This was an unannounced comprehensive inspection that took place on 29 August 2017.

Marwood Residential Home provides accommodation and care for up to 24 people who are aged over 65. The home is located on two floors and has two communal lounges, a dining room, a large garden and a reading corner where people could spend time together. At the time of inspection there were 18 people using the service.

At the last Care Quality Commission (CQC) inspection on 30 June 2016, the service was rated as requires improvement overall. The recruitment procedures were not always followed, a member of staff was administering medicines without the appropriate training. People had restrictions placed on them without the correct process being followed and health professionals had not been contacted for advice in relation to concerns about a person's diet. The provider had not submitted all notifications they were required to. We found one breach of regulations. After the inspection the provider wrote to us to say what they would do to meet legal requirements in relation to a breach in Regulation 11 Need for consent. At this inspection we found the service had made the required improvements.

The service had a registered manager. 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 protected from the risk of harm at the service because staff knew their responsibilities to keep people safe from avoidable harm and abuse. Staff knew how to report any concerns that they had about people’s welfare.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where risks had been identified there were actions in place to reduce these.

There were enough staff to meet people’s needs safely. The provider had safe recruitment practices. This assured them staff had been checked for their suitability before they started their employment.

People’s equipment was regularly checked and there were plans to keep people safe during significant events such as a fire. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

People’s medicines were handled safely and were given in accordance with their prescriptions. Staff had been trained to administer medicines and had been assessed for their competency to do this.

Staff received appropriate support through an induction, support and guidance. There was an on-going training programme to ensure staff had the skills and up to date knowledge to meet people’s needs.

People received sufficient to eat and drink to help maintain their health and well-being. Their health needs were met by staff supporting them to access health care professionals promptly.

People were supported to make their own decisions. Staff and the registered manager had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that assessments of mental capacity had been completed where there were concerns about people’s ability to make decisions for themselves. Staff sought people’s consent before delivering their support.

People were involved in decisions about their support. Staff treated people with respect. Staff knew people they cared for and treated people with kindness and compassion.

People received care and support that met their individual needs and preferences. Care plans provided information about people so staff knew what they liked and enjoyed. People took part in activities that they enjoyed.

People and their relatives knew how to make a complaint. The provider had a complaints policy in place that was available for people and their relatives.

People and staff

This was an unannounced comprehensive inspection that took place on 30 June 2016.

Marwood Residential Home is a care home registered to accommodate up to 24 people who are aged over 65. The home is set over two floors with lift access to both floors. The home has two lounges and a dining room where people can relax. At the time of the inspection 20 people were using the service.

The service had a registered manager. 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 told us that they felt safe when staff supported them and that they enjoyed living at Marwood Residential Home.

Risk assessments were in place which described how to support people in a safe way. The service had safeguarding and whistleblowing procedures in place. Staff were aware of their responsibilities in these areas.

The provider carried out pre-employment checks before staff started to work to make sure that staff were suitable to work at the service. We found that one staff member had information of concern on their Disclosure and Barring service checks and this had not been reviewed to make sure that they did not present a risk to people who used the service.

People told us that there were not enough staff. We found that there were times when staff were not available in communal areas and people had to wait for support.

People received their medicine as it had been prescribed by their doctor. However, staff had not always signed to say that creams had been applied. Most staff were trained and assessed as competent to administer medicines. We found that one staff member was administering medicines without appropriate training.

Staff were supported through training and supervision to be able to meet the needs of the people they were supporting. They undertook an induction programme when they started to work at the service.

Staff sought people’s consent before providing personal care. People’s capacity to make specific decisions relating to their care had not been assessed. People had restrictions placed on them without the appropriate process being followed under the Mental Capacity Act.

People were supported to maintain a balanced diet. However, advice of a dietician had not always been sought when it was required. People were usually supported to access healthcare services.

People told us that staff were caring. Staff we spoke with had a good understanding of how to promote people’s dignity. Staff understood people’s needs and preferences.

People were involved in decisions about their care. They told us that staff treated them with respect.

People were involved in the assessment of their needs. People and their relatives were involved in the review of their needs.

People were supported to take part in activities that they enjoyed.

People told us they knew how to make a complaint. The service had a complaints procedure in place.

The service was led by a registered manager who understood most of their responsibilities under the Care Quality Commission (Registration) Regulations 2009. The registered manager had not notified the Care Quality Commission of all incidents that they were required to. The registered manager had not completed a Provider Information Return when this had been requested.

People were asked for their feedback on the service that they received. The provider carried out monitoring of the quality of the service.

We found one breach 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.

Our inspection team was made up of one inspector. There were 21 people using the service on the day of our visit. We spoke with eight people who used the service, one relative of a person who used the service and four members of staff. They helped answer our five questions which are set out below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and were treated with respect and dignity by the staff. Staff had regular supervision and annual appraisals were being completed. Staff had received mandatory training. This meant that staff had the right knowledge to meet people's individual needs.

No person in the home was subject to Deprivation of Liberty Safeguard. We saw no restrictions on people’s liberty. Specific training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been provided for staff. The Mental Capacity Act and Deprivation of Liberty Safeguards is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive.

Improvements were needed in ensuring people were protected against the risks associated with water temperature in some rooms.

Is the service effective?

All people we spoke with told us the care and support provided was good and they got on well with staff. They said staff were helpful and listened to them. One person told us, “They always have time for me”. Another said, “They are very helpful to us – we couldn’t ask for more”.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person’s care. This helped staff provide care and support according to the person’s needs and choices.

Is the service caring?

People who used the service understood the care choices available to them. All of the people we spoke with were happy with their choice of home and told us their privacy and dignity was respected. People expressed their views and were involved in making decisions about their care.

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this. This helped to make sure people felt listened to and their needs were met.

Is the service responsive?

People had regular opportunities to do things they enjoyed. A range of activities was provided for people who used the service. People told us they enjoyed these activities.

Information on how to make a complaint was available in the home and in the information pack given to people who used the service and their representatives. There had been no recent complaints.

Is the service well-led?

The service had a quality assurance system. We found that a range of internal audits were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service was identified and followed up.

People who used the service were asked for their views about the quality of care and support being provided. This meant that the care and service provided was informed by the comments made by people who used the service.

During our visit we were able to speak with seven people who were using the service. They told us that they were very happy with the care and support they received. One person told us: “The staff are very helpful and friendly, it’s a very nice place.”

We also spoke with four visitors and four members of staff. This enabled us to gather their views on the service and the care and support being provided. A visitor told us: “I don’t think you could do better, the staff are wonderful, maybe a little overworked sometimes, but they never skimp on the care for mum.”

People told us that they had been asked for their consent to the care and support that they received before they moved into the service and that the staff always asked for their consent before providing the help that they needed.

We looked at some care plans and found that they included the actions the staff needed to take to meet the individual needs of those in their care.

People told us that the food was very good and they were always given a choice. One person told us: “I really like the food; they ask me what I like as there is always a choice.”

Everyone we spoke with knew what to do if they were unhappy about something. One person explained: “I would talk to xxxxx [the manager] but I can’t grumble about anything.”

We were told that the staff were helpful and supportive and we observed them throughout our visit, carrying out their duties in a kind and patient manner.

During our visit we were able to speak with seven people who were using the service. All told us that they were very satisfied with the care and support they were receiving. One person told us, “it’s been fantastic, nothing is too much trouble.” Another explained, “they’re all brilliant.”

We were also able to talk with five visitors and four members of staff

People told us that they were treated with respect and the staff were kind and supportive. One person told us, “the staff are really respectful, I can’t rate them highly enough.” Another explained, “the staff are wonderful, ever so cheerful, I am quite content.”

People told us that they felt safe with the carers who supported them. One person explained, “the staff are fantastic, I don’t worry about them because I know they're in the right place and they’re being cared for.” Another told us, “no way has anyone been unkind.”

We observed the staff going about their work in an unhurried manner and they provided care and support at a pace that suited each individual person.

We spoke with six people currently using the service and one relative. Everyone spoken with told us that they were very happy with the care and support provided. They told us:

"It's a lovely place, I've nothing to say but good things, they certainly look after you".

"They've made me feel very much at home".

"The staff are very nice, they treat me very well".

“They keep my room lovely and clean".

"One of the reasons we chose here was because of the staffing levels, especially at night, here there's always two staff on and that’s what mum needs".

"They let you get up when you like, they never rush you".

"There’s always someone available when you need them".

They told us that they enjoyed the activities that were provided, with one person explaining, "I like singing, I get to do that here".

People explained to us that they felt safe and able to talk to staff should they have any comments or concerns to share.