We carried out inspection visits on 08 and 09 February 2018. The first day of our inspection visit was unannounced and on our second day we announced our visit.

Marian House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and nursing care for up to 42 older people. There were 35 people living in the home at the time of our inspection visits.

There was a registered manager in post and they were present at the time of 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.

We had last undertaken an inspection visit on 23 and 24 February 2017 and the overall ratings given were Requires Improvement as three of the five key questions, safe, responsive and well led were Requires Improvement. The other two key questions, effective and safe had a rating of Good.

At this inspection we found the provider had made significant improvements and achieved an overall rating of Good.

People told us they felt safe when staff supported them with their needs and staff applied their training when using equipment to ensure people were safe and comfortable. Staff practices were consistent in monitoring people’s care needs so risks to people from avoidable harm were reduced.

People were supported by sufficient numbers of staff with the right skills to meet their needs who had been deployed so risks to people’s safety were reduced as they received timely care. Recruitment checks had been completed before new staff were appointed to make sure they were suitable to work with people who lived at the home.

Staff knew how to protect people and reduce accidents and incidents from happening by ensuring people’s needs were met in a safe way. Staff applied their training and followed the registered provider’s policies in how to recognise and report any concerns so people were kept safe from harm and abuse.

People were happy with the support they received from staff in order to take their medicines as prescribed. Staff practices around the administration and management of people’s medicines reduced the risks of people not receiving their medicines as prescribed to meet their health needs.

People felt staff were caring towards them and staff had developed respectful relationships with people. People’s privacy and dignity were respected by staff who worked to a set of values around providing care centred on each person.

People valued the responsiveness of staff when being supported with their needs. There were on-going developments in offering people things to do for fun and interest which met their particular needs.

Care records were personalised and there were future plans to introduce electronic care records as another tool to support people in receiving consistent care. Staff knew people well and used every opportunity to continue to enhance their skills and knowledge in order to effectively meet people’s needs. Staff provided end of life care in a sensitive and kept people at the centre at this important time in their lives so they lived well until they died.

People were supported to have maximum choice and control of their lives and support workers supported them in the least restrictive way possible; the policies, procedures and staff training supported this least restrictive practice.

People had been helped to eat and drink enough to stay well. People had access to a range of health and social care professionals when they required specialist help.

People valued th

This inspection took place on 23 and 24 February 2017 and was unannounced. At our last comprehensive inspection in July 2016, we identified a number of breaches of the regulations and concerns in relation to the care that people received. We had identified concerns in relation to staffing and the quality and safety of the care and support provided. We identified concerns as to the registered provider’s oversight of the service to monitor such issues and to ensure that legal requirements were met. We also identified failures to ensure that people were treated with respect, that people’s needs and wishes were acted upon, and that people had access to adequate nutrition and hydration. After our comprehensive inspection in July 2016, the registered provider had written to us to say what they would do to meet legal requirements in relation to the breaches.

At this inspection, we found that the registered provider had fulfilled most aspects of their action plan and had met all of the regulations. During this inspection, we discussed with the registered provider that we had identified further areas of improvement in relation to record keeping and auditing processes to help drive and sustain such improvements. The registered provider and registered manager were receptive to this feedback and assured us that this would be addressed.

Marian House Nursing Home is a care home with nursing for up to 42 older people. There were 31 people living at the home at the time of our inspection. There was a registered manager in place who was present throughout our inspection and who had joined the service in September 2016. 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.

People and relatives told us that people were safe living at the home. Improvements had been made as to how people’s risks were managed and monitored, although systems were not robust. People gave mixed feedback as to whether staff were always available to provide timely support, although improvements had been made in this area. Further improvement was required in respect of record keeping to ensure that people received safe and consistent support with their medicines.

People were supported by staff who were provided with ongoing appropriate guidance and training for their roles. People were supported to make their own choices and decisions, although records to reflect this practice required development. People were supported to access healthcare services and to maintain safe hydration and nutritional levels to promote their health and well-being.

People were supported by staff who treated them with respect and they were described as kind and caring, however recent feedback from some people showed that this support was not consistent or timely. People and relatives were involved in care planning and had been asked for their feedback about the home.

People were not always supported to participate in activities of interest to them. The registered provider had plans to make improvements in this area. People’s care plans had been updated recently to reflect their personal interests and wishes, although care planning and risk assessments did not always reflect people’s support needs.

People and relatives were able to raise complaints at the home and had access to guidance about how to do so. The registered manager had addressed and taken learning from complaints that had been raised. People and relatives we spoke with told us that they were happy with the care provided. We saw that people and relatives had been told about developments at the home and that they had been asked for their feedback to inform some of these improvements.

Staff we spoke with told us that they felt supported in their rol

We carried out an unannounced comprehensive inspection of this service on 20 and 21 July 2016. Breaches of seven legal requirements were found and the service was placed into special measures. This was because people were not always supported by suitably deployed staff who had received sufficient training and guidance to care for people safely and in line with their needs, for example with safe moving and handling practices. We also found that staff did not always meet people’s needs or interact with people with care or respect.

After our comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the seven breaches of regulation. We also met with the provider to discuss our concerns about the service and to hear about the improvements they planned to make.

Following this contact with the provider, we received further information of concern in relation to the safe moving and handling of people who were living at the home. We received information about two incidents that had occurred at Marian House Nursing Home showing that two people had come to harm, and that this could have potentially been avoided.

The information we received indicated that people were not always supported to move safely in line with safe moving and handling guidelines. As a result we undertook an unannounced focused inspection on 8 November 2016 to follow up on these concerns. This report only covers our findings in relation to this. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Marian House Nursing Home on our website at www.cqc.org.uk.

The registered manager of the service had left in September 2016 and the provider had recruited a new manager to the post in September 2016. The new manager was in the process of applying to become the registered manager. 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.

Marian House Nursing Home provides accommodation for up to 42 older people who require nursing care and support with their personal care. There were 37 people using the service at the time of our inspection. During this focused visit, we looked at the risk to people living at the home who required support with moving and handling.

The manager had taken some steps to improve the quality and suitability of equipment at the home where they had identified that people were not always supported to use equipment that was safe and in a good working condition.

The manager had taken some steps to improve staff deployment and ensure that people were always supported by the correct number of staff, although people could not be always confident that their personal needs would be met in a timely way.

The manager had begun to investigate and analyse trends of accidents and incidents that had occurred at the home to help prevent the risk of similar occurrences in future.

Staff had not always received appropriate training and guidance in relation to safe moving and handling practices, including for example, supervision and competency assessments. Some staff who had been supported to receive such guidance recently, told us that they had found this useful.

We observed that people were supported to move around the home safely and that staff practice in this area had improved. The manager had clarified the guidance available to staff about people’s needs in relation to equipment use and moving and handling. Most staff we spoke with demonstrated an understanding of people’s moving and handling support needs or knew where to access this guidance.

People’s consent was sought and we observed that people’s choices were respected by staff. Processes were not always followe

This inspection took place on 20 and 21 July 2016 and was unannounced. The service is a care home that provides personal care and accommodation for up to 42 older people. There were 39 people using the service at the time of our inspection. There was a registered manager in place. 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.

We last inspected this service in July 2013 and found no concerns. We identified concerns at this inspection in relation to staffing, which included recruitment processes, training, deployment and staff interaction with people who used the service. We identified concerns with the leadership and culture of the service and found that people were not always protected by processes and safe staff practice.

Although staff had received guidance in relation to safeguarding processes, they did not always protect people from harm. Risks were not always managed effectively to help people maintain their health and a high number of incidents had occurred at the home, which records showed had not been analysed for themes or trends to learn from and to prevent further incidents.

People received their medicine safely, yet they did not always receive their medicines in a way that maintained their dignity. Although audits had identified some inaccurate medicines recording, this issue had not been rectified and put people at risk of not receiving their medicines as prescribed. Records showed that staff had not received training or updated guidance in relation to medicine administration.

Feedback showed that there had not always been enough staff to meet people’s basic needs at all times and our observations confirmed this. People were not always protected by safe staff recruitment practices. Records were not robust to support the running of the service or to assist in keeping people safe.

Staff had not received all training for their roles and our observations confirmed that they were not consistently equipped with the knowledge and skills to meet people’s needs. Where some staff were aware of appropriate and safe practices, they failed to consistently apply these to protect people from harm.

The service did not act in line with the principles of the Mental Capacity Act. Some people were restricted by staff practices at times and we saw that this caused them distress. People were not always supported to make decisions and their consent and choices were not consistently sought or respected.

People did not always have access to sufficient nutrition and hydration to help them to stay safe and well and healthcare professionals had raised concerns about this. There were ineffective processes in place to ensure that people were always supported by competent staff in a way that reflected their needs, or that concerns that people had not eaten were recognised or addressed.

Most relatives told us that staff met people’s needs, yet feedback suggested that this was inconsistent and we saw that some staff did not understand people’s needs. People had access to healthcare support as required for their needs and healthcare professionals told us that staff referred people promptly for support.

Staff were not consistently caring and failed to develop meaningful relationships with people and involve them in their care. Staff did not consistently express compassion or concern for people and did not always seek to act on their wishes. There were not robust systems in place to ensure that staff were aware of people’s interests and preferences. Staff failed to consistently treat people with dignity and respect.

Care was not always responsive to all people’s needs in a way that enabled them to have a good quality of life. Care plan reviews were not

There were 39 people living at the home at the time of our inspection. We spoke with nine people using the service, five staff, six relatives, the manager and the provider and a GP. All nine people spoken with were complementary about their care and staff. One relative told us, “If there was a home I had to go in then this would be the one’’.

People told us and we saw that staff respected their privacy and dignity and that they were given choices about their care. One person told us, “I have been here for two years, I cannot praise the staff enough, kind considerate and very helpful’’. This meant people were happy with their care.

People’s care and health care needs were planned and met in a personalised way. All staff spoken with told us they had the information they needed to care for people safely.

Staffs were clear about the action to take should they become aware of an allegation of abuse in the home. All nine people spoken with told us they felt secure and knew who to tell if they had concerns and were confident that these would be acted upon.

Staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff had the skills to care for people safely.

There were systems in place to monitor how the home was run, and action taken where feedback from the people using the service would improve the service provided to them.

Some of the people who lived at the home had dementia and were not always able to tell us about their experiences. We used a formal way to observe people during this visit to help us understand their experiences of care. We call this a Short Observational Framework for Inspection (SOFI). We spent 20 minutes in a communal area and observed two people recording their experiences at regular intervals. We spoke with three people living in the home, the manager, two staff and three relatives.

We saw that staff treated people with respect and dignity. One of the three people spoken with told us, “Staff are extremely professional, respect your views and are very sensitive to your medical condition’’. Another person told us, “I made the right move, living here makes me feel safe’’.

Staff told us they had a range of training so that they have up to date knowledge and skills in order to support the people who live there.

Staff supported people to meet their health needs to ensure their well being.

People were supported to eat a healthy and nutritious diet to help keep them healthy.

Improvements in the service were made by listening to the views of people using the service and their relatives and taking the appropriate actions.

All three relatives spoken with were happy with the service provided. One relative told us “It is a nice home comfortable, pleasant, and the staff are very kind''.

People who use the service told us, and records showed that systems were in place to monitor the experiences of people who use the service.

The majority of people were unable to express their views about the service. Those people who were told us:

"Its a nice home, nice staff who are friendly and helpful''.

Another person told us, "The food is good, nice bedroom, kind staff'.

We observed how care workers interacted with people. We saw care workers speaking to people with respect, giving people choices, and offering support when required.

We observed how people were supported at lunch time, and found improvements were required.

Overall people told us they were happy with the care being provided and felt supported when required.

Relatives had made comments about the service in a book that is held in the reception areas of the home.

Comments included:

"Please accept our sincere thanks and the professional way in which you look after my relative''.

" Thank you for the loving care and respect you give to my relative''.

" The kindness you give to people is exemplary''