About the service: Marcris House is a care home that was providing accommodation and personal care to 32 people, some of whom are living with dementia. At the time of the inspection 30 people were using the service.

People’s experience of using this service: There were systems in place which provided guidance for staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe. Risk assessments were in place to identify how the risks to people were minimised. Staffing levels were kept under review to ensure there were sufficient staff that were suitably trained to respond to people's needs. Recruitment checks had been carried out to ensure staff were suitable to work with vulnerable people. People received their medicines safely. People were protected from the risk of infection.

People's needs were assessed and the service continued to support people to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and to have access to healthcare 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. Refurbishment work at the service was ongoing.

During the inspection we observed staff to be kind, patient and friendly. People's dignity and privacy was respected by staff.

People were involved in the planning of their care and staff responded to people's preferences. Care plans contained sufficient detail, but work was being completed to ensure they were personalised. People had opportunities to engage in activities and planned events that interested them. Staff took steps to investigate complaints and to make any changes needed. People were supported at the end of their lives to have a comfortable, dignified and pain free death.

There were a number of audits and checks in place to help ensure standards were maintained. These were all clearly documented and records were up to date.

Rating at last inspection: Rated Good (Report published 12 August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained Good overall.

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

This inspection took place on 23 June 2016. Marcris House is a care home that provides accommodation and personal care provides accommodation and care for up to 32 people who do not require nursing care.

A registered manager was in post at the 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.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

Staff had received training in keeping people safe and they knew how to raise any concerns if they suspected someone was at risk of abuse or harm. Staff understood the risks people could face day to day and how they needed to ensure their safety.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider had followed the MCA code of practice in relation to DoLS.

People knew how to complain and felt confident their concerns would be listened to and people's complaints were valued and used to improve the service.

People's medicines were managed safely, staff received training and the registered manager took prompt action in response to feedback from external pharmaceutical audits.

There were enough staff to meet people's individual needs, and staffing was adjusted when people's needs changed.

There were systems to monitor and improve the quality of the service. Checks were carried out to ensure care was delivered safely and effectively.

This inspection took place on 31 October 2014.

Marcris House is registered to provide accommodation for 32 older people who require personal care. There were 27 people living in the home on the day of our inspection.

The service had not had a registered manager working there since December 2013. 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 provider had not told us about events that they were required to so that we could see that they were taking suitable action to manage these properly. Systems to check the quality and safety of the service were not effective. Up to date guidance about protecting people’s rights had not been followed and clear explanations were not always recorded for decisions made on a people’s behalf. You can see what action we told the provider to take at the back of the full version of the report.

People felt safe. Areas of the premises were not well maintained. Staff were appointed after checks were completed to ensure they were of suitable character to look after the people they supported. There were enough staff available to meet people’s needs and support people individually. Medicines were safely stored and were given to people in the way that was prescribed for them.

People were provided with nutritious food that they enjoyed and they were given the help they needed to eat and drink well. People were supported to gain access to health professionals and services that they needed. Aspects of the environment were not effectively adapted to meet people’s needs.

Staff felt well supported and most had received the training needed to do their job well. Staff asked people’s agreement before carrying out any care and tasks.

People felt well cared for by kind and caring staff who treated them with dignity and respect. Staff took time to communicate with people living in the service in a way that people were able to accept and benefit from. People spoke highly of the staff and the level of care they provided to people living in the service. Visitors were welcomed and people’s right to privacy was upheld.

People’s care was planned and reviewed with them or the person acting on their behalf. This made sure that people’s preferences were included and that staff had information on how best to meet people’s needs.

People felt able to raise any complaints and were sure they would be listened to. Information to help them to make a complaint was readily available. Complaints received by the service were responded to promptly.

When we carried out an inspection of Marcris House on 04 July 2013 we identified areas where the cleanliness was not of a satisfactory standard. We asked the provider to tell us what they were going to do to ensure that the essential standards were met. We carried out a further inspection on 25 October 2013 to check that improvements had been made.

During our inspection on 25 October 2013 we noted that the home looked clean and there was no offensive odour present. Windowsills and furniture were dust free. We saw that the carpets in the lounges, corridors and the bedrooms we looked at were clean and free from stains.

We saw that the only staff members who had not received training on infection control in the 12 months prior to our inspection on 25 October 2013 were the cook, who had food and hygiene qualifications, and one care worker who was on maternity leave. This meant that the provider could be confident that there were effective systems in place to reduce the risk and spread of infection.

We spoke with three people and the relative of one person who lived at the home. People told us that they were happy with the care that they or their relative received. A relative said "They look after [name] a treat." They told us that they liked the food that was provided to them. One person told us "I have no complaints at all."

On the day of our inspection the home appeared to be clean, although we noticed that there was a slightly unpleasant odour. However, as we walked around the home we identified areas where the cleanliness was not of a satisfactory standard. We saw that chairs in the main lounge were dirty and stained. We saw that in some bedrooms there was no dispenser for paper hand towels in the en-suite bathrooms and these were left in piles on shelves.

Marcris House has a mix of converted and purpose built rooms. All of the purpose built rooms have en-suite bathrooms but some of the converted rooms in the older part of the home share bathroom and toilet facilities. Whilst all rooms were of an adequate size the proportions varied considerably,

The manager told us that the staffing levels needed were assessed using the dependency levels of the people who lived at the home. Agency staff were used when needed to ensure that staffing levels were maintained.

We saw that the manager had regular meetings with the people who lived at the home and had undertaken surveys of friends, relatives and professional agencies that came into contact with the home.

Due to the presence of their cognitive impairment, discussion with the majority of people using the service was limited.

We spoke with three people at the service. People told us that they liked living at the home. One person said, “Staff are very helpful and friendly”. When we asked one person who lived at the service if their privacy and dignity was respected they told us “Yes, the staff here are all very good and look after me very well”. They also said that staff were “Very helpful”.

We found that people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected from unsafe or unsuitable equipment.

There were enough qualified, skilled and experienced staff to meet people’s needs.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

People were protected from the risks of unsafe or inappropriate care and treatment.

Due to cognitive impairment and disorientation to time and place, there was limited discussion with the people who use the service. People living in the home looked happy and well cared for. They were happy to chat to us and they interacted well with the staff team.

People with whom we spoke said that they had choice in their day to day lives and that staff were respectful. People said "The staff listen and do what you ask" and "I feel well cared for".

People living in the home were happy with the food provided and felt that they had choice. Overall, the people living in the home were content and happy.

Relatives with whom we spoke were positive about the home and felt that the staff were helpful and communicated well with them. Some relatives felt that the social care in the home was satisfactory whilst others felt that more could be done.

Health care professionals with whom we spoke said that they had no concerns about the care provided at the home.