Background to this inspection
Updated
19 October 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team consisted of 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Marquis Court (Tudor House) Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Marquis Court (Tudor House) Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post. A new manager had been in post for approximately 6 weeks and had submitted an application to register. We are currently assessing this application. At the time of our inspection, the registered manager continued to support the new manager with the running of the home.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 19 September 2023 and ended on 26 September 2023. We visited the location’s service on 19 and 26 September 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
During the site visit, we spoke with 6 people who lived at the home and 1 relative. We spoke with 6 staff including a nurse, care staff and domestic staff. We also spoke with the registered manager, the new manager in post and the regional manager.
Following the site visit, the Expert by Experience spoke with 9 additional relatives by telephone.
We looked at 7 people’s care records and 5 people’s medicine administration records (MARs). We also viewed 3 staff files and documentation related to the governance of the service.
The provider sent us further documentation we had requested following the site visit including safety certificates and evidence of actions they had taken since the inspection.
Updated
19 October 2023
About the service
Marquis Court (Tudor House) Care Home is a nursing home providing personal and nursing care to up to 52 people. The service provides support to older people some of whom are living with dementia. The care home accommodates people across two separate floors in one building each with their own separate facilities. At the time of our inspection there were 17 people using the service.
People’s experience of using this service and what we found
Significant improvements had been made to assessing people’s risks, but further improvements were required to ensure all risks were escalated when needed. For example, risk assessments did not contain sufficient guidance regarding escalating concerns around people’s continence needs. Risk assessments were updated when needed but quality checks did not always ensure other related documentation was also amended to ensure guidance for staff remained consistent. Systems in place to review daily records did not always identify concerns. Where one person’s dentures had broken, this had been documented by staff but not escalated. Audit documentation was not always completed in full, so it was not clear when actions had been addressed.
People told us they felt safe and staff understood how to manage their risks. People were supported by a sufficient number of staff to meet their needs safely. People received support with repositioning or wound care in line with their care plans. Improvements had been made to the storage of medicines and medicines were now stored safely. Protocols had been put in place for ‘when required’ medicines and these were administered safely. The home was clean, and measures were in place to reduce the risk of infection. Where things went wrong, the provider had taken action.
People’s needs assessments were holistic and considered their likes, dislikes and preferences. People’s diverse needs had been considered in their assessments such as how they would like their religious needs met. People were supported by well trained staff who had the skills and competence to meet their needs. People were supported to eat and drink in line with their care plans. People’s nutritional and fluid intake and weights were monitored when needed. The provider was proactive in referring to health professionals to ensure people received the care they needed. People had personalised their bedrooms and the home had been adapted to support people with their orientation around the home. 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.
People were supported by staff who treated them with kindness. Relatives told us staff were caring and knew people well. Staff respected people’s privacy and dignity. Staff promoted and encouraged people’s independence where possible.
People had choice over how their needs were met, and care was delivered in a personalised way. People were supported by staff who knew them well. People had personalised care plans in place that were regularly reviewed. Complaints were addressed in line with the provider’s complaints policy and relatives told us they were satisfied with how the provider addressed complaints.
People had end of life plans in place. An activities programme was in place and people told us there was enough for them to do. People were supported by staff who understand how to communicate with them to maximise their understanding.
The manager was new to their role, but people and relatives knew who they were and spoke positively about them. The manager was well supported by the registered manager and regional manager and the management team were clear about their roles. Quality monitoring systems at the home had improved significantly. Systems had been implemented to improve clinical oversight and these were effective. People and relatives were encouraged to provide feedback regarding the home and action was taken on this. The provider worked closely with other professionals and with the local authority to make improvements.
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 inadequate (published 20 January 2023) and there were 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.
The service is now rated requires improvement. This service has been rated either requires improvement or inadequate for the last 9 consecutive inspections. Despite the repeated requires improvement ratings, significant improvements had been made at this inspection, but more improvements are required, and the provider needs to evidence these improvements can be sustained over a longer period of time.
This service has been in Special Measures since 20 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.