Background to this inspection
Updated
20 December 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by one inspector and an Expert by Experience.
An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by experience made telephone calls to people’s friends and relatives.
Service and service type
Marlyn House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was not a registered manager in post. A new manager was in post who had started working at the home recently. They had not yet applied to register with us.
Notice of inspection
The inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since our last inspection. We also gathered feedback from the local authority.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
During our inspection we spoke with the provider, the manager and three care staff. We spoke with four people living in the home. We also spoke with eight friends or relatives on the telephone. We looked at the care records for ten people. We checked that the care they received matched the information in their records. We looked at records relating to the management of the service, including audits carried out within the home.
After the inspection.
We continue to review the information we held about the service.
Updated
20 December 2023
About the service
Marlyn House is a care home providing personal care to 18 people at the time of the inspection. The home is registered for up to 18 people. People have access to their own bedroom along with communal spaces including lounges and gardens.
People's experience of using this service and what we found
People did not always receive safe care, as care plans and risk assessments were not always in place. When events or incidents had occurred, these were not always documented, and it was unclear what action had been taken. There was no evidence lessons were learnt when things went wrong. Infection control procedures were not always followed to ensure the spread of infection was reduced. There were safeguarding procedures in place however these were not always followed to ensure people were protected from potential harm.
The systems in place were not effective in identifying areas of improvement and often there were no audits in place or inconsistently completed. Documentation was not always available or stored where the manager or provider thought it was. Key information had also not always been documented. For example, when the someone had fallen. We were not always notified of events that had happened at the service.
We received mixed views on staffing, there was a dependency tool in place that worked out the staff levels for the home.
Improvements had been made to how medicines were managed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where needed capacity assessments and best interest decisions were in place.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (Published 2 March 2020) and there were breaches of regulations.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
We received concerns in relation to infection control, safety and medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marlyn House on our website at www.cqc.org.uk.
During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to regulation 12, Safe care and treatment, regulation 13, safeguarding service users from abuse and improper treatment and regulation 17, Good governance.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information, we may inspect sooner.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.
This will usually lead to cancellation of their registration or to varying the conditions of the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.