”.

The recording in care plans and monitoring charts did not always detail the actions that staff had taken to support a person when a concern had been identified. For example, some people had been prescribed topical medicines. Administration charts were in place to record when these had been applied. However we saw that these were not being completed in line with what had been prescribed.

There was a mixed response to the activities provided. Some people spoke positively about the events on offer with comments including “Never bored, there are lots of things to do if you want them”. Some observations however showed that people were not always engaged in meaningful ways, however an additional new activity co-ordinator had been recruited.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home. However not all of the concerns we identified had been picked up by these quality monitoring systems and action taken to minimise the risks to people.

People and their relatives spoke positively about the registered manager’s leadership and told us she was available if they needed to see her. Comments included ‘The manager is very hands on, any problems get sorted” and “The manager is very good. She drops in and chats to me most days”. Staff also told us they felt supported by the registered manager who was approachable if they had any concerns to discuss.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

One person living at the home said 'staff are very good'.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were not cared for by staff who were fully supported to deliver care and treatment to an appropriate standard.

The provider did have an effective system in place to identify, assess and manage potential risks to the health, safety and welfare of people who use the service.