The inspection took place on the 18 and 19 January 2017 and was unannounced. At the last inspection on 2, 3 and 7 September 2015 we found the provider had breached two regulations associated with Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014). These breaches related to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). The provider had not always ensured people’s medicines were managed safely and that complete and contemporaneous records were maintained in respect of each service user to ensure risks to their health and wellbeing were managed appropriately. We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulation. At this inspection we reviewed whether or not these actions had now been taken and found the provider was meeting the requirements of the HSCA 2014. We found improvements had been made regarding the storage and administration of medicines and the completion of documentation relating to the delivery of people’s care.
Marnel Lodge Care Home, to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 62 older people who have a range of needs, including those living with Parkinson’s disease, sensory impairments as well as epilepsy and diabetes. The first floor of the home provides specialist care to people living with dementia. The home is purpose built to meet people’s needs and is situated in a residential area on the outskirts of the town of Basingstoke. Facilities includes two dining rooms and two lounges on both floors with a secure rear garden and patio area as well as a café area for people, visitors and relatives on the ground floor of the home. At the time of the inspection 58 people were using the service.
The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People using the service told us they felt safe, relatives agreed they felt their family members were kept safe whilst living at the home. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.
People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. Appropriate risk assessments were in place to keep people safe.
Overall, sufficient numbers of staff were deployed in order to meet people’s needs in a timely fashion. The registered manager was addressing unplanned staff absence, which at times had caused a staff shortage. Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence required to support people safely.
People were protected from the unsafe administration of medicines. Nurses were responsible for administering medicines and had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Nurse’s skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.
People were supported by staff who had relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.
People, where possible, were supported by staff to make their own decisions about their care and treatment. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed an understanding of what constituted a deprivation of person’s liberty. People had been appropriately assessed as to whether they could consent to living at the home prior to applications being submitted. Authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted.
People were supported to eat and drink enough to maintain a balanced diet. We saw meals were prepared to meet people’s individual nutritional and hydration requirements. Staff followed guidance in people’s care plans to ensure they received a meal which met their needs. Alternatives were offered and prepared when people did not wish to eat one of the two main meals on offer and people were encouraged to eat and drink sufficiently to maintain their health and wellbeing.
People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.
Staff had taken time to develop close relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These were practically demonstrated by the registered manager and staff during their regular and comfortable interactions with people.
People received personalised and respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised care plans. Care plans contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. People were encouraged and supported by staff to make choices about their care including how they spent their day within the home.
Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. Relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager. People and relatives were also asked to complete an annual quality assurance questionnaire to provide their views on the quality of the care and support provided.
People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. A range of activities were available to people to enrich their daily lives. Staff were motivated to ensure that people were able to participate in a wide range of activities and encouraged them to participate where possible.
People living with dementia benefited from an environment that was adapted to meet their needs. A programme aimed at improving the care that people living with dementia experienced was underway at the time of our inspection. This included a comprehensive staff training programme to ensure all staff had the knowledge and skills to provide responsive and effective care for people living with dementia.
The registered manager ensured staff were involved in creating the values for the home, which included writing a ‘Philosophy of Care’ for both floors. These detailed the way in which care would be delivered to people and were openly displayed in communal areas of the home. Staff understood these and we saw these standards were evidences in the way care was delivered.
The registered manager fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events happened. This allowed the CQC to monitor that appropriate action was taken to keep people safe.
Relatives told us the registered manager was competent in the efficient running of the home and staff confirmed they felt supported in their roles. The registered manager provided strong positive leadership and promoted the providers values.
Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided. The provider routinely and regularly monitored the quality of the service being provided in order to drive continuous improvement.