This inspection took place on 24 January 2017 and was unannounced. At our previous in June 2016 we had concerns that people were not always receiving care that was safe, effective or well led and we had asked the provider to improve. We had found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection in June 2016 the registered manager sent us an action plan informing us how they planned to make the required improvements. At this inspection we found that the actions had been met and the provider was no longer in breach of any Regulations.

Marrow House is registered to provide care and support for up to 21 people. There are 16 places that offer Intermediate Care and an additional five places have the facility to offer residential support for up to six weeks whilst a permanent placement is identified. At the time of this inspection 17 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.’

People were being safeguarded from abuse as staff and the management followed the local safeguarding procedures if they suspected someone had suffered potential abuse.

Risks of harm to people were assessed and action was taken to minimise the risks through the effective use of risk assessment.

There were sufficient suitably trained staff to keep people safe and meet their needs in a timely manner. Staff had been recruited using safe recruitment procedures to ensure that were of good character and fit to work with people who used the service.

People's medicines were stored and administered safely by trained staff.

The principles of The Mental Capacity Act (MCA) 200,5 were being followed as the provider was ensuring that people were consenting to or when they lacked mental capacity, were being supported to consent to their care.

Staff told us and we saw they had received training and were supported to be effective in their roles.

People were supported to maintain a healthy diet. People were referred to other health care agencies for support and advice if they became unwell or their needs changed.

People were treated with dignity and respect and their right to privacy was upheld.

Care was personalised and met people's individual needs and preferences. Staff were responsive to people's changing needs and supported people towards achieving their own level of independence.

The provider had a complaints procedure and people told us they felt they could approach the management with concerns and they would be dealt with.

There were systems in place to monitor and improve the quality of service.

This inspection took place on 14 June 2016 and was unannounced. This was the service's first inspection since registering as a service for reassessment and rehabilitation in March 2016. We found that people were not always receiving care that was safe, effective or well led. We have asked the provider to improve and will be returning to ensure the required improvements have been made.

Marrow House is registered to provide care and support for up to 21 people. There are 16 places that offer Intermediate Care and an additional five places have the facility to offer residential support for up to six weeks whilst a permanent placement is identified. At the time of this inspection 20 people were using the service. One of these people was a permanent resident.

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.

People were not always safeguarded from abuse as when suspected abuse had been reported to the management this was not always acted upon and investigated. Other incidents of possible abuse had not been passed onto the management to be able to investigate.

Risks to people were not always recognised and minimised. Risk assessments had not been up dated or put in place to ensure that people were receiving care that was safe and met their needs.

People were not always supported to consent to their care and support. Some people's needs required reassessing on admission into the service to ensure that they still consented to decisions that had been made when they had been unwell and unable to consent.

People's medicines were not always managed safely. Records did not confirm whether people had had their medicine and some out of date medicine had been in use.

The provider did not have effective systems to be able to monitor the quality of the service being provided. Clear and concise records were not maintained and this resulted in people not always receiving care that was safe and effective.

People were supported to maintain a healthy diet, however records kept were not always accurate in relation to what people drank and this put people at risk.

There were sufficient suitably trained staff to meet the needs of people who used the service. They had been recruited using safe recruitment procedures. Staff felt supported and had training to fulfil their role.

People's health care needs were met. When people required health care they received it in a timely manner.

People were treated with dignity and respect and their privacy was maintained. People were encouraged to be as independent as they were able to be and staff supported people to reach their identified goals.

People's needs were assessed and regularly reviewed and they were offered choices dependent on their preferences and these were respected. People felt they were able to complain and that the registered manager was approachable.

There were 11 people in the home on the day of our inspection. Some people were permanent residents, some staying for respite care and some for hospital discharge support. Everyone at the home had a diagnosis of dementia.

We spoke with five people during our inspection and reviewed 11 comment cards. One relative said, “I am constantly impressed with the care and treatment that is provided at Marrow House. People are looked after in a safe and caring environment, delivered in a professional manner”.

People were treated as individuals and care was provided with dignity, respect and compassion. A relative told us, “Marrow House is second to none when it comes to looking after people with dementia. I have peace of mind all the time. I know my X is cared for all the time”.

We saw that staff sought specialist advice and support to maintain people’s physical and mental health with the urgency required to keep people safe.

There was evidence that the provider assessed the quality of the care they provided through regular audit of services.

Staff had received training in the care of people with dementia. Staff we spoke with were able to explain the different types of dementia and knew the needs of the people they cared for well.

People who lived at the home were involved in the assessment of their care needs and wishes. People told us that care was provided in provided in the way that met their needs.

People were happy with the care and support they received. They were supported to have their health and personal care needs met. They had the opportunity to take part in activities of their choice.

People told us that they felt safe living at the home. Care staff were aware of areas of risk and knew what to do to reduce them.

One person said “I always get my tablets when I stay here. When I am at home I forget to take them, but the girls here make sure I get what I need”. Systems were in place to ensure medication was securely stored and people who used the service received their medicines as they were prescribed. We spoke with two people who said they were happy with the way that they received their medication.

One person who used the service told us, "I like it here the staff are great, they like a joke". We spoke with five members of staff about training. All staff were happy with the level and variety of training that they have received. One care worker said “I can always ask for new or additional training if I need it”. Another said “my manager is very supportive”.

Records we looked at were appropriately managed and stored.

Marrow House provided care and support for 16 people who were permanent residents and had 12 beds for people requiring short stay or respite care. To be considered for admission to this service people had to be diagnosed with dementia. The stated aims of the service were, “To create a homely, relaxed atmosphere for people with dementia care needs, by helping them to maintain their independence and maintain daily living skills within the capabilities of their disability.”

The service is one of Stoke-on-Trent City Councils ‘Centre’s of excellence.’ The home re-opened in February 2010 after a programmme of redevelopment and refurbishment. Essentially the service has been redesigned to meet the needs of people with dementia after consultation with experts.

At Marrow House we were accompanied by an expert by experience for part of our visit. This is someone who has either used or uses social care services or has experience of caring for someone who has. Our experts by experience are people of all ages, with different impairments and from diverse cultural backgrounds, the expert we used for this visit was provided by Age UK. During the visit they spoke to people using the service and relatives. They looked at what happened around the home and saw how everyone was getting on together and what the home felt like. They took some notes and wrote a report, we have included their observations in our report.

Our expert commented that, “There are two main units within the building, identical in layout and differentiated by colour scheme. One area had been converted into a simulated “street” with features like street lamps, and a “pub” with piano, a dart board (with safety darts), where we were told singsongs take place in the evenings. There was a hair-dressing salon and room for showing films. There was a lounge and separate dining area for each of the units. There was a very pleasant outdoor seating area, with a greenhouse, plants and flowers, which is easily accessible from both lounges and doors open onto this area from the lounges. This area was safe and enclosed, situated in the centre of the complex, is well-designed and contributes to quality of life in the home.”

During the visit to Marrow House we spoke with nine people using the service and three relatives, comments included.

“I have been very happy with the care and support my relative receives at Marrow House.”

“Staff are nice and friendly. They talk to you.”

“Staff are “fairly attentive” and “this is the best home I’ve been in.”

A relative said; “When I knock at the door the staff seem to always know where my relative is.” They also said their relative spent most of their time in the communal areas which they considered a good thing, as otherwise they might feel isolated. “I wouldn’t like to think of my relative going into their room in the early evening and not coming out again until breakfast.”