About the service:

Marland Court is a residential care home that was providing personal and nursing care to 19 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

¿ People told us they felt safe at Marland Court. Staff understood how to protect people from harm and safeguarding policies and procedures were in line with local authority and national guidelines. Regular checks on the safety and security of the premises were undertaken.

¿ There were sufficient staff to ensure basic needs were met but care staff were expected to undertake regular cleaning and household duties. This meant that they did not always have enough time to attend to their caring and support duties. We recommended that the service reviewed the deployment of staff and consider the impact on people’s well- being.

¿ Any accidents and incidents were recorded., with evidence of learning from incidents and action taken to prevent reoccurrences.

¿ Medicines were well managed. Senior staff had been trained to manage medicines and competency checks were carried out on a yearly basis. People told us they were happy with the support they received to take their medicines.

¿ Having a small staff team meant people were supported by staff who knew them well and how they liked their needs to be met.

¿ Staff told us that they were supported and encouraged to keep their knowledge up to date and were given opportunities to learn. They had access to regular face to face training and were able to apply their knowledge to assist the people they supported.

¿ People enjoyed the food at Marland Court. A visiting family member told us that their relative “Loves the food and woofs it down. We know he's eating: he’s putting on weight". Staff understood and monitored people’s dietary requirements and communicated well with the cook to ensure any changes in need were quickly addressed.

¿ Person centred care and support was delivered by kind and patient staff, and we received positive feedback from people about the caring nature of all the staff at Marland Court. They told us that they had a say in how their care was delivered, and that staff respected their personal belongings.

¿ At the time of our inspection nobody was identified as having any specific cultural or religious requirements or diverse needs, but staff we spoke with understood how to work with people from diverse backgrounds

¿ Care plans provided sufficient information to guide and instruct staff on how to deliver care and support. However, there were not always enough staff to provide stimulation and activities.

¿ The service was well managed by a registered manager who was well respected by the people living and working at Marland Court. She understood her duties and responsibilities and ensured a visible presence throughout the service.

¿ We saw and were told that people were consulted on how they wanted their support to be delivered, and there was evidence of good partnership working, especially with the local authority and commissioning teams.

¿The service met the characteristics for a rating of ‘good’ in the four key areas of Effective, Caring, Responsiveand Well led, and Requires improvement in Safe.

¿ More information is in the full report.

Rating at last inspection:

Requires improvement (Report published 21 February 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

Our previous inspection in January 2018 (Published March 2018) identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. These were in relation to; the provider had failed to notify the Commission, as required by legislation, that three Deprivation of Liberty Safeguards (DoLS) applications had been authorised by a supervisory body, had failed to display their previously awarded rating as required, had failed to store hazardous su

We inspected Marland Court on the 10 and 11 January 2018. The first day of the inspection was unannounced. Marland Court 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.

Marland Court is registered to provide accommodation for up to 24 older people who require personal care. There were 17 people using the service at the time of the inspection. The home is a converted and extended house situated in its own grounds in a quiet residential road; close to the main road that connects the towns of Rochdale and Heywood. There is adequate car parking to the front of the home.

We last inspected Marland Court on 25 and 26 April 2017. During that inspection we found there were several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; unsafe and unclean premises, no effective system in place to assess, monitor and improve the quality and safety of the service, insufficient staff on duty, medicines were not managed safely, the privacy and dignity of people who used the service was compromised and suitable and sufficient activities and community involvement were not provided.

Following the last inspection of 25 and 26 April 2017 we took enforcement action in respect of the provider failing to comply with Regulation 12 (2)(d) of the Health and Social Care act 2008 (Regulated Activities) Regulations 20014 (unsafe premises) and Regulation 17 (1)(2)(a) of the Health and Social Care act 2008 (Regulated Activities) Regulations 20014 (an ineffective system in place to assess, monitor and improve the quality and safety of the service). Warning Notices were served on the registered provider requiring them to comply with the relevant regulations within 14 days from the date of the Warning Notices. During this inspection we found that the provider had complied with the requirements of the Warning Notices.

The service was also placed into Special Measures following the last inspection which meant it was kept under regular review and inspected within six months of the last inspection report being published. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following the last inspection of 25 and 26 April 2017 we asked the provider to take action to make improvements. The provider sent us an action plan informing us that they had taken action to ensure the regulations had been met.

During this inspection we found there had been a significant improvement and the provider had met all the previously breached regulations. Due to the improvements seen on this inspection the provider has been taken out of Special Measures.

Although we found that improvements had been made, we found further breaches of the Health and Social Care Act 2008 (Regulated-Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This was in relation to; the provider had failed to notify the Commission, as required by legislation, that three Deprivation of Liberty Safeguards (DoLS) applications had been authorised by a supervisory body, had failed to display their previously awarded rating as required, had failed to store hazardous substances safely and failed to ensure that staff received appropriate induction and training to a satisfactory level on commencing their employment.

You can see what action we have told the provider to take at the back of the full version of the report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. 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.

We inspected Marland Court on the 25 and 26 April 2017. The first day of the inspection was unannounced. Marland Court is registered to provide accommodation for up to 24 older people who require personal care. There were 16 people using the service at the time of the inspection. The home is a converted and extended house situated in its own grounds in a quiet residential road; close to the main road that connects the towns of Rochdale and Heywood. There is adequate car parking to the front of the home.

We last inspected Marland Court on 25 June 2015 where we found the service was meeting all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home did not have a manager who was registered with the Commission (CQC). There had been no registered manager in post since July 2016. A new manager had recently been appointed but had not started the process of registering with the CQC at the time of the inspection. A registered manager is a person who has registered with the CQC 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.

During this inspection we found there were eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Where regulations have been breached information regarding these breaches is at the back of this report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. We will report on this when it is complete. Where providers are not meeting the fundamental standards we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service. When we propose to take enforcement action our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

The provider had failed to ensure the premises were kept clean and safe. This placed the health and safety of people who lived, worked and visited the home at risk of harm. There were unguarded hot radiators and pipes and some windows were without restrictors. This posed a serious risk of harm to people who used the service. The periodic gas safety check and fire risk assessment had not been undertaken by their due date and there were no records in place to confirm if the periodic inspection of the electrical installation had been undertaken. Following the inspection, action had been taken to address most of the safety issues and we were sent confirmation that the gas and electricity facilities had been serviced and the fire risk assessment had been undertaken. During the next inspection we will check if the outstanding safety issues have been addressed.

There were not enough staff on duty at all times to ensure that people were adequately supervised and cared for safely.

Medicines were not managed safely. The storage and disposal of medicines was not as safe as it should have been and people were at risk of not getting their medicines in accordance with their needs and wishes.

The privacy and dignity of people who used the service was compromised. This was because there were no locks on toilet and bathroom doors and the bedroom of one person who was in hospital was being used by another person. Since the inspection we have been told that locks have been fitted to the toilet and bathroom doors. This will be checked on the next inspection.

Suitable and sufficient activities and community involvement were not provided to help promote people’s well-being.

There was no effective system in place to assess, monitor and improve the quality and safety of the service. Some of the systems that were in place did not identify the issues of concern that we found on this inspection.

Although staff

Marland Court is registered to provide accommodation and personal care for up to 24 older people. It is located in Rochdale close to local amenities and public transport. This was an unannounced inspection which took place on 25 June 2015. There were 15 people living in the service at the time of our inspection.

We previously inspected this service on 22 August 2014 and found that the service had breached two of the three regulations assessed. We issued compliance actions that required the provider to make the necessary improvements in relation to the management of records and medicines.

We inspected this service again on 13 January 2015 and found that the service was in breach of six regulations. We issued compliance actions that required the provider to make the necessary improvements in relation to record keeping, consent, supporting staff and respecting and involving people who used the service. We also issued a warning notice which required the provider and registered manager to take urgent action to make the necessary improvements in relation to assessing and monitoring the quality of the service provided.

Following the inspection in January 2015 the provider sent us an action plan telling us about the steps they were going to take to ensure compliance with the regulations.

During this inspection we found that the required improvements had been made and the service was compliant with the regulations we assessed.

The home 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.

People who used the service told us that Marland Court was a safe place to live. Staffing levels were sufficient to meet the needs of people who used the service.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

We found that recruitment procedures were thorough and protected people from the employment of unsuitable staff.

We saw that people were supported to take their medicines as prescribed. Members of staff responsible for the administration of medicines had received training and their practice was regularly assessed to ensure correct procedures were followed.

The home was clean and appropriate procedures were in place for the prevention and control of infection.

Members of staff told us they received regular training to ensure they had the skills and knowledge to provide effective care for people who used the service. The staff team had also completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). However, senior staff were responsible for making applications and knew when and how to submit one.

People who used the service told us the meals were good. Special diets and people’s individual likes and dislikes were catered for. Snacks and drinks were available between meals. We found that people’s weight and nutrition was monitored so that prompt action could be taken if any problems were identified.

People were registered with a GP and had access to a full range of other health and social care professionals.

Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner. People who used the service told us they liked living at the home and received the care and support they needed.

We saw that care plans included information about people’s personal preferences which enabled staff to provide person centred care. These plans were reviewed regularly and updated when necessary to reflect people’s changing needs.

People were supported to pursue their own interests and hobbies in addition to the leisure activities organised at the home.

A copy of the complaint’s procedure was displayed in the dining room and on the back of each bedroom door. The registered manager had investigated resolved one complaint since the last inspection.

Members of staff told us they liked working at the home and found the registered manager approachable and supportive.

We saw that systems were in place for the registered manager to monitor the quality and safety of the care provided.

This was an unannounced inspection which took place on 13 January 2015.

We previously inspected this service on 4 June 2014 and found that the service had breached one of the five regulations assessed. We issued a compliance action that required the provider to make the necessary improvements in relation to the management of medicines.

We inspected this service again on 22 August 2014 to check whether the required improvements had been made and in response to information of concern we had received about staffing levels and moving and handling procedures. During this inspection we found that the service had breached two of the three regulations assessed. We issued compliance actions that required the provider to make the necessary improvements in relation to the management of medicines and records.

Marland Court is situated in Rochdale and provides accommodation and personal care to people over the age of 65. There are 24 bedrooms in total of which three are double rooms. There were 17 people living in the home at the time of our inspection.

The home 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People who used the service and the visitors we asked told us that Marland Court was a safe place to live.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

We observed unsafe practice when two care workers transferred one person from a wheelchair to an armchair in the lounge. One of the care workers involved told us she had not received training in moving and handling procedures.

We saw that care plans lacked guidance for staff to follow about when people should be given medicines prescribed to be taken ‘when required.’

Although the home was generally clean we saw that three toilets remained soiled until mid-afternoon.

We found that recruitment procedures were thorough so that people were protected from the employment of unsuitable staff.

The system in place for staff supervision and appraisal did not adequately support staff to work safely and continue their training and development.

There was no evidence to demonstrate that any of the staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who are unable to make decisions about their own care and treatment.

All the people we asked told us the meals were good. Snacks and drinks were readily available throughout the day. We found that people’s weight and nutrition was monitored so that prompt action could be taken if any problems were identified.

People were registered with a GP and had access to a full range of other health and social care professionals.

People who used the service told us they received the care and support they needed. Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner.

We found that’s people’s preferences were not always considered in the daily routine. There was an expectation that most people would be up and ready for breakfast by 8am. This meant that care workers started getting people up at 5am irrespective of their wishes.

Information about people’s interests and hobbies was not recorded in people’s care plans. This made it difficult to engage people with a dementia in meaningful activities.

A copy of the complaint’s procedure was displayed in the home. A record of complaints, any investigation and the action taken to resolve the problem was available.

The registered manager needed to be more proactive in obtaining the views of people who used the service and their representatives in order to identify areas for improvement.

The system in place for monitoring the quality of the service provided required further development. The registered manager had not identified and addressed the shortfalls we found during this inspection.

The purpose of this inspection was to check that the provider had made the required improvements following the last inspection of 4 June 2014 when a compliance action was issued. Although the provider was requested to send us an action plan explaining how this issue was to be addressed this plan has not been submitted. We have also received information which raised concerns about staffing levels and moving and handling procedures.

During our inspection visit we spoke with one person who used the service, two care workers, the manager and the deputy manager. We also looked at medication and care records and staff training records.

We found that records for the management of medication were up to date and accurate. However, we also found that medication was not always given to people at the right time in relation to food. With the exception of pain killers medication was given to people between 8am and 8pm. Giving people their medication at the wrong time in relation to food and not allowing sufficient time to elapse between doses could seriously affect the health and wellbeing of people who used the service.

Discussion with two care workers and examination of records confirmed that all members of staff were required to attend moving and handling training annually. One person told us she felt safe living at the home and said, “The staff are excellent.”

We saw that care records lacked the information required in order to ensure people received safe and consistent care.

During our inspection visit we spoke with four people who used the service, the relative of one person who used the service, three members of staff and the registered manager. We also looked at records to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

We saw that people were treated with dignity and respect. Two people told us the home was a safe place to live. One person told us they would tell a member of staff if they were unhappy about anything and said, “I can talk to them.”

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. Policies and procedures were in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Members of staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

Recruitment procedures were thorough and made sure that all the required information was obtained before any new employees started working at the home. These procedures helped to protect people from the recruitment of unsuitable staff.

Medication was managed and administered by members of staff who had received training in the management of medication. However, we saw that some of the medication administration records had not been accurately completed. Although there was no evidence of any medication errors a lack of clear records increased the risk of mistakes being made.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medication.

Is the service effective?

People’s health and care needs were assessed with them or their relatives before they were admitted to the home. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people’s changing needs.

We found that people’s weight and appetite was monitored. When any problems were identified advice was sought from the doctor, speech and language therapist and dietician. We saw that care workers were attentive to people’s needs at lunch time and sat next to the people who required assistance to eat their meal.

Discussion with care workers and examination of records confirmed that induction training was in place for new employees. In addition to this a rolling programme of training was in place so that all members of staff were kept up to date with current practice.

Is the service caring?

We saw that members of staff spoke to people in a courteous and friendly manner and offered appropriate encouragement when supporting people. People who used the service told us they liked living at the home and received the care and support they needed. . One person said, “The staff are very nice and friendly.” The relative of one person said, “They’re doing a good job. The staff are very good.”

People’s personal preferences, interests and diverse needs had been recorded in their individual care plans and support was provided in accordance with people’s wishes.

People who used the service and their representatives were given the opportunity to complete annual satisfaction questionnaires. These questionnaires were then evaluated in order to identify any areas for improvement.

Is the service responsive?

People who used the service told us the daily routine was flexible and they could choose when to get up and go to bed and whether to spend time in their own room or in communal rooms. One person said, “You can do what you want.”

Leisure activities were routinely organised at the home. These included arts and crafts, reminiscence, jigsaws, armchair exercises and visits to local attractions such as the pub.

People knew how to make a complaint if they were unhappy. One person told us they would tell a member of staff if they were unhappy about anything and said, “I can talk to them.”

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 way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered most aspects of the service provided.

Discussion with members of staff confirmed that they had received appropriate training and understood their roles and responsibilities. This helped to ensure that people who used the service received the care and support they needed.

Two care workers told us the manager was approachable and supportive.

We received an action plan in September 2013 that stated the actions the provider had put in place to rectify the areas of non-compliance we had identified in the inspection conducted in June 2013.

During this inspection we found that the provider had carried out sufficient actions to meet the areas of non-compliance we had identified in the inspection conducted in June 2013.

We spoke with one person who was using the service. They told us they were happy with the attitude of the staff and felt that staff treated them with respect and dignity.

They felt safe living at the house and had no issues or concerns.

The person told us that they felt the environment was pleasant and the home looked nice.

During the visit we spoke with one relative of a person who uses the service. They told us they were very happy with the staff and the care received seemed genuine. The visitor felt that the home was safe and told us that their relative had gained weight since they had been at the home. The visitor we spoke with told us they did not have any concerns about the number of staff at the home.

We spoke with four people who lived at Branksome Care Home and one visitor. We heard a range of comments about the home and these included, “It’s okay here” and “I’m looked after”. One visitor said his relative was happy living in the home and two people told us that the food was very good.

The provider of the care home sent out resident and relative questionnaires in June 2011. Comments from the returned questionnaires were positive and included, from a relative, “I am happy with all aspects of care my mother receives at Branksome”. In addition, stakeholder satisfaction surveys had been sent out by the provider and one response from a health care professional stated, “Staff are willing to work together and are willing to give assistance when necessary. Always polite and courteous”.

We spoke with three people, however only one person was happy to talk to us without becoming unsettled. This person was positive about her experience of living in the home. She commented positively about the staff, the food and her care. She told us that she felt safer in the home than ‘when she lived in her own home. She also said that she liked to read books and the newspaper when she lived in her own home but she had not had the opportunity to do this at Branksome Care Home but she did watch more television.