Mariners Park Care Home

Mariners Park Care Home is a residential care home providing personal and nursing care to people, some of whom were living with dementia. At the time of inspection, there were 36 people living in the home. The home is part of a range of services provided by Nautilus Welfare Fund to former seafarers and their families.

People’s experience of using this service and what we found

Systems in place to monitor the quality and safety of the service were not fully effective in identifying areas of the service that required improvement or ensuring conditions of registration were adhered to. The service had not addressed all the issues raised at the last inspection.

Whilst care plans had been improved, further work was needed to these as they contained conflicting information regarding people’s needs and the support they required. Records did not show that care was always delivered as planned, such as repositioning support. We found the systems in place to manage people’s medicines were unsafe and risks to people were not always assessed and managed robustly, which placed them at risk of harm.

People were supported by trained staff who had been safely recruited. There were sufficient staff available to provide support to people when they needed it. Systems were in place to help minimise the spread of infections within the home.

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. People’s consent was sought in line with the principles of the Mental Capacity Act 2005.

Records showed that people’s nutritional needs and preferences were assessed, and kitchen staff had access to this information. People told us they enjoyed the meals available; they had plenty to eat and drink and there was always a choice of meal.

Feedback regarding the care and support people received was positive. People told us they were well cared for, and that staff were kind, caring and worked in ways that protected their privacy. Staff encouraged people’s independence where possible and systems in place supported people to be involved in decisions regarding their care. Support provided to people at the end of their lives was praised by relatives.

A range of activities were available, and people were supported to maintain relationships that were important to them.

People and their relatives told us the home was well managed and they could raise any complaints or concerns they had with the knowledge they would be listened to, and action would be taken to address the issues.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 June 2019). The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

At the last inspection the provider was found to be in breach of regulations. They completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that some improvements had been made, but further improvements were still required, and the provider remained in breach of some regulations.

Why we inspected

This inspection was prompted out by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to the management of medicines, risk management, accurate record keeping and the governance of the service at this inspection. Since the last inspection we recognised that the provider had failed to adhere to a condition of their registration. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mariners Park Care Home is a home providing accommodation and personal care for up to 32 people including people living with dementia. At the time of our inspection, there were 29 people living at the service.

We found the following examples of good practice.

People living in the home and their relatives were supported to maintain contact. There was visiting arrangements in place so relatives could see their loved ones regularly reducing the risk of infection to visitors and people living at the home.

The registered manager was aware of their responsibilities and managed the COVID-19 outbreak with support from relevant partner agencies.

The registered manager had identified, assessed and mitigated COVID-19 related risks to people, staff and visitors.

There was a programme of regular COVID-19 testing for both people living in the home, staff, essential carers and visitors to the home. Screening procedures included temperature checks and a negative lateral flow test.

Regular infection control audits were completed and the provider and manager had oversight of infection prevention and control processes.

Staff used personal protective equipment (PPE) and followed guidance and practices. There was abundant PPE available to staff.

People’s experience of using this service:

The systems and processes in place to monitor the quality and safety of the service were not always effective in identifying and driving up improvements. This meant that the service was not always well led.

The culture of the service was not always open and transparent. At times during the inspection the manager was defensive and dismissive which made it difficult to discuss the concerns we identified during the inspection and the improvements that needed to be made.

Medication management did not adhere to best practice guidelines published by the National Institute of Social Care (NICE) with regards to the storage, administration or management of medicines. This meant it was not safe.

Where people’s capacity to consent to their care was in question, the Mental Capacity Act 2005 (MCA) was not always followed to protect their human rights.

Some care plans contained sufficient information on people’s needs and risks but others did not. Dementia care planning was poor and there was little evidence that people’s end of life wishes were discussed with them and properly planned for.

Risks in relation people’s care were not always adequately minimised in the delivery of care. For example, support to help people change position to relieve pressure on their skin was not always provided at the required frequency. The provider’s fire evacuation procedure was also unclear as it did not ensure everyone living in the home had a suitable means of escape.

People told us that the home could do with more staff on duty. Some said their needs were not always met in a timely manner because of this. This indicated that staffing levels required improvement.

Staff recruitment was overall satisfactory. Pre-employment checks were undertaken to ensure staff were suitable to work with vulnerable people but their application forms were not always fully completed. This aspect of recruitment required improvement.

Staff had access to a range of training to support them to be effective in their job role. They received adequate supervision and told us they felt supported by the manager in their day to day duties.

People received enough to eat and drink and told us their nutritional preferences were respected. Where professional dietary advice was given, this had been followed but one person had requested a small change to their diet which had not been acted upon.

People told us that staff were kind, caring and patient and our observations confirmed this. People told us that they felt staff knew them well. They said they felt safe at the home and had a choice in how they lived their lives.

A range of activities were offered to meet people’s social and recreational needs. People told us that there was plenty to join in with if they wanted. Regular meetings took place with people living in the home and staff to ensure that their views and opinions with regards to the service were sought.

People’s needs were met by a range of health and social care professionals. People told us that staff were quick to get the doctor if they became unwell.

Rating at last inspection and why we inspected: At the last inspection the rating of the service was good. At this inspection the rating has not been maintained. At this inspection, the service has been rated 'Requires Improvement'.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see full report which is on the CQC website at www.cqc.org.uk

At the time of the inspection, the home had a manager who was registered with the Care Quality Commission. 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.

The manager and staff had knowledge of the Mental Capacity Act (2015), and Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately. People were supported to make everyday choices within their capacity to do so.

Staff we spoke with had a good understanding and knowledge of people`s individual care needs. We observed that people were treated with dignity and respect and support was provided in a kind and caring manner. Family members and friends visited during the day with no restrictions.

The home was purpose built and provided a spacious, comfortable and safe environment. All parts of the premises were clean and tidy. People’s medicines were managed safely.

We observed that there were enough staff on duty and people did not have to wait for staff to attend to them. The rotas we looked at confirmed that these staffing levels were maintained by some use of agency staff. People had a choice of meals and received the support they needed to eat and drink.

The home employed a social activities organiser and a dementia support worker who provided support for people both in the home and in the community.

Care records we looked at showed that people's care and support needs were assessed before they moved into the home. Plans were in place for meeting people’s needs and managing risks. These were reviewed regularly.

We saw evidence of regular staff meetings and meetings for people who lived at the home and their families. People were also invited to give their views in an annual satisfaction survey. A series of quality monitoring audits was carried out.

As part of this inspection we spoke with two people who lived at the home, one relative, the registered manager, the deputy manager, one member of the care team and a member of the nursing team. We also reviewed records relating to the management of the home which included three care records, daily written records, three staff files, training records, audit and complaint records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. The home had recently undergone a refurbishment and offered a pleasant, homely environment for people to live in.

During our inspection of the home in October 2013 we found that people's care records did not contain clear or sufficient information on people's needs, risks or care. Records associated with people's care were also not stored securely to protect people's confidential information. We asked the provider to make improvements in the way in which care was planned and delivered and the recording and safe storage of people's information. At this inspection, we found that improvements had been made.

Records showed that people's needs and care were now appropriately risk assessed and care plans regularly reviewed to ensure they remained effective and safe. Care plans were person centred and gave clear guidance to staff on how to care for people. Where people's needs had changed, care plans had been kept up to date so that the care provided continued to meet their needs. Daily written records showed that people had received the care outlined in their care plans and that prompt access to medical support was organised in the event of people's ill health.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. People we spoke with said 'I'm very well looked after. From the very first day, it's been very accommodating' and 'All (staff) that I've met are pretty good'. The relative we spoke with said staff looked after their relative very well. They said 'It's great. The staff are great' and they 'Always have time for a chat about them'.

During our inspection of the home in October 2013, we found that training and support for some staff was not adequate. We asked the provider to make improvements to the support and training arrangements in place for staff. At this inspection, we found that improvements had been made.

Staff told us they now received regular support and training to enable them to provide care and treatment safely and to an appropriate standard. Staff we spoke with said the management of the home had improved and that the manager and the deputy manager were approachable and supportive.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and supported people at their own pace. People told us they were treated with dignity and respect and that staff were nice. People said 'It's the best that can be expected" and 'I'm very satisfied'.

Relatives we spoke with said they felt involved in people's care and that staff kept them fully informed. Comments included '. They came and assessed them. We can talk to all of them without exception. All compassionate and understood our needs as a family'.

People were given appropriate information in relation to their care and regular opportunities to express what was important them in terms of their life at the home. This showed us that the home valued people's views and opinions in the delivery of their care.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

The service worked well with other healthcare professionals to ensure that people received the health and social care support they required. For example, we saw evidence that GPs, dieticians, chiropodists, physiotherapists, district nurse, and dentists were all involved in people's care and that their professional advice was followed by the home.

Is the service well-led?

People we spoke with said the service was well managed. One person said 'It's very well run'. They told us the manager and staff were approachable and easy to talk to. They said if they had any concerns they would feel comfortable talking to them. We saw that an easy to understand complaint procedure was in place and any complaints received had been appropriately investigated and responded to.

People's and/ or relative feedback on the quality of the service provided was regularly sought through quarterly residents/relatives meetings and an annual satisfaction questionnaire. Records confirmed that people's views and suggestions had been taken on board where possible.

The provider conducted a range of monthly checks on the quality and safety of the service which included care plans, environmental and infection control audits. Where improvements were required these had been acted upon.

We found that the service was well led. Staff had a good understanding of the ethos of the home and were positive about working for the provider.

We checked the provider's progress at this visit and found that sufficient improvements had been made.

We saw that one safeguarding incident has been reported since our last visit. Records showed an appropriate investigation was conducted and the appropriate authorities notified. This indicated that there were now suitable arrangements in place respond appropriately to allegations of abuse.

We reviewed the administration of medication and found that medicines were now stored securely and safely administered. Staff administering medication had received refresher training and their competency was checked. This meant there were checks in place to ensure staff had the skills and knowledge to safely administer medication.

The provider had developed a staffing tool that enabled them to assess safe staffing levels based on the needs of the people who lived at the home. Staffing levels had been increased and new staff were appointed. We observed that the number of staff on duty on the day of our visit was sufficient.

A system was in place that enabled the quality of care plans, medication administration, staffing levels, accidents and incidents and the environment to be regularly monitored. This meant effective systems were in place to identify and manage the risks to people's health, safety and welfare.

People and/or relatives at the home had received a satisfaction survey that checked they were satisfied with the service provided. We reviewed the survey results and saw that people's feedback was positive.

We saw people's needs were assessed and care planned. There was however a lack of accurate information about peoples needs and we saw that the planning and delivery of care did not ensure people's welfare and safety needs were fully met.

During our visit the manager told us about a number of safeguarding allegations. We found the provider had not followed local safeguarding protocols to respond appropriately to the allegations of abuse and had failed to safeguard people from further risk.

We examined the arrangements in place for the administration of medication. We found that medication was not stored, administered or managed appropriately.

We reviewed three staff records. We saw the necessary checks to ensure staff were suitable to work with vulnerable people had been undertaken but there was inconsistent evidence of appropriate staff support and training. We looked at staffing levels at the home due to concerns raised during our visit. We found the number of staff on duty was insufficient to meet people's needs.

We reviewed the provider's quality monitoring systems. We found there were no systems in place to monitor the quality of the service, the risks in the delivery of care or people's views on the service provided.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.