Lotus Care Marmaduke Street

Lotus Care Marmaduke is a care home which provides accommodation and nursing care for older people some of whom were living with dementia. The service accommodates up to 48 adults. Accommodation is provided over two floors. At the time of our visit, 38 people were living there.

People’s experience of the service and what we found

Some training courses were not completed and required improvement. Some medical professionals had raised communication and competency as an issue before we inspected. The provider had started to address this. Some records were in the process of being re-written in preparation for transferring over to an electronic system.

There was a range of audits completed which had already identified the need for some improvements and there was a detailed action plan in place to address this however there were still some gaps in records. There was not a registered manager in post, however staff spoke positively about the interim manager. Staff and people who lived at the home were engaged with via regular meetings. The provider worked closely with the local authority and safeguarding adult team. The provider was aware of their obligations under duty of candour to be open and honest regarding any failings in the service and had informed CQC of any notifiable events.

People we spoke with said they felt safe living at the home. Risk assessments were in place and they were robust, informative and reviewed regularly or when someone’s needs changed. The home was clean and there were good infection prevention control procedures in place. Medication was managed safely and there was enough staff on shift to ensure people were supported safely. There was a process for assessing incidents and accidents, and these were reviewed by the provider for emerging patterns and trends.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (27 November 2020).

Why we inspected

This inspection was prompted by a series of concerns shared about the service with regards to medication management, risk assessments, staffing, staff knowledge and skills and end of life care. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. We found during this inspection the provider needed to make some improvements.

Enforcement

We have identified breaches in relation to governance and records.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Lotus Care Marmaduke Street on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice

• Safe procedures were followed for admitting people to the service. People were only admitted following evidence of a negative COVID-19 test. On moving into the service people were required to self-isolate for 14 days.

• Shielding and social distancing rules were complied with. The environment had been adapted to support social distancing. There was a dedicated part of the service identified to accommodate people should they test positive for COVID-19, develop COVID-19 or show symptoms.

• People living at the home and staff had access to regular testing.

• Guidance on the use of PPE and current IPC procedures were clearly visible across the service.

• Stocks of the right standard of personal protective equipment (PPE) were well maintained and staff used and disposed of it correctly.

• Staff had received infection control training were supported in their roles. We observed people with staff and saw that they had become comfortable with staff wearing appropriate personal protective equipment such as masks and apron

• Visits were pre-arranged and restricted to essential visitors. Visitors were provided with personal protective equipment which they were required to use throughout the visit.

• Staff reassured people throughout the pandemic and provided them with the support they needed to maintain regular contact with their family and friends through the use technology.

We were assured this service were following safe infection prevention and control measures to keep people safe.

Further information is in the detailed findings below.

Marmaduke Street is a residential care home providing personal and nursing care to 32 people aged 65 and over at the time of the inspection. The service can support up to 48 people in one adapted building. The home is situated over two floors, with residential support offered downstairs and nursing support upstairs. Both sections of the home specialise in providing care to people living with dementia.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we found decisions made in people’s best interest did not always involve the most appropriate people. We made a recommendation about this.

There were systems in place to monitor the quality of the service. Although this had improved from the last inspection, we found there were still further improvements needed to ensure actions were followed through.

We found some issues with risk assessments not always being updated with information after incidents occurred. However, people told us they felt safe living at the home. People said the staff treated them with respect and kindness and we observed this.

People told us they felt they were involved in decisions about their care, but not with decisions about the home. We saw evidence the provider completed regular feedback surveys with people, and evidence residents and relatives’ meetings were planned. However, these meetings had not actually taken place due to non-attendance. The registered manager is trying to address this.

Most care plans were detailed and contained information regarding people’s preferences, likes, dislikes and routines. This helped staff support people in line with their preferences. However, we noted the level of personal information varied between files. In those instances, staff were still able to support people in line with their preferences as they knew them well and asked them.

People received the support they needed to eat and drink and maintain a healthy and balanced diet. Staff knew people's dietary needs and people told us they enjoyed the food available to them. People could enjoy snacks throughout the day and were able to choose alternative meals if they did not like what was on the menu.

An activities coordinator had been employed since the last inspection. This had improved people’s experience in the home. People told us they enjoyed the activities and we saw this during the inspection.

Staff understood their role and had confidence in the manager. Staff told us they worked well together as a team, and there was good morale amongst them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 June 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Marmaduke street is situated in Liverpool and provides personal care, nursing care and accommodation for up to 48 people. The home is situated over two floors. All bedrooms are single occupancy, and there are communal areas on each floor with a shared garden.

Marmaduke Street 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.

Marmaduke Street accommodates 48 people in one adapted building. There is a downstairs section of the home, which offers residential support, and an upstairs section, which is designed for people with nursing needs. Both sections of the home specialise in providing care to people living with dementia.

At the time of our inspection there were 20 people receiving support in the upstairs section of the home and 16 in the downstairs section.

There was a manager in post, however they had not yet registered with the Care Quality Commission.

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.

It was not always clear that the Mental Capacity Act 2005 (MCA) was applied correctly and decisions were being made in people's best interests. Most records we viewed in relation to the MCA did not have specific decisions recorded on them and best interest processes for people were not always considered.

Care plans, paperwork and records were not organised or set out in a format which was clear and concise. Some people's records were missing pieces of information or not completed accurately or in full. There was a lot of information in people’s care plans which was out of date and still had the logo from the old provider on the front. We saw on day two of our inspection that the provider had already begun to amend this information and they showed us a completed care plan, in a new and more organised format.

Governance arrangements were in place and regular checks on service provision were being completed, however these checks were not always effective. They had failed to highlight some of the issues we saw during our inspection.

Staffing was a concern on day one of our inspection, particularly on the residential section of the home. We observed staff to be exceptionally busy, and people had to ask for things repeatedly. Staff did not raise any concerns however some people we spoke with did confirm this could sometimes be an issue. There were no issues with regards to staffing in the nursing section of the home.

We have made a recommendation regarding this.

People told us they felt safe living at the home.

Medication was safely managed, stored and administered. People received their medications on time.

Staff were recruited and selected to work at the home following a robust recruitment procedure. The manager retained comprehensive records of each staff member, and had undertaken checks on their character and suitability to work at the home.

The home was clean and tidy. There was provision for personal protective equipment stationed around the home, and staff were trained in infection control procedures. We did raise on day one of inspection that the outside smoking areas were untidy, due to the disposal of cigarette butts. We saw on day two of our inspection this had been actioned and the outside areas had been tidied to a high standard.

Staff were able to describe the process they would follow to ensure people were protected from harm and abuse. All staff had completed safeguarding training. There was information around the home which described what people should do if they felt they needed to report a concern.

The training matrix showed that staff were trained in all subjects which the provider considered mandatory to their role, and as stated in the provider's training policy. New staff with no experience in health and social care were enrolled on an induction process which was aligned to the principles of the Care Certificate.

Staff received regular supervision and appraisal. We did see some gaps in the recording of this however, the manger was able to explain the reasons for this.

People were supported to eat and drink in accordance with their needs. People, who were assessed as at risk of weight loss had appropriate documentation in place to monitor their food and fluid intake. We did raise at the time that some of these documents were not completed accurately or in full. Where specialist diets were needed for some people, the chef had knowledge of this.

The service worked in conjunction with all medical professionals to ensure people had effective care and treatment.

Everyone had records in their files relating to external appointments with healthcare professionals such as GP's, opticians, dentists or chiropodists. The outcome of these appointments was recorded in people's records.

We observed kind and caring interactions between staff and people who lived at the home. Staff spoke kindly and fondly about people, and demonstrated a good knowledge about them, their likes and their needs. People told us they liked the staff and felt that they were kind to them.

There was information recorded in people's care plans with regards to their likes dislikes and how their care should be delivered.

People confirmed they knew who the manager was. Team meetings and resident meetings took place. Feedback was gathered from people who used the service and their families.

We saw all notifications had been sent to CQC.

You can see what action we told the provider to take at the back of this report.