Marshview

Marshview is a residential care home providing personal care to 13 older people in one adapted building. The service can support up to 23 people who were living with a range of needs associated with the frailties of old age.

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

We found improvements were needed to people’s care plans and the providers quality assurance system. The audit system had not identified the shortfalls we found in relation to people’s records. We made a recommendation about this.

People received care and support that was person-centred and met their individual needs. This was because staff knew them well. People were supported to engage in a range of activities that they enjoyed and were meaningful to them.

People were supported to receive safe care. Staff understood the risks associated with the people they supported, and they did this safely. People were supported to receive their medicines when they needed them.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions they should take if they identified concerns. There were enough staff working to provide the support people needed, at times of their choice.

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 received training and supervision to help them meet the needs of people living at the home. Staff told us they felt supported by the registered manager and their colleagues.

People were supported to receive healthcare services when they needed them. People were provided with a wide choice of healthy, freshly cooked meals, drinks and snacks each day.

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 21 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have identified improvements were needed in relation to record keeping and the quality assurance system at this inspection.

Follow up

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

Marshview is a residential care home located in the village of Hailsham, East Sussex providing care and support for up to 17 older people. The service supported the needs of people living with dementia and related conditions, sensory needs and diabetes. The building has 11 single bedrooms and three shared bedrooms. Marshview has a ground floor and first floor which can be reached by stairs or a chair lift. Car parking is available at the front of the building. At the time of the inspection there were 14 people living at the service.

There was a registered manager that had oversight of the whole service. 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.

Medicines were managed safely. Processes were in place which ensured that people received their medicines on time and ‘as required.’ People received care and support from staff that knew them well, and had the knowledge and skills to meet people’s individual care needs. People told us staff were kind and caring. People and their relatives spoke positively about staff, their comments included, “I like living here, staff are very helpful” and “It's a very well run home with very caring staff”.

There were policies and procedures in place that informed staff of how to keep people safe and these were followed. Staff were trained in safeguarding adults and understood how to recognise and report any signs of abuse.

The service had safe recruitment practices in place. Staff underwent the necessary checks which determined they were suitable to work with adults at risk before they started their employment. There were enough staff to meet the needs of people living at the service. In a recent resident survey, people reported that they had received all their personal care in a timely manner.

Staff received regular training to ensure they remained up to date with their knowledge and skills required for their role. Staff were supported through regular supervisions and team meetings.

People told us that staff always treated them with kindness and respect. They told us that staff were mindful of their privacy and dignity and encouraged them to be as independent as possible.

People's risks were anticipated, identified and monitored. Individual risk assessments were completed to ensure people and staff were protected from risk of harm. Risks were reviewed regularly to identify any changes to the person. Staff managed risk effectively and supported people's decisions, so they had as much control and independence as possible.

Care plans provided staff with clear direction and guidance as to how to meet people's preferred needs. Relatives spoke positively about the care and support that had been delivered. Comments included, "My dad is looking so much better. His hair has been cut, his nails are now clean and his personal care needs have been addressed. All this in such a short time. I'm so pleased and relieved".

People had enough to eat and drink. People were offered drinks and snacks throughout the day. People who had been identified as at risk of weight loss or weight gain were weighed regularly. One person was managing their diabetes through diet and records clearly showed their food and fluid intake. This ensured people's health and well-being was closely monitored and any changes were responded too.

Daily records were completed and reflected on each area of the care plan. Records completed by staff included references to medication, activities, sleep pattern, as well as other specific information relevant to the individual person.

People knew how to raise concerns and make complaints. People and their relatives confirmed they were confident that any concerns or complaints would be dealt with promptly and to their satisfaction.

There were quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The registered manager was visible within the service and regularly visited people to seek their views about the service.

The registered provider undertook regular audits at the service. Analysis was used to identify areas for development.

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. We spoke with five people who lived at the home, one relative and four members of staff, including the registered manager. We also spoke with a community nurse who was visiting the home.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found

Is the service safe?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us "It's a real comfort to know that mum is safe and well cared for."

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them, and, as far as practicable, they were involved in developing and reviewing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives said that they had been involved in reviewing care plans and they reflected their current needs.

People's needs were taken into account with the accessible layout of the service, enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

The home had systems in place to assess and manage risks and to provide safe and effective care. The staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with conditions such as dementia and Parkinson's disease. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person using the service told us, "Everyone here is so kind and helpful ' I'm very satisfied."

We spoke with relatives who said they were able to visit at any time and they were always made to feel very welcome. They told us 'Whenever I visit there are always staff around and they are kind, friendly and provide good quality care.' We saw that the staff took time with people over lunch and when they were moving about within the home. We observed high levels of respect and people were treated sensitively with consideration and dignity.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to take part in a range of activities, reflecting their interests and preferences, both in and outside the service.. The home had access to an adapted minibus, which helped to keep people involved with their local community. A care worker told us "We spend time with people and get to know them individually, so we can find out what their interests are and how they like to spend their day."

People's needs were assessed before they moved into the home and detailed care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people's individual care needs. We saw that the staff monitored weight, nutrition and hydration and handover sessions were helpful and informative. Call bells were answered according to the home's procedure and people had access to a programme of activities.

We were told by the manager that the service had good systems in place to monitor its own standards of service delivery and to gain feedback from people using the service, their relatives and other stakeholders. As well as satisfaction questionnaires, the manager told us they operated an 'open door policy' so people who used the service and visitors to the home could discuss any issues they may have.

People told us they were asked for their feedback on the service and their feedback was heard and changes were made as a result. People and their relatives, who we spoke with, also knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up and consistent way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Care workers told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in. They also told us that they felt valued and supported by the manager and were happy and confident in their individual roles.

We spoke to five people who used the service in depth, two relatives, a visiting health care professional and the three care staff that were on duty. This included the home manager. We spent time with people using the service and observed interaction they had with each other and the staff.

We saw staff asked for people's consent before they provided any care or treatment. People told us they were asked for their consent before any care and support was provided. One person told us, 'I have reviewed my care plan with my keyworker and agreed to the planned care provided.'

People told us that they were treated with kindness and respect. One person said, ''I am very happy here they look after me very well indeed.'

The home was clean and hygienic with systems in place to prevent cross infection. There were enough qualified, skilled and experienced staff to meet people's needs.

We saw that complaints were taken seriously and there was an effective complaints system available. These processes ensured complaints raised were resolved to people's satisfaction with information used to change practice.