Marlfield Care Home With Nursing

Updated 2 March 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 7 February 2022 and was announced. We gave the service one hour’s notice of the inspection.

Updated 2 March 2022

We undertook an unannounced inspection of Marlfield Care Home with Nursing on 12 and 13 December 2017. When the service was last inspected in October 2016, one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. This related to failings in the safe management of medicines. The provider wrote to us in December 2016 and told us how they would achieve compliance with the regulation. During this inspection we found some improvements had been made, but some areas of practice required further improvement.

Marlfield Care Home with Nursing 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. The service is able to accommodate up to 74 people. At the time of the inspection there were 70 people living at the service.

There was a registered manager in post at the time of this inspection. 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.

Although we found improvements in medicines management since our last inspection, further improvements were required. During the inspection we found that where people had PRN (as required) medicines, for example paracetamol, guidance around when and why to administer these medicines could be improved. In addition to this, we found within one care record a person had fallen and no update to the person’s care records or risk management guidance had been completed in their care plans.

People were positive about the care they received and spoke highly of the staff that supported them. People’s relatives also commented positively on how safe they perceived the service. Staff understood local safeguarding procedures and how to escalate complaints both internally and externally. People’s risks were assessed and managed, and staff understood and applied risk management measures. Staffing levels met people’s needs and recruitment was safe. The equipment and environment was subject to servicing and testing. Infection control guidance was followed and the service was clean.

People received effective care with the use of nationally recognised tools and guidance. People and their relatives spoke positively about care provision. Staff understood the protected characteristics of the Equality Act 2010 and told us how they applied it to their work. Staff received induction, ongoing training, supervision and appraisal. Clinical staff received support in their development and training. People were supported with their nutritional and hydration needs. People had access to healthcare professionals to meet their ongoing health needs.

People were supported by the adaptation and design of the service. Staff were following the principles of the Mental Capacity Act 2005, however we found practice in relation to decision specific capacity assessments and best interest processes required improvement. We have made a recommendation to the provider about this. The service had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005.

People told us staff were caring and supported them in a kind and compassionate way. We made observations to support this. People’s relatives were mostly positive about the care provided in the service and were complimentary about staff. We reviewed a selection of compliment cards sent to the service that reflected the verbal feedback we received from people and their families. People told us that staff treated them with dignity and respect and gave examples of how staff achieved this. People’s visitors were welcomed at the service which reduced the risk of social isolation.

People and their relatives said the care they received met their needs and that staff at the service were responsive. People felt involved in decisions about their care. Relatives told us they felt involved in care decisions. Care records were personalised and reflected people’s physical, emotional and communication needs. We made observations that care was being delivered in line with people’s assessed needs and preferences. The service provided activities over seven days. This comprised of both internal and external activity provision. During the inspection people were involved in festive activities and were supported well by staff. There was a complaints system in operation which people and their relatives felt they could use. People were supported at the end of their life to have a comfortable, dignified and pain-free death in accordance with their wishes.

Staff we spoke with felt valued and supported and commented positively on the proactivity and visibility of the registered manager. People and their relatives were positive about the service management and were happy to approach senior staff if required. There were governance systems to monitor the health, safety and welfare of people. The service received provider level support in monitoring the effectiveness of internal governance systems. There were systems to communicate with staff. There were systems to continually learn and improve and the service worked from a quality improvement plan based on feedback from the provider audits and external agencies.