About the service Marula Lodge is a nursing home. The service provides personal and nursing care for up to 42 people with complex needs including distressed behaviours related to dementia and mental health needs. At the time of the inspection there were 15 people living at the service.
People’s experience of using this service and what we found
People were not always protected against risks associated with their care. The environment and equipment was not set up to meet the complex needs of people. The local authority were not always being informed when safeguarding incidents occurred. The care people received was restrictive and people were not always being protected from the risk of abuse.
Accidents, behaviours and incidents were not always recorded in sufficient detail, and not enough action was taken to reduce further risks to people.
Staff were not deployed effectively to ensure that people received their care when needed and there was a lack of training specific to the needs of people. Supervisions with staff were not effective in identifying shortfalls. The provider did not have appropriate systems in place to review the level of individual needs of people to ensure sufficient staff were on duty.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were not always supported with their independence and there were times when staff were not as kind and attentive as they should have been.
The provider failed to ensure there was robust auditing to review the quality of care. Notifications were not always being sent to the CQC where it was appropriate to do so.
We did see instances where staff were caring and understood how to support people who were anxious. People were supported with hydration and relatives fed back that people enjoyed the food. People had access to support from visiting healthcare professionals.
Rating at last inspection
This service was registered with us on 6 May 2021 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about the staff levels at the service, staff unlawfully restraining people and the dementia environment not suiting the needs of people. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The provider has provided us with assurances they will not be admitting people to the service until improvements have been made.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to the deployment and training of staff, people not being protected against the risk of unlawful restraint and abuse, the principles of the mental capacity act not being applied, risks associated with people’s care not being managed in a safe way, lack of meaningful activities for people, the environment not being set up to meet people’s needs and lack of robust provider oversight of the quality and safety of care at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk