Marlborough Lodge

Marlborough Lodge provides accommodation and personal care for up to 18 people. The service provides support to adults who are over and under 65 years, people living with dementia and mental health conditions, people who have a physical disability and people with sensory impairment. At the time of our inspection there were 11 people living at the service.

Accommodation is provided in one adapted building over two floors. People had their own room and there was a communal lounge, a dining area and communal bathroom facilities. People could access a garden from the ground floor.

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

Medicines management had improved, and people had their medicines as prescribed. Staff had been trained on administering medicines and their competence was regularly checked. We have made 1 recommendation about receiving and acting on medicines’ safety alerts.

Risks to people’s safety were in place and reviewed by management or senior staff. However, some risk management plans did not consider all factors which affect risk. For example, falls risk assessments did not review what medicines people were prescribed which might affect mobility. We also found some risk management plans were generic and not personalised. The provider assured us they would review these areas and identify appropriate improvements.

Monitoring to mitigate risks had improved. People at risk of developing pressure ulcers had air mattresses in place and staff were checking these to make sure they were safe. Some monitoring records had been filled in prior to care being delivered. The provider assured us this was a recording error, and they would give staff further training.

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.

Staff had been recruited safely and there were enough staff available to respond to people’s needs. Staff had time to sit with people and did not appear rushed. People and relatives told us staff were kind and caring. Staff training had improved, and the induction process had been reviewed to make sure staff were well prepared for their work. Staff told us they were supported and felt able to share their views or raise concerns.

People and relatives told us the service was safe. Staff had been trained on safeguarding and all concerns had been shared with the local authority. Incidents and accidents were recorded, and management reviewed them to identify causes. Any learning was cascaded to staff in handovers, team meetings or supervisions.

People had choice of meals and were served hot food in a timely way. People and relatives told us the food was good and visitors were welcome to join people for a meal if they wished.

However, we found limited evidence of people being involved in their care and support. The provider told us it was not easy at times for people living with dementia to understand. We have made a recommendation about using different ways to involve people in their care planning.

People were referred to healthcare professionals in a timely way. Staff had a weekly visit from a healthcare professional to review health needs and staff could contact GPs easily. At the time of the inspection, nobody had any wounds needing care from community nurses.

There was a registered manager in post and we were told they were approachable. Quality monitoring systems were in place and helped to identify areas of improvement. The provider had a service improvement plan to log actions for improvements. There had been no complaints since the last inspection and no surveys had been carried out.

The provider had registered with the Information Commissioner’s Office (ICO) for using CCTV equipment in communal areas. The correct rating for the service was displayed at the service and on the provider’s website.

The home was clean, and staff used cleaning schedules to record all areas of the service were cleaned regularly. There was personal protective equipment available, and we observed staff using this in a safe way. Staff followed good infection prevention and control guidelines, for example, staff were not wearing inappropriate jewellery on their fingers.

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 3 May 2023) and there were breaches of regulation. Following the inspection, we served the provider a Warning Notice and we imposed a condition on their registration. This condition was for the provider to send Care Quality Commission (CQC) a monthly action plan and summary of injuries and safeguarding incidents. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 11 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We 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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Recommendations

We have made 2 recommendations about receiving and acting on medicines alerts and involving people with dementia in their care.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. The provider has a condition on their registration to submit a monthly action plan.

Marlborough Lodge provides accommodation and personal care for up to 18 people. The service provides support to adults who are over and under 65 years, people living with dementia and mental health conditions, people who have a physical disability and people with sensory impairment. At the time of our inspection there were 17 people living at the service.

Accommodation is provided in one adapted building over two floors. People had their own room and there was a communal lounge, a dining area and communal bathroom facilities. People could access a garden from the ground floor.

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

The provider failed to make sure risks were consistently identified and assessed. This meant the provider could not demonstrate management plans were in place to mitigate risks and keep people safe. Where risks had been identified, management plans lacked details and were not personalised. Monitoring evidence for the risks identified such as food and fluid monitoring did not demonstrate actions were being taken when needed.

The provider failed to ensure behaviour support plans were detailed and personalised. For example, plans we reviewed gave guidance for staff to ‘monitor’ or to ‘reassure’, but it was not clear what this meant and how it would support the person.

Incidents and accidents were not robustly reviewed. This meant the provider could not demonstrate action they had taken to prevent reoccurrence. Where action was recorded in response to risk, the provider could not provide evidence the action had been completed. This placed people at risk of avoidable harm.

The provider failed to ensure there was sufficient guidance for staff in relation to people’s health conditions. People had sustained unexplained injuries which were being treated by community nursing teams. However, there were no details in people’s care records about the wound or the treatment being provided. This meant staff did not have guidance about what to do if they were concerned about the injuries or dressings in between nurses visiting.

The provider failed to ensure medicines were managed safely. People prescribed ‘as required’ medicines did not always have a protocol in place. Medicines did not have dates recorded when they were opened which increased risks of staff using expired medicines. Staff were not recording required temperatures of all medicine’s storage.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider used CCTV in communal areas around the service. They were not able to provide us with evidence they were registered with the Information Commissioner’s Office. There was also no evidence in people’s records they had consented to being filmed.

The provider failed to ensure safeguarding incidents were consistently reported to the Local Authority Safeguarding Team. There was an additional failure to ensure notifiable events were reported to CQC through statutory notifications.

Staff were observed using unsafe moving and handling techniques during our inspection. This placed people at risk of avoidable harm. Training for moving and handling was not carried out by a person who had skills, knowledge and competence to instruct others. Staff had not received a comprehensive induction and had not been given training about how to evacuate the service in the event of an emergency. We observed staff treating people in a way that was not person-centred or responsive to their needs.

The provider failed to implement effective quality monitoring systems. Audits carried out had not identified concerns we found, and some did not cover areas of poor practice. This meant the provider was not identifying issues so they could make the necessary improvements. The provider carried out improvements when given feedback by CQC but should not rely on inspections for quality checks.

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 requires improvement (published 12 April 2022) and there were 2 breaches of regulation 12 and 17. 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 carried out an unannounced focused inspection of this service on 11 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and Well-led which contain those requirements.

We 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.

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. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marlborough Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, need for consent, staffing and good governance at this inspection.

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

Following our site visit we met with the provider to seek assurances about what action they were going to take following our visit. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

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 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.

About the service

Marlborough Lodge is a residential care home providing personal care for up to up to 18 people. The service provides support to people aged 65 and over, including those living with dementia. At the time of our inspection there were 18 people using the service. Accommodation is provided in one adapted building over two floors.

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

During this inspection, we found two breaches of regulations in relation to infection control and good governance.

The service was not always clean and the risk of infection was not always managed effectively.

Risks to people were not always recorded consistently. Medicines were administered safely however we saw that missing medicines had not always been investigated appropriately.

The service did not always follow best practice guidance or advice from other agencies. The service’s visiting policy was not in line with Government guidance and the service had taken admissions against advice of the local health protection team. There were quality assurance systems in place however these were not always effective.

People were cared for by staff who were recruited safely and were trained appropriately for their role. People’s relatives told us they were happy with the safety of the service.

Relatives and staff told us the service had a registered manager who was open and approachable and communicated clearly with people, staff, relatives and professionals.

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

Rating at last inspection

The last rating for this service was good (published 12 December 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to infection control and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

Marlborough Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate up to 18 people. Accommodation is provided in one adapted building over two floors. Not all the rooms have en-suite facilities, there are communal bathrooms and toilets available. There was a small garden area at the back of the property.

At our last inspection in August 2017 we found one breach of the Regulations because the environment was a risk to people’s safety. In addition, we were concerned about the way in which the service recorded people’s food and fluids. At this inspection we found the improvement to the environment had taken place and fluid charts were also recording totals of fluid consumed. However, we have found concerns in other areas and have made two recommendations.

There was a registered manager in post who was also the provider. 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 provider had also employed an additional home manager who was in the process of registering for this service. For the purposes of this report we will refer to them as the home manager.

People were not always able to have the help and support they needed, when they needed it because they had to wait for staff. This had an impact on mealtimes. Whilst people had sufficient food and drink, they did not have the support to eat at the time they needed it. People had to wait for staff to be available before they could have their meal.

Staff were not always trained and supported effectively. New staff received an induction but it was not robust and did not follow the industry standard. Staff did not have sufficient opportunity for supervision to enable them to feel supported.

The provider had adapted the conservatory to become an office which had removed a communal room. This meant people had less space to use to seek a quieter room or talk to relatives in private. The premises lacked orientation signage to help people move around the building.

The service overall was clean and well maintained. There were no unpleasant odours. Staff followed good infection prevention and control practice guidelines. The premises and equipment were maintained and serviced when required.

People’s needs were assessed and where needed referrals were made to visiting healthcare professionals. Records demonstrated that people had access to services such as GP’s, physiotherapists, speech and language therapists and community nurses.

People had the opportunity to record their wishes for end of life care, this information was in people’s care plans. Where the service had provided end of life care the staff had worked with healthcare professionals to make sure people were as comfortable as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were aware of the principles of the Mental Capacity Act (2005) and how they applied this to their day to day practice.

Medicines were managed safely. We observed staff administering medicines and found their practice to be safe. Medicines were stored safely and people had their medicines reviewed by their GP.

Accidents and incidents had been recorded in detail and action taken to minimise the risk of reoccurrence. All accidents and incidents had been reviewed by the registered manager to look for trends.

Risks had been identified and safety measures put in place to keep people safe from harm. All risk assessments were reviewed regularly. Care and support plans contained sufficient detail to support the staff to deliver personalised care.

Staff were recruited safely as the required pre-employment checks had been completed. Staff understood the different types of abuse and how to report any concerns.

Complaints were managed and records demonstrated the actions taken. Quality assurance systems were in place but were not robust.

Since the last inspection in September 2015 there has been a change to this service’s registration. Fidelity Healthcare Limited became the registered provider for this service and a new registered manager was in post. This was the service’s first rated inspection under the new provider, Fidelity Healthcare Limited.

We inspected Marlborough Lodge on 29 and 30 August 2017 and this inspection was unannounced. The registered manager was approachable and available throughout our 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.

During our inspection we noticed some environmental factors that could cause a potential risk to people’s safety. For example one person’s bedroom had no hot tap indicator on their sink. Some areas of the home were cluttered with furniture and equipment making them less user friendly for people. We saw that some exposed brickwork had left a metal mesh visible and sticking out which posed a risk to people if they walked too close and caught their leg or tried to touch it. The registered manager took action to address the concerns raised during and after the inspection.

Some areas of the home needed attention to maintain the cleanliness. For example some of the sinks in people’s rooms and toilets were not always clean and an odour of urine was detected in some areas. We saw that for 11 days in August 2017 there was no documented record that any cleaning had taken place. However we did see housekeeping staff around the home during our inspection and relatives told us they felt the home was kept clean.

Although quality assurance systems were in place to monitor the quality of service being delivered, the environmental factors that we found during this inspection had not been identified prior to this so that action could be taken to prevent a potential risk to people’s safety.

The provider had systems in place to manage risk and protect people from abuse. Staff were aware of their responsibilities and knew how to identify if people were at risk of abuse and what actions they needed to take to ensure people were protected.

Staff received an in-depth induction to the service and were supported to undertake training relevant to their roles. One staff commented “My induction was very good, I shadowed [more experienced staff] and they took me around the home.”

The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social care needs. The organisation of the care plans needed reviewing and the registered manager was looking to change the format to make it clearer. People’s care needs were regularly reviewed to ensure they received appropriate and safe care, particularly if their care needs changed.

Staff worked closely with health and social care professionals for guidance and support around people’s care needs. Health care professionals praised the working partnerships they had developed with the management and staff which enabled people to receive effective and responsive care to meet their needs.

Staff were attentive to people’s needs and people received care and support from staff who had got to know them well. People and their relatives praised the staff for the care and compassion shown commenting “The staff are all very nice and caring to me” and “The staff are lovely, I’m so lucky to have my relative there, I have been to other homes and we are lucky. She’s so happy there and always smiling.”

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.