Marland Court

Updated 20 October 2022

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

Two inspectors and an expert by experience undertook the inspection on day one. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector visited the service on day two.

Service and service type

Marland Court 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. Marland Court is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced on the first day.

What we did before the inspection

We reviewed information we had received about the service, such as notifications. These are events that happen in the service that the provider is required to tell us about. We also sought feedback from the local authority.

The provider completed 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. We used all this information to plan our inspection.

During the inspection

We observed how staff provided support for people to help us better understand their experiences of the care they received. We spoke with 10 people living in the home, 4 members of staff, the cook, the manager, the operations manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with a visiting healthcare professional.

We had a tour of the building with the operations manager and reviewed a range of records. This included 4 people’s care documentation, 2 staff files and a sample of people’s medication records. We also reviewed a range of records relating to the management of the service.

After the inspection

The manager sent us information about their planned actions in response to the findings of the inspection.

Updated 20 October 2022

About the service

Marland Court is a residential care home providing personal care for up to a maximum of 24 people. The service provides support to older people. At the time of our inspection there were 19 people living in the home.

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

People were generally satisfied with the service and told us the staff were helpful and pleasant. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. Staff and people living in the home raised concerns about the staffing levels. The manager made ongoing arrangements to increase the number of staff on duty on the second day of the inspection. We found some gaps in the recruitment records of new staff. There were shortfalls in some people’s care plans and records and risks to people’s health safety and well-being had not always been assessed and managed. The home had a satisfactory standard of cleanliness; however, staff were not always wearing their face masks correctly. Medicines were not always managed safely.

People were mostly satisfied with the food. However, dietary records were not consistently completed and we noted people were not provided with adapted cutlery or plate guards. We made a recommendation to improve people’s dining experience. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; however, there were appropriate policies and systems in the service. There were no mental capacity assessments seen and although Deprivation of Liberty Safeguards applications had been made, the list of applications and authorisations was out of date. We made a recommendation about these issues. Staff received appropriate training. The provider was due to introduce a more extensive training programme. Some areas of the home looked worn and damaged and would benefit from redecoration and refurbishment. We also noted there was a crack in the assisted bath chair which meant it was unsafe to use. The nominated individual had plans to improve the home and started making arrangements to replace the bath chair. People’s mental and physical health needs were not always recorded in their care plan. Staff were unaware of one person’s complex medication conditions and how these impacted on their life.

People’s dignity and independence was not always upheld and maintained. At the time of the inspection, people living on the top floor could not access the ground floor because the passenger lift was not in operation. The lift was unreliable and had broken down previously. The provider had planned arrangements to fit a stair lift. Whilst bedroom doors were fitted with locks which enabled people to open the door from inside without a key, they could not regain access without staff unlocking the door. People had not been issued with keys, which had a potential impact on their independence and autonomy. People also raised concerns about the laundry arrangements. Following the inspection, the manager confirmed the home would be refurbished and the laundry arrangements were under review.

People’s needs and preferences were not always reflected in their care plan. The temporary care plans were brief and lacked detail. One person receiving end of life care did not have a plan setting out their final wishes. Monitoring charts designed to monitor risks were not always fully completed. There was no evidence to demonstrate people were involved in the development and review of their care plan. The manager informed us a new electronic care planning system was due to be implemented. People had few opportunities to participate in activities, which meant they were at risk of social isolation. Following the inspection, the manager advised an activity coordinator would be recruited.

Whilst the management team carried out a series of audits as part of the governance systems, we found a number of shortfalls during the inspection in respect to the management of risks and medicines, maintaining people’s dignity and independence, planning people's care and the completion of records. We also found people were given limited opportunities to express their views. We saw no evidence of group residents’ meetings and people had not been invited to complete a satisfaction survey.

The nominated individual, operations manager and manager were all new to their roles. The nominated individual had purchased the provider company in July 2022 and the manager had been in post two weeks. They were all committed to making improvements to the service and had plans to improve people’s quality of life and the standards in the home. We will check any improvements on our next inspection of the home.

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

Rating at the last inspection and update

The last rating for this service was good (published 5 July 2021). We also carried out two inspections on 23 December 2021 and 26 January 2022, both of which focused on infection prevention and control and were unrated. Prior to this, we carried out a comprehensive inspection 13 March 2019.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing issues, the environment, quality of care, record keeping and the management of the home.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to the management of risks and medicines, failure to maintain and uphold people’s dignity and independence, planning people's care and the governance and record keeping systems. We also made a recommendation about improving people’s dining experiences. Please see the action we have told the provider to take at the end of this report.

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.