This inspection was unannounced and took place on 22 and 23 October 2018.

Marlborough Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate up to 18 people. Accommodation is provided in one adapted building over two floors. Not all the rooms have en-suite facilities, there are communal bathrooms and toilets available. There was a small garden area at the back of the property.

At our last inspection in August 2017 we found one breach of the Regulations because the environment was a risk to people’s safety. In addition, we were concerned about the way in which the service recorded people’s food and fluids. At this inspection we found the improvement to the environment had taken place and fluid charts were also recording totals of fluid consumed. However, we have found concerns in other areas and have made two recommendations.

There was a registered manager in post who was also the provider. 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 provider had also employed an additional home manager who was in the process of registering for this service. For the purposes of this report we will refer to them as the home manager.

People were not always able to have the help and support they needed, when they needed it because they had to wait for staff. This had an impact on mealtimes. Whilst people had sufficient food and drink, they did not have the support to eat at the time they needed it. People had to wait for staff to be available before they could have their meal.

Staff were not always trained and supported effectively. New staff received an induction but it was not robust and did not follow the industry standard. Staff did not have sufficient opportunity for supervision to enable them to feel supported.

The provider had adapted the conservatory to become an office which had removed a communal room. This meant people had less space to use to seek a quieter room or talk to relatives in private. The premises lacked orientation signage to help people move around the building.

The service overall was clean and well maintained. There were no unpleasant odours. Staff followed good infection prevention and control practice guidelines. The premises and equipment were maintained and serviced when required.

People’s needs were assessed and where needed referrals were made to visiting healthcare professionals. Records demonstrated that people had access to services such as GP’s, physiotherapists, speech and language therapists and community nurses.

People had the opportunity to record their wishes for end of life care, this information was in people’s care plans. Where the service had provided end of life care the staff had worked with healthcare professionals to make sure people were as comfortable as possible.

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. Staff were aware of the principles of the Mental Capacity Act (2005) and how they applied this to their day to day practice.

Medicines were managed safely. We observed staff administering medicines and found their practice to be safe. Medicines were stored safely and people had their medicines reviewed by their GP.

Accidents and incidents had been recorded in detail and action taken to minimise the risk of reoccurrence. All accidents and incidents had been reviewed by the registered manager to look for trends.

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Marlborough Lodge is a small care home which provides accommodation and personal care for up 18 people, some of whom are living with dementia. At the time of our inspection there were 17 people living in the home, one person was in hospital and one person was receiving respite care at the service.

Since the last inspection in September 2015 there has been a change to this service’s registration. Fidelity Healthcare Limited became the registered provider for this service and a new registered manager was in post. This was the service’s first rated inspection under the new provider, Fidelity Healthcare Limited.

We inspected Marlborough Lodge on 29 and 30 August 2017 and this inspection was unannounced. The registered manager was approachable and available throughout 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.

During our inspection we noticed some environmental factors that could cause a potential risk to people’s safety. For example one person’s bedroom had no hot tap indicator on their sink. Some areas of the home were cluttered with furniture and equipment making them less user friendly for people. We saw that some exposed brickwork had left a metal mesh visible and sticking out which posed a risk to people if they walked too close and caught their leg or tried to touch it. The registered manager took action to address the concerns raised during and after the inspection.

Some areas of the home needed attention to maintain the cleanliness. For example some of the sinks in people’s rooms and toilets were not always clean and an odour of urine was detected in some areas. We saw that for 11 days in August 2017 there was no documented record that any cleaning had taken place. However we did see housekeeping staff around the home during our inspection and relatives told us they felt the home was kept clean.

Although quality assurance systems were in place to monitor the quality of service being delivered, the environmental factors that we found during this inspection had not been identified prior to this so that action could be taken to prevent a potential risk to people’s safety.

The provider had systems in place to manage risk and protect people from abuse. Staff were aware of their responsibilities and knew how to identify if people were at risk of abuse and what actions they needed to take to ensure people were protected.

Staff received an in-depth induction to the service and were supported to undertake training relevant to their roles. One staff commented “My induction was very good, I shadowed [more experienced staff] and they took me around the home.”

The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social care needs. The organisation of the care plans needed reviewing and the registered manager was looking to change the format to make it clearer. People’s care needs were regularly reviewed to ensure they received appropriate and safe care, particularly if their care needs changed.

Staff worked closely with health and social care professionals for guidance and support around people’s care needs. Health care professionals praised the working partnerships they had developed with the management and staff which enabled people to receive effective and responsive care to meet their needs.

Staff were attentive to people’s needs and people received care and support from staff who had got to know them well. People and their relatives praised the staff for the care and compassion shown commenting “The staff are all very nice and caring to me” and “The staff are lovely, I’m so lucky to have my relative there, I have been to other homes and we are lucky. She’