We carried out an unannounced inspection of Marmora in September 2017 and found there were four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed regarding safe care and treatment, safeguarding service users, staffing and good governance. The registered provider submitted an action plan to us about the measures they were taking to address the concerns found at the previous inspection.

At this inspection on 7 and 16 August 2018, we checked that the registered provider had made the required improvements. Since our last inspection of the service, improvements had been made and the service was compliant with the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

The management team had made significant progress to address the previous concerns and we have now rated this service overall, 'Good'.

Marmora is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 27 older people who may have varying levels of dementia related needs. Marmora does not provide nursing care.

Marmora is situated in a residential area, close to the seafront and the town centre. The premises is on three floors with each person having their own individual bedroom and communal areas are available throughout. At the time of our inspection, 24 people were using the service.

There was 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.

Systems and processes had been implemented to monitor and improve the quality and safety of the service provided. The registered manager was pro-active, committed to continuous development and worked closely with the registered provider which had led to improvement in the managerial oversight of the service. Measures had been taken to strengthen the management team of Marmora and this had led to positive outcomes for people.

People and their relatives were very positive about the approach of the registered manager and the improvements they had made. Complaints and concerns were suitably investigated and dealt with and good records management was in place.

Staffing levels had been reviewed and there were adequate numbers of staff on duty to support people and meet their needs and people were provided with supervision, stimulation and meaningful activity. Staff had been recruited safely and were trained and supported to meet people’s needs.

Safe processes were in place for the administration of medicines and there were procedures in place to ensure the safety of the people who used the service. There were systems in place to safeguard people from abuse and the recruitment of staff was safely completed to make sure they were suitable to work in the service. Staff were aware of their responsibilities and knew how to report any concerns.

Staff demonstrated an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) 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 support this practice.

Risk assessments and care plans provided detailed and relevant guidance for staff in the home. People were supported effectively with their nutritional needs and received personalised care from a staff team who were kind and caring, respected their privacy and dignity and promoted their independence.

This inspection took place on 27 September 2017 and was unannounced.

Marmora was last inspected on 13 May 2015 and was given an overall rating of 'Good'.

Marmora provides accommodation and personal care for up to 27 older people who may have varying levels of dementia related needs. There were 25 people using the service at the time of this inspection.

The service did not have a registered manager. A new manager had been appointed and commenced employment on 2 May 2017, they had submitted an application to the Commission for registration and this was being processed.

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.

Prior to this inspection we received information of concern from various sources about the quality and safety of care provided at Marmora. We shared this information with the local authority safeguarding team. The outcome of their visits found that elements of the concerns were substantiated.

Our findings and feedback from the local authority and other healthcare professionals indicated failures around staffing significantly contributed to the number of safeguard concerns linked to poor practice, numbers and skills mix of staff.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There had been a lack of oversight of the service by the provider to ensure the care the service delivered was of good quality, safe and continued to improve.

We found serious shortfalls in medication management and people were not always receiving their prescribed medication which placed their health and welfare at risk.

Thorough risk assessments had not been carried out routinely to identify and mitigate risks in relation to people’s support needs, fire safety and infection control. Necessary health and safety precautions had not been taken within the home to protect people from harm.

An effective system was not in place to ensure there were sufficient numbers of staff on duty to support people and meet their individual care needs. There were not enough staff to provide adequate supervision, nutritional support, stimulation and meaningful engagement/activity.

People’s care was not co-ordinated or managed to ensure their specific needs were being met. People were not always supported to ensure that they had enough food and drinks to support their health needs. Records were incomplete and not assessed, we could not be assured that people had been given enough to eat and drink. Where people of low weight turned down food, or had a low appetite, this was not always being effectively managed. This put people at risk of losing, or not maintaining their weight.

People were supported to see, when needed, health and social care professionals.

Care records provided insufficient guidance for staff in providing safe care and in supporting people’s wellbeing. We found improvements were needed in staff’s understanding of dementia care to enable them to support people in providing care that was effective and person centred. This included staff’s knowledge in managing high levels of anxiety and associated behaviour and supporting people to have access to meaningful stimulus, tailored to their level of dementia.

Training for staff was not managed effectively. There were shortfalls in mandatory training and staff had not received training in subject areas relevant to people's needs. The provider had made arrangements to develop staff training and development. However where we identified shortfalls in staff’s knowledge of supporting people with dementia, medication, nutrition, fire safety, risk and pro

The inspection took place on 13 May 2015 and was unannounced. Marmora provides accommodation and personal care and support for up to 27 older people, some who may have a mental health need. At the time of our inspection there were 26 people who lived in the service.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

The service had appropriate systems in place to keep people safe, and staff followed these guidelines when they supported people. There were sufficient numbers of care staff available to meet people’s care needs and people received their medication as prescribed and on time. The provider also had a robust recruitment process in place to protect people from the risk of avoidable harm.

People’s health needs were managed by staff with input from relevant health care professionals. Staff supported people to have sufficient food and drink that met their individual needs. People’s privacy and dignity was respected at all times.

People and their relatives were involved in making decisions about their care and support. Care plans reflected people’s care and support requirements accurately and people’s healthcare needs were well managed. Staff interacted with people in a caring, respectful and professional manner, and responded well to people’s care and support needs.

People were encouraged to take part in interests and hobbies that they enjoyed. They were supported to keep in contact with family and develop new friendships so that they could enjoy social activities outside the service. The manager and staff provided people with opportunities to express their views and there were systems in place to manage concerns and complaints.

There was an open culture and the management team demonstrated good leadership skills. Staff were enthusiastic about their roles and they were able to express their views. The management team had systems in place to check and audit the quality of the service. The views of people and their relatives were sought and feedback was used to make improvements and develop the service.

We used a number of different methods to help us understand the experiences of people who used the service. Some of the people who used the service had complex needs which meant they were not able to tell us about their experiences. Where people were unable to provide a response or tell us about their experiences, for example as a result of their limited verbal communication or poor cognitive ability. We noted their non- verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Marmora to be positive.

We saw that people had individual ways of communicating and were able to make members of staff aware of their needs and preferences.

We found that staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service.

Marmora was effectively run by a competent manager; there were robust systems and processes in place to ensure people received a good service that took into account their needs and preferences.

People who use the service told us that that they liked living there. One person who had been there for a year said that they knew who their keyworker was and that staff were always available to always available to help should they need it. They also said that staff sit with them and go through care plans with them. Another who had been a resident for 10 years said that it was a beautiful place and staff were always available. Both said that they did most things by themselves and they were encouraged to do this.

The provider had systems in place to ensure that people who use the service were involved and respected in their care and that their care and welfare were protected. We found that workers were suitably qualified, skilled and experienced. The staff we spoke supported this and said that they received lots of training and could always ask for any training they required. There was a robust system in place to ensure that the quality of service was assessed, monitored and evidence of this system was seen.

The people who use the service were encouraged to be involved in the planning of thier care which was supported by their involvement in the care plans and the My Choice form within their files which identifies their likes and dislikes.

The people with whom we spoke made the following comments:

“I am happy here”, “I like living here and we all get on” and “They help me and tell me what to do."

Those people with whom we spoke said they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

People using the service told us that staff helped them with their medication when they needed it.

People told us that they feel well looked after by the staff at Marmora. One person with whom we spoke said "It is not your own home but they treat us so well here"

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.

People with whom we spoke told us that their privacy, dignity and independence are

respected and that their views on the support and care they receive are taken into

account.

They also told us that generally they were able to make choices about aspects of their

care. For example, we spoke with three people about how they are supported to

choose what to eat each day. They told us that staff offer them a choice of meals each

day and they can choose where they have these. They are also able to make a

decision as to whether or not they participate in social activities.

One relative with whom we spoke confirmed they were happy with their relative's care

and support and found staff to be kind and caring.

One person said, in relation to personal care, "I can do most things myself but if I need

help I can ask for it."

The people with whom we spoke made the following comments:

“I am happy today”, “I like living here and we all get on” and “They help me and tell me what to do”.

Those people with whom we spoke said they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

People with whom we spoke during the inspection were happy at the home and liked the way it was presented.

People told us that they feel well looked after by the staff at Marmora. One person with whom we spoke said "It is not your own home but they treat us so well here"

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.