Archived: Marlborough Court

Marlborough Court is a care home providing personal and nursing care to people aged 65 and over at the time of the inspection. The care home can support and accommodate up to 78 people across three separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia. At the time of the inspection there were 41 people using the service.

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

Risks to people were managed effectively to reduce harm to them. Management plans provided guidance to staff to reduce risks to people. People were safeguarded from the risk of abuse. Staff had received safeguarding training and knew the actions to take to report abuse.

Incidents and accidents were reported, and the registered manager reviewed, analysed and took actions to ensure learning from them. People’s medicines were administered and managed safely. Staff received support from staff when they needed it as there were enough staff available to support them. Staff were trained in infection control and followed procedures to reduce risks of infection.

People’s needs were assessed in line with best practice guidance and covered a range of people’s needs. People were supported to eat balanced diet and drink enough to keep hydrated. Staff had an induction when they started their jobs; and they were supported through regular training and supervision to deliver their roles effectively. People had access to healthcare services they needed to maintain good health; and staff liaised effectively with other services.

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. People’s consent was sought for the care and support they received.

The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

People told us staff were kind and compassionate to them. People were treated with respect and dignity. People received care and support that met their individual needs. Care plans were up to date and reflected people’s needs. People’s end-of-life wishes were documented in their care plans and followed. People were engaged in activities to occupy them.

People and their relatives knew how to raise complaints about the service. The registered manager responded to complaints appropriately in line with the provider’s procedure. The provider worked in partnership with other organisations and services to develop and improve the service. The service had effective systems to monitor the quality and safety of the service.

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 (published14 November 2020). The service was put under Special Measures.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. 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.

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

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.

There were appropriate infection prevention and control measures in place. At the time of this inspection, visitors including relatives were not being admitted into the home unless those with exceptional circumstances such as people receiving end of life care. The provider had procedures in place to ensure people could receive visitors safely. All visitors were required to complete a coronavirus test and were only allowed into the home with a negative test result. A pre-booked visiting system was in place and at a designated visiting area. Visitors were required to undertake a temperature check, wear appropriate personal protective equipment such as a face covering and complete a Covid-19 declaration form.

There was sufficient stock of personal protective equipment (PPE) including, masks , gloves, aprons, face shields and hand sanitisers for disinfecting. We observed all staff had suitable PPE on and a staff member showed us how they don and doff (put on and take off) their PPE. Two staff told us they felt safe working at the service.

The home appeared clean and furniture was spaced-out to promote and maintain social distancing rules.

The service had arrangements in place to test people and staff for coronavirus in line with current government guidance on testing.

Where people had tested positive for Covid-19 or had recently returned from hospital, they were supported to isolate in their room or on an isolation unit and were regularly monitored for 14 days to minimise the spread of infection.

Staff had completed infection prevention and control training and coronavirus training which

included donning and doffing and the safe disposal of PPE.

Marlborough Court is a care home providing personal and nursing care to 69 people aged 65 and over at the time of the inspection. The care home can support and accommodate up to 78 people across three separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

People were at risk of avoidable harm. Staffing levels were not sufficient to ensure people received safe care and support. Action was not taken to ensure learning from incidents and accidents and when things go wrong.

Staff were not kind and compassionate towards people and did not treat people with respect and dignity. Staff did not always communicate and involve people and their relatives in their day-to-day care and support.

The service was not well-led. The culture of the service did not promote safe care and positive outcomes for people. The registered manager and provider had not taken adequate steps to address concerns relating to poor care, staff conduct and practice. The registered manager did not check the quality of care and risk management plans to ensure they achieved positive outcomes for people.

People’s relatives told us they did not receive updates about the service. They had not been given avenues to feedback about or be involved in the running of the service. Relatives complained the registered manager was not accessible and did not maintain communication with them.

Systems and processes in place did not effectively safeguard people from abuse.

People’s medicines were administered and managed safely. There were systems in place to control the risks of infection and staff followed this.

The registered manager notified reportable incidents and events as required by their registration.

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

Rating at last inspection and update

The last rating for this service was Good (published 10 January 2018).

Why we inspected

We received concerns in relation to neglect and poor care and the management of people’s risk of falls. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this 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 coronavirus and other infection outbreaks effectively. The provider was following infection control procedures to prevent and manage the risk of infection and coronavirus.

We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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 We will continue to monitor the service and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, staffing levels, dignity in care 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

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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.

Marlborough Court provides care for up to 78 older people requiring residential or nursing care, some of whom may be living with dementia. The service is provided over three floors. Thames unit on the ground floor provides nursing care for 21 people, the Union Jack unit on the first floor provides residential care for 28 people who live with dementia and King George unit on the top floor provides residential care for 29 people. At the time of this inspection the home was providing care and support to 66 people.

Marlborough Court did not have a registered manager in post. The registered manager had resigned their post just prior to the 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. The deputy manager was in day to day charge of the home and was being supported by senior managers. The regional manager told us they were in the process of recruiting a new manager to run the home.

There were safeguarding procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure in place and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. There were enough staff on duty to meet people’s needs. Risks to people had been assessed and reviewed regularly to ensure their needs were safely met. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals. The home was clean, free from odours and was appropriately maintained.

The deputy manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work, they had received regular supervision and training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.

People’s privacy was respected. People and their relatives, where appropriate, had been consulted about their care and support needs. People received appropriate end of life care and support when required. Care plans and risk assessments provided guidance for staff on how to support people with their needs. There was a range of appropriate activities available for people to enjoy. People knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

There were appropriate arrangements in place for monitoring the quality and safety of the service that people received. The provider took into account the views of people and their relatives and visiting professionals through surveys. The results were analysed and action was taken to make improvements for people living at the home. Staff said they enjoyed working at the home and they received good support from the deputy manager and senior managers.

At our previous inspection on 26, 27 and 28 April 2016 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that action had not always been taken to support people where risks to them had been identified. Staff did not assess risks to people using the service in a timely way following a fall. Staff were not updating some people's care plans to reflect their current or changing needs. Staff had not received the appropriate support, training and supervision to enable them to carry out their duties. Untrained staff were administering medicines to people using the service. Some staff were not aware of their responsibility to report abuse. Staff were not always aware of people's care needs. People using the service were not always treated in a dignified manner. The provider's systems for monitoring the quality of the service provided to people were not operating effectively as we found some issues with care plans and risk assessments that the provider had not identified.

Following that inspection we imposed urgent conditions on the provider’s registration at the home. We told the provider to not admit any new people to the home without the prior written agreement of the Care Quality Commission. We told the provider to undertake audits of the training and supervision provided to all staff working at the home. We asked the provider to send CQC a report of the result of these audits and any action taken or to be taken as a result of the audit. We also placed the home in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

The provider had not admitted any new people to the home since the last inspection. They sent us reports from the result of the audits they carried out. They also sent us regular weekly updates regarding the training and supervision of all staff working at the home. As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five key questions, it is no longer in special measures. We have removed the urgent conditions from the providers registration at the home as the Commission no longer feels they are necessary.

At this inspection we found that risks to people using the service were assessed, reviewed and managed appropriately. People’s medicines were managed appropriately and they were receiving their medicines as prescribed by health care professionals. There were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks were being carried out before staff started working at the home and there were enough staff to meet people’s needs.

All staff had completed mandatory training in line with the provider’s policy; they were receiving regular formal supervision and, where appropriate, an annual appraisal of their work performance. The manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. People were being supported to have a balanced diet and they had access to health care professionals when they needed them.

Staff had a good understanding of peoples care and support needs. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. People using the service and their relatives were provided with appropriate information about the home in the form of a service user guide and people’s privacy and dignity were respected.

Peoples care files had been reviewed and updated following our last inspection to make sure they accurately reflected their individual needs. Where people’s needs had changed their care records were being updated to reflect these changes. Staff had a good understanding of people’s care and support needs. People were provided with a range of appropriate social activities. The home had a complaints procedure in place.

The provider had taken action to make sure that the systems for monitoring and improving the quality and safety of the services provided to people were operating effectively. Although the home did not have a registered manager in post the current manager had applied to the CQC to become the registered manager for the home. The provider took into account the views of people using the service and their relatives through relatives meetings and surveys. Staff said they enjoyed working at the home and they received good support from the manager. There was an out of hours on call system in operation that ensured that management support and advice was always available to staff when they needed it.

Marlborough Court provides care for up to 78 older people requiring residential or nursing care, some of whom may be living with dementia. The service is provided over three floors. Thames unit on the ground floor provides nursing care for 21 people, the Union Jack unit on the first floor provides residential care for 28 people who live with dementia and King George unit on the top floor provides residential care for 29 people. We last inspected Marlborough Court in June 2015. At that inspection we judged that the home was outstanding in the key questions effective and well led. The overall rating for the home was “Outstanding”.

At the time of this inspection, a number of changes had taken place in the home, which negatively impacted on the quality of care provided to people. The overall rating of the home dropped from outstanding to inadequate. The primary reason for the decline in quality and rating is the changes in management and staffing.

The home did not have a registered manager in place. The previous registered manager left the home in December 2015 and the previous deputy manager left the home in February 2016. Twenty one other staff had left employment at the home from 28 December 2015 to 24 April 2016 including two senior health care assistants and seven health care assistants. Some regular bank staff had also stopped working at the home. The current manager started working at the home on 1 February and a deputy manager had been appointed on the 1 April 2016.

At this inspection we found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014 in relation to safe care and treatment and staffing. Action had not always been taken to support people where risks to them had been identified. Staff did not assess risks to people using the service in a timely way following a fall and Staff did not respond appropriately and in good time when a service user had a fall. Staff were not always following the guidance as recorded in some people's care files and staff were not updating some people's care plans to reflect their current or changing needs. Staff had not received the appropriate support, training and supervision to enable them to carry out their duties. We found that untrained staff were administering medicines to people using the service.

Some staff were not aware of their responsibility to report abuse. Staff were not always aware of people's care needs. Some staff had not had the time or the opportunity to read care files and risk assessments or get to know the people using the service. People using the service were not always treated in a dignified manner. The provider's systems for monitoring the quality of the service provided to people were not operating effectively as we found some issues with care plans and risk assessments that the provider had not identified.

We found that appropriate recruitment checks took place before staff started work. People received their medicines as prescribed by health care professionals. There were arrangements in place to deal with foreseeable emergencies. People had individual emergency evacuation plans which highlighted the level of support they would need to evacuate the building safely.

The manager understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to ensure that people were receiving the food and fluids as recorded in their care plans. People had access to a GP and other health care professionals when they needed them.

People using the service and their relatives, where appropriate, had been consulted about their care and support needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

Staff said they enjoyed working at the home and they received good support from the manager. There was an out of hours on call system in operation that ensured that management support and advice was available to staff when they needed it.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

We found that each person had a care and support plan with relevant risk assessments which was updated monthly to meet people's changing needs. People were provided with a choice of suitable food and drink and people's weights were being monitored monthly to reduce the risk of malnutrition and dehydration. The provider had policies and procedures in place to ensure that vulnerable adults were protected from abuse and staff had appropriate access to these policies. We found that suitable arrangements were in place for obtaining, storing, administering, recording and disposing people's medication. Support was in place for staff through an induction, training, supervision and team meetings.

We spoke with a person who had recently moved into the home who told us the food was good and a friend had been at the home `for a long time and that the staff were patient and `good people'.

Some relatives told us that the staff were very busy at lunch times and not always able to provide assistance as promptly as they needed to and their relatives had to wait for long periods of time before help was given.

We found that care plans had been re written and reviewed on a monthly basis although there were concerned about aspects of the care individuals had received. There are systems in place to report safeguarding incidents and the provider has implemented a quality assurance programme.