Archived: Marsh House

Updated 20 November 2020

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.

We received information of concern about infection control and prevention measures at this service. This was a targeted inspection looking at the infection control and prevention measures the provider has in place.

This inspection took place on 10 November 2020 and was announced.

Updated 20 November 2020

Marsh House provides personal care for up to 33 older people. At the time of our inspection there were 27 people living there. The home is situated in a rural area close to the towns of Chorley and Leyland. There is a large dining room, communal areas, hairdressing room and conservatory area. A substantial, well-maintained garden is available at the rear of the home for people’s leisure. These areas are accessible to people who use a wheelchair and there is also a stair-lift in place.

There was no registered manager in place. 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. However, we saw evidence the manager at Marsh House was in the process of registering.

At the last inspection on 13 December 2016, we rated the service as requires improvement. This was because developments undertaken by the provider needed to be embedded to demonstrate consistent good practice over time.

We additionally made recommendations for the provider to update their recruitment practices and to ensure staff received end of life care training. We further recommended the provider adapted the home's environment to support the independence of people who lived with dementia.

Marsh 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, both of which we looked at during this inspection.

During this inspection, we found the provider had sustained improvements following our last inspection. One staff member said, “Since [the new manager’s] taken over it’s been a different home. She’s behind me and I’m flying.” They had additionally taken action to meet the recommendation we made about safer recruitment practices. The management team assessed gaps in employment history to ensure candidates were suitable to work with vulnerable adults.

Furthermore, the provider had developed the environment to enhance the experiences of people who lived with dementia. Bedroom doors had photographs of people from important life events, such as a picture of an individual when they worked in a public house.

Additionally, the manager had clearly documented people’s end of life care planning and related preferences. When we discussed end of life care with staff we found they had a good understanding of relevant principles.

However, care records we looked at contained limited information about the management of risks to people from unsafe or inappropriate support. Assessments to mitigate risks, such as malnutrition and medication administration, were not always completed or in place.

We have made a recommendation about improving risk assessment to protect people from unsafe or inappropriate care.

People we spoke with told us they felt safe and comfortable at the home. Staff had safeguarding training to enhance their skills to protect people from potential abuse, inappropriate support or poor care.

We reviewed rotas and found staffing levels and skill mixes were sufficient to help people with a timely approach. The manager checked staff learning with competency testing and question sessions, which covered multiple areas including personal care, infection control and the MCA.

We noted staff gave people their medicines with a safe and patient approach. All the staff who administered medication received training and competency testing to underpin their skill and knowledge. One person said, “The staff are very effective, good with your medication.”

Staff promoted lunch as a sociable occasion and ensured a welcoming atmosphere during mealtimes. They documented people’s preferences and special diets, whilst frequently checking their weights and monitoring their health against any potential concerns.

During our inspection, we saw staff continuously asked people’s permission before they undertook any tasks. Staff had training and understood the principles of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS).

When we discussed the principles of good care, staff demonstrated a good level of awareness. This was enhanced by clear involvement of people and their relatives in their care planning. One person who lived at Marsh House told us, “Very nice staff. Yes, they’re kind and compassionate.”

The manager and staff worked hard to understand people’s backgrounds, preferences to care and how they liked to be supported. Care records we reviewed included their life histories to help employees gain a better awareness of each person.

People and staff said they felt the management team was visible about the home and the new manager was experienced and had good leadership skills. We saw records demonstrated action had been taken when the provider’s wide-ranging quality assurance systems identified issues.