The inspection took place on 14 March 2017 and was unannounced. The previous inspection took place in April 2016 at which time the service was rated as ‘requires improvement’ as there were concerns around how risk was documented and shared, care records had not been updated and quality assurance audits were not always effective.

The Marillac is a nursing home that provides accommodation, nursing and rehabilitation support for up to 52 people with complex physical and sensory disabilities. On the day of our inspection there were 51 people using the service.

The service had a registered manager in post. 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.

At this inspection we found risks were managed safely as there had been improvements made in how information around risk was recorded and shared. Staff demonstrated a good awareness of the risks to people and knew how to manage these safely.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

There were sufficient staff employed who had been recruited safely and who had the skills and knowledge to provide care and support that met people’s needs and preferences.

Staff were aware of their whistle-blowing and safeguarding responsibilities. They knew the signs to look for that might indicate that people were being abused and who to report any concerns to.

Staff received regular supervision and support from the management team which provided an effective method of assessing staff competency and promoting learning and development.

People were involved in making decisions about the care and support they received. Where people experienced difficulties with decision-making, they were supported by staff who were aware of their responsibilities under the Mental Capacity Act (2005) legislation.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS), making applications when necessary.

People had access to food & drink that they enjoyed which matched their preferences and met any health needs.

The service supported people to maintain their health as they had access to a wide range of healthcare professionals.

Staff respected people’s privacy and choices and treated people with kindness and respect.

People were encouraged to be independent and take part in interests they enjoyed.

The service supported people to maintain relationships with friends and family and links with their community so that they were not socially isolated.

Robust quality assurance systems were now in place which meant that the service was effectively monitoring the quality and safety of the service and driving improvements.

There was an open culture and the provider encouraged and supported staff to provide care that was centred on the individual.

The inspection took place on 14 March 2017 and was unannounced. The previous inspection took place in April 2016 at which time the service was rated as ‘requires improvement’ as there were concerns around how risk was documented and shared, care records had not been updated and quality assurance audits were not always effective.

The Marillac is a nursing home that provides accommodation, nursing and rehabilitation support for up to 52 people with complex physical and sensory disabilities. On the day of our inspection there were 51 people using the service.

The service had a registered manager in post. 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.

At this inspection we found risks were managed safely as there had been improvements made in how information around risk was recorded and shared. Staff demonstrated a good awareness of the risks to people and knew how to manage these safely.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

There were sufficient staff employed who had been recruited safely and who had the skills and knowledge to provide care and support that met people’s needs and preferences.

Staff were aware of their whistle-blowing and safeguarding responsibilities. They knew the signs to look for that might indicate that people were being abused and who to report any concerns to.

Staff received regular supervision and support from the management team which provided an effective method of assessing staff competency and promoting learning and development.

People were involved in making decisions about the care and support they received. Where people experienced difficulties with decision-making, they were supported by staff who were aware of their responsibilities under the Mental Capacity Act (2005) legislation.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS), making applications when necessary.

People had access to food & drink that they enjoyed which matched their preferences and met any health needs.

The service supported people to maintain their health as they had access to a wide range of healthcare professionals.

Staff respected people’s privacy and choices and treated people with kindness and respect.

People were encouraged to be independent and take part in interests they enjoyed.

The service supported people to maintain relationships with friends and family and links with their community so that they were not socially isolated.

Robust quality assurance systems were now in place which meant that the service was effectively monitoring the quality and safety of the service and driving improvements.

There was an open culture and the provider encouraged and supported staff to provide care that was centred on the individual.

We spoke with three people who used the service and a visiting relative during our inspection on 31 October 2013. We also spent time observing the care and support provided to people. People told us they received good care at The Marillac. One person said, “I am well cared for. Your care is a matter of concern to them [staff]. You know you are being cared for as they anticipate your needs. You know they are aware and picking up on signs.”

We looked at the care records for three people who used the service. We found that people’s care needs were assessed and monitored and they received care that met their needs. People’s medicines were safely managed.

There were arrangements in place to minimise the risk of abuse or harm to people who used the service. People told us they felt safe at The Marillac. Effective systems were also in place to reduce the risk of infection.

People were supported by enough staff to meet their needs. We found that the staff team was well organised and effectively led to ensure people who used the service received the care they needed. A person who used the service told us, “There are enough staff. You cannot legislate for good care. The staff themselves have to be caring people. Carers here have a graciousness about them. They are perfectly free of any gender bias. Male and female staff are equally caring. They all apply their skills and particular talents to their caring role.”

We spoke with people who used the service but their feedback did not relate to this standard.

People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

People told us they were satisfied with the quality of care and support they received at The Marillac. Comments included, “I love living here and I get on well with everyone.” A visitor said, “My relative was in a previous home and I now know what I have to compare against and this is a fabulous home for my relative.”

People told us that their opinions were always sought, they were involved in decision making and they had choices available. People who used the service said that they were given dignity and respect at all times during their personal care, while they were being assisted to move and at meal times.

We found that robust recruitment procedures were in place and staff were given training. People told us that staff were skilled and looked after them well. One person said, "The staff are marvellous here and give so much warmth to my family member.” Another person said, “The nurses know what they are doing here.”

We found that medicines were not safely managed for the protection and wellbeing of people who used the service. We found that records were not accurate and medicines were not securely stored or in an appropriate environment. The management team of The Marillac confirmed that the concerns would be addressed promptly.

People told us they were satisfied with the care and support they received at The Marillac. They also felt that their dignity and privacy was respected. One person using the service said “They really look after us and it is really respectful." People with whom we spoke told us they were satisfied with the way the home looked after medication.

People were happy with their surroundings at The Marillac. One person using the service said “The room is amazing, the facilities are lovely and the grounds are beautiful."

People living at The Marillac and their relatives told us that they felt that staff were skilled and understood their needs. One person said “Staff are very understanding, they know what I need and have experience of my condition, it is nice to be treated with respect, and they are very supportive. They are inspirational people.”

Relatives and people using the service said they were involved in planning the care and support provided so their views and wishes were taken into account. A relative spoken with said “It’s a wonderful place, we see the managers about, we have been to some meetings for relatives, the care is excellent.”