Archived: Marian House Care Home

Marian House Nursing Home offers personal care for up to 20 older people and is run by a Roman Catholic religious congregation. At the time of our inspection, 12 people were living at the service, most of whom were catholic nuns.

At our last inspection, Marian House Nursing home was registered to provide nursing care. Following our inspection, the provider made an application to remove this regulated activity and on 2 November 2016, the service became a residential care home.

The previous registered manager had left the service on 3 November 2016 and there was a manager in post at the time of our inspection who was in the process of registering with the Care Quality Commission (CQC). 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 and their relatives told us that the staff and manager were extremely caring and communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. The staff team knew people well and were exceptional at delivering care that made people feel valued. The provider and manager were passionate about promoting person centred values as the basis of the service and ensured these were followed by the care staff.

The whole staff team understood the importance of ensuring people’s emotional, spiritual and cultural needs were met as well as their physical needs. All the staff had been trained in end of life care to ensure they provided sensitive and compassionate care for people who were reaching the end of their life.

The provider had taken action to meet the concerns identified at the inspection of 30 November 2015 and had put systems in place for the safe management of medicines.

The manager undertook medicines audits and ensured that staff received training in the administration of medicines and had their competencies regularly assessed.

The provider had made improvements and had acted in accordance with the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity was assessed and they consented to their care and support. Processes had been followed to ensure that, where needed, people were deprived of their liberty lawfully.

People and staff told us they felt safe and there were systems and processes in place to protect people from the risk of harm. There were enough staff on duty to care for people and numbers were adjusted according to people’s needs.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

Staff received regular training, supervision and appraisal. The manager attended forums and conferences in order to keep abreast of developments within social care.

People’s nutritional and healthcare needs had been assessed and were met.

Care plans were in place and people had their needs assessed and reviewed regularly. The care plans contained detailed information and reflected the needs and wishes of the individual.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. Relatives were sent questionnaires to gain their feedback on the quality of the care provided.

People, relatives and professionals we spoke with thought the home was well-led. The staff told us they felt supported by the manager and there was a family atmosphere and a culture of openness and transparency within the service.

Marian House provides accommodation and nursing care for up to 25 older people and is run by a Roman Catholic religious congregation. There were fourteen people living at the service at the time of our inspection, most of whom were catholic nuns.

There was a registered manager in post at the service at the time of 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.

People’s capacity to make decisions about their care and treatment had not always been assessed. The staff did not always understand the legal processes required when relatives consented on behalf of people.

Processes had not always been followed to ensure a person had been deprived of their liberty lawfully. The provider had not made an application under the Mental Capacity Act Deprivation of Liberty Safeguards for at least one person who was receiving medicines covertly.

We found evidence that staff did not always understand the need to obtain consent from people. They told us that they obtained consent verbally. This did not provide evidence that people had agreed to their care and support.

There were arrangements in place for the management of people’s medicines and senior staff had received training in the administration of medicines. However, care staff were requested to assist qualified nurses in the administration of controlled medicines even though they had not received any training. This meant that they would not be able to identify any errors made by their senior colleagues and therefore people would not be protected against the risk of receiving the wrong medicines.

Some signatures were missing on medicines administration records, and staff were unable to confirm if this was an oversight and whether the medicines had been given.

There were no maximum/minimum temperatures recorded for the medicines fridge. During the inspection, the temperature for the fridge was found to be too high.

People and staff told us they felt safe and we saw there were systems and processes in place to protect people from the risk of harm. There were sufficient staff on duty to meet people’s needs and six of them including the registered manager lived at the home. This meant that staff were always available in the event of shortage to ensure people’s safety.

People’s nutritional needs were met, and people gave positive feedback about the food. We observed people being offered choice at the point of service and the food was cooked using fresh ingredients.

Staff received training, supervision and appraisal. The registered manager sought guidance from other healthcare professionals and attended workshops and conferences in order to keep abreast of developments within social care.

Staff were caring and treated people with dignity and respect. Care plans were in place and people had their needs assessed. The care plans contained detailed information and reflected the needs and wishes of the individual.

A range of activities were provided at the service and some people told us they were able to go out either by themselves or with a member of staff. We saw that people were cared for in a way that took account of their diversity, values and human rights.

People, staff, relatives and healthcare professionals told us that the registered manager and staff were approachable and supportive. The registered manager told us they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the Mental Capacity Act 2005, the management of medicines and governance. You can see what action we told the provider to take at the back of the full version of this report.

At this inspection we spoke with four people who lived at the home and eight members of staff.

People told us they were happy living at the home and they were well cared for. We found the provider had made improvements to care planning and these records were accurate and up to date. The staff told us they felt well supported. We saw they had enough information to care for people safely and they were appropriately trained. The provider had systems to monitor the quality of the service and to ask for the views of stakeholders.

The staff were aware of people's needs and delivered the care and treatment people required with the input of other healthcare professionals where this was required. The care plans however did not always reflect the changing needs of people and therefore people could be at risk of receiving unsafe or inappropriate care and treatment. The records maintained about the care people received, such as food and fluid balance charts, were not comprehensively maintained to protect them against the risks that can arise if records were not kept appropriately.

The provider had effective arrangements to protect people from the risks that can arise if medicines were not managed appropriately. Staff recruitment procedures were in place and being followed. However staff were not comprehensively supported in their jobs and professional and personal development. This was because they had not received a structured induction and regular supervision or appraisal. Staff meetings although arranged were not regular and no minutes were available in the home for staff to read.

Whilst the service had some arrangements in place to gain people's views about the service, other arrangements to monitor and assess the quality of the service were not effective. It did not have an effective system of audits to assess the various aspects of the services provided. Staff did not have access to suitable policies and procedures to support them in their role because these had not been reviewed or updated to reflect current practice and legislation.

One person was self-medicating which was their choice and staff told us that this was regularly reviewed and that their ability to take their medicines safely was assessed daily.

At this inspection we found that the areas we had previously identified as requiring improvement, had been improved, however further improvement was identified as being needed for one of the two outcomes. As a result we judged that the provider was compliant with outcome 16 of the essential standards of quality and safety but remained non-compliant with outcome 9 and further improvements were needed with the management of medications.

We spoke with six people using the service, one visitor and four staff.

People expressed their satisfaction with the service and the care they were receiving. They said staff listened to them and treated them with respect. One visitor said, 'they treat people as individuals and have time for everyone.'

People's nutritional needs were being identified and met. One person said. 'the food is lovely' and another said 'the food is beautiful and we get plenty of variety.'

Systems were in place for the management of medicines, however these were not always being followed and shortfalls were identified with the recording and storage of medicines, which could place people at risk.

There were enough staff on duty to meet the needs of the people using the service. Staff had received training to provide them with the knowledge and skills to care for people effectively.

Systems were in place for the auditing and monitoring of equipment, systems and safe working practices, however action was not always being taken to follow up on any shortfalls identified, to minimise risks to people.