Archived: Marlow

At the last inspection, the service was rated Good overall and Good in each domain apart from Well-Led which was rated Requires Improvement. We found a breach of regulation relating to good governance and asked the provider to submit an action plan on how they would address this breach. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and registered manager had taken appropriate action and the regulation had been met.

This inspection was undertaken on 12 June 2017 and was unannounced.

A registered manager was 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.

Medicines were not always managed safely. Some medicines had not been disposed of as required. One medicine had not been disposed of despite it being beyond the expiry date. Another medicine should have been disposed of following a single use, but was still in the fridge. These two people’s health may have been compromised because they were at risk of receiving medicines that were out of date. The temperature in the medicines room, on at least two occasions, was in excess of the maximum temperature of 25 degrees Celsius recommended under pharmaceutical guidance. Controlled drugs were not stored securely in line with the Misuse of Drugs (Safe Custody) Regulations 1973. Medicines were not stored safely in the manager’s office on the first floor. There was a gap in recording on one Medication Administration Record relating to the administration of a medicine to be taken as required.

A system of audits had been put in place to measure and monitor the quality of care delivered and the service overall. In the main, these were effective in identifying any areas for improvement and actions that needed to be taken. However, the audit in place in relation to the management of medicines had not identified the issues we found at this inspection.

People felt safe living at Marlow and staff had been trained to recognise the signs of potential abuse. They knew how to report any concerns and had been trained appropriately. People’s risks had been identified and assessed appropriately and there was guidance for staff on how to mitigate risks. There were sufficient numbers of staff on duty to keep people safe and robust recruitment systems were in place.

Staff completed a range of comprehensive training to enable them to support people effectively and safely. They were encouraged to study for additional qualifications and new staff followed the Care Certificate, a universally recognised qualification. Staff had regular supervision meetings with their line managers and attended staff meetings. Staff had been trained to understand the Mental Capacity Act 2005 and put this into practice. Staff routinely asked for people’s consent. People were supported to have sufficient to eat and drink and were encouraged to maintain a healthy diet. People had access to a range of healthcare professionals and services.

Staff were kind and caring with people and positive relationships had been developed. People were treated with dignity and respect. Staff knew people’s likes and dislikes and their cultural needs were catered for. Staff enjoyed spending time with people. If appropriate, and if people’s needs could be met at the home, then end of life care was available, in line with people’s last wishes.

Care plans provided detailed information about people, including their personal and social histories. Staff were familiar with the content of these care plans and provided care in a person-centred way. Some activities were organised for people at the home and other activities were arranged in line with people’s individual interests, for example, attending college or a day centre. Complaints were managed in line with the provider’s complaints procedures.

People and their relatives felt the home was well managed. They were asked for their views about the home through families and friends surveys. People’s views were obtained on an individual basis at 1:1 meetings with their keyworkers. Staff were asked for their feedback about the service. The home was in the process of being taken over by a new provider.

Observation during the visit enabled us to see how people's choices and views were taken into account in the way the service was provided. Observation during the visit showed staff supporting people to make choices and demonstrated individualised care.

People experienced care and support that met their needs and protected their rights. Care plans were person centred and identified people's preferences and difficulties. We observed people choosing how to occupy themselves in the service with appropriate support.

People who used the service were protected from the risk of abuse because the provider had taken reasonable action to identify possible abuse and prevent abuse from happening. We spoke to staff who demonstrated an understanding of safeguarding procedures and how to escalate concerns.

There was sufficient qualified and experienced staff available to meet people's needs. Staff had received relevant training and development to meet the assessed care needs of people who use the service.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Observation during the inspection showed staff supporting people to make their own choices.

People experienced care, treatment and support that met their needs and protected their rights. Care plans were person centred and documented people's wishes in relation to how their care was provided. We observed that people choose how to occupy themselves in the service.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with staff and staff demonstrated an understanding of the safeguarding procedures and the different forms of abuse.

There were enough qualified, skilled and experienced staff to meet people's needs. People were observed being supported by staff throughout the day. Staff had received specific training to meet the individual care and treatment needs of people who use the service