Marriott House & Lodge

Marriott House and Lodge is a care home registered to provide nursing and residential care and accommodation for 119 people with various health conditions, including dementia and sensory impairment. There were 65 people living at the service on the day of our inspection. Marriott House and Lodge is a large converted care home located in Chichester, West Sussex.

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

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were enough staff to care for them. One person told us, “They are all very kind to me and they make sure I’m happy. They are good people. “Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “I’m very happy with the care. [My relative] is happy here. They do a lot of work around the food he likes and I’m confident he is being well cared for.”

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.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this.

People received good care that met their needs and improved their wellbeing. The staff team were dedicated and enthusiastic.

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 (published 14 December 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the key questions of effective, caring and responsive. We therefore did not inspect these. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has remained as Good.

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.

Marriott House and Lodge is a care home registered to provide nursing and residential care and accommodation for 119 people with various health conditions, including dementia and sensory impairment. There were 84 people living at the service on the day of our inspection. Marriott House and Lodge is a large converted care home located in Chichester, West Sussex.

People’s experience of using this service:

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “They are very respectful. They ensure [my relative’s] dignity and wishes are adhered to”.

People enjoyed an independent lifestyle and told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. One person told us, “If there’s a singalong, I join in. There’s a mini bus that takes us to a school, we sit in with the class and get on with the children, and you can use the garden”.

People felt the service was well presented and welcoming to them and their visitors. A relative told us, “[My relative] came straight from the hospital. They are very welcoming, and it has all worked out for her”.

People told us they thought the service was well managed and they enjoyed living there. One person told us, “The staff are happy. There’s a very happy atmosphere”.

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “I’m up to date with training, it happens regularly”.

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.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received high quality care that met their needs and improved their wellbeing from dedicated and enthusiastic staff. A member of staff said, “The residents are amazing, we get to know them, and they get to know us which is important too”.

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

Rating at last inspection: Requires Improvement (report published 12 December 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good. If we receive any concerning information we may inspect sooner.

There was no registered manager 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. Day to day management of the service was carried out by an interim general manager, a senior deputy manager and a deputy manager. However, despite having management arrangements in place, the service had been without a registered manager for a significant period of time.

On the day of our Inspection there were sufficient staff to support people. However, the provider relied heavily on agency staff and this had impacted on people’s experience of the care they received.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. People were treated with dignity and respect, and they were encouraged to be as independent as possible.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Risks associated with people’s care, the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included, arts and crafts and visits from external entertainers. There were representatives from local churches, so that people could observe their faith. People were also encouraged to stay in touch with their families and receive visitors.

People were cared for in a clean and hygienic environment and appropriate procedures for infection control were in place. Healthcare was accessible for people and appointments were made for regular check-ups as needed.

Care plans described people’s preferences and needs, including their communication needs. People’s end of life care was discussed and planned and their wishes had been respected.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as the care of people living with dementia.

Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. People’s care was enhanced by adaptations made to the service.

People were happy and relaxed with staff. They said they felt safe and staff had received supervision meetings with their manager and formal personal development plans.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank.

People were encouraged to express their views. People said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where the management team was always available to discuss suggestions and address problems or concerns.

The home did not have a registered manager, the previous registered manager had left on 12 May 2017. 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.

A manager was in post but they had not applied to become registered with CQC. They told us that they were leaving and the second day of our visit coincided with their last day in post. The provider’s regional director was present during the inspection and told us that a new manager had been appointed and was due to start the week following the inspection.

At the last inspection on 4 and 5 August 2015 we had no concerns and the service was rated ‘Good’ overall. At this inspection we found three breaches of the regulations and other areas of practice that needed to improve.

There were not always enough staff to care for people safely. People and their relatives expressed concerns that people had to wait for their care needs to be met. One person said, “At times I have to wait for staff and when they do come they always appear rushed.” Another person commented, “Sometimes you wait over half an hour.” Call bell records confirmed that people regularly waited for longer than they should reasonably expect for staff to respond. This was identified as a breach of regulations. The provider took immediate action to increase staffing levels and improvements were noted on the second day of the inspection.

Most people and their relatives spoke highly of the staff and the care they received. One person said, “They are a very nice group of girls, I call them my grand-daughters.” However people’s dignity was not always protected because staff were not responding to call bells in a timely way. Some people told us that staff were not always kind and caring. One person said, “There are some good ones (staff), and some are not so good. They do what has to be done but don’t look beyond that.” A relative described how they had heard a staff member speaking 'sharply' to their relative. People and their relatives told us that most of the staff were kind and caring in their approach however not all interactions between staff and people were consistently positive. This was identified as a breach of the regulations.

The provider had a number of management systems and processes including audits, to monitor quality at the home. However, these had not always been effective in identifying shortfalls in the quality of the service. There was a lack of management oversight in some areas of practice which meant that the manager could not always be assured that risks to people were being effectively managed. This was identified as a breach of the regulations.

People were receiving their medicines safely but some PRN (as required) medicines were not always documented clearly. This put people at risk of receiving inappropriate doses of their medicines and was identified as an area of practice that needed to improve.

Risks to people were identified and care plans were regularly updated to guide staff in how to provide care safely. However, staff were not always following the care plans consistently. This meant that people were at risk of receiving inappropriate or unsafe care. This was identified as an area of practice that needed to improve.

There was a wide range of organised activities on offer for people at the home. However, whilst the activities programme was meeting some people’s needs, other people remained at risk of social isolation. Some people said they didn’t have enough to do, one person said, “The activities are very good but I don’t join in because it’s not my type of thing.” Meeting people’s need for social interaction and stimulation and supporting them to follow their interests is an area of practice that needs to improve.

People knew how to access the provider’s complaints system and the manager monitored all complaints. Some people told us that they did not feel confident to raise complaints because they were not sure how their concerns would be addressed. This was identified as an area of practice that needed to improve.

Staff demonstrated understanding of their responsibilities with regard to safeguarding people and knew who to speak to if they had any concerns. People said they felt safe living at the home, one person told us, “I always felt safe here from day one.” Incidents and accidents were being recorded and monitored to identify and address any patterns or trends.

People were having enough to eat and drink and they told us that they enjoyed the food on offer. Staff were knowledgeable about people’s dietary needs. Staff supported people to maintain their health and to access health care services when they needed to. One person said, “If you need the doctor they arrange it.” People and their relatives said that they had confidence in the skills and knowledge of the staff. Staff told us they received the training and support they needed. One staff member said, “I’m up to date with my training and I have asked to do additional training in End of Life Care because that’s a particular interest for me.” Staff had received training in the Mental Capacity Act and understood their responsibilities.

People were being supported to make decisions about their care. They told us that they felt their views were listened to. A relative told us, “I am here for a review today, they keep me fully involved.” Staff had a good understanding of how to protect people’s privacy. People told us that staff supported them to maintain their independence. One person said, “I like to be independent and do as much as I can for myself.” Staff demonstrated that they knew people well and provided care in a personalised way, respecting people’s wishes.

The provider sought the views of people and their relatives on the quality of the service and used this information to drive improvements. We were told that a refurbishment plan was in place to update areas of the home to give it the 'Wow factor.'

Staff had developed good links with the local community and staff told us that they had benefitted from additional training as a result. Staff spoke highly of the management of the home and described an open and supportive atmosphere. The regional director told us that the provider was committed to making improvements at the home.

You can see what actions we have asked the provider to take at the back of the full version of this report.

This inspection was carried out by one inspector. We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were told no applications had been made under DoLS as it had not been necessary. The manager confirmed they understood when an application should be made to deprive someone of their liberty and how to submit one.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve

The registered manager set the staff rotas. They took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

We observed medication records had not always been completed to confirm medication had been given. This meant that people may not have been given medication as prescribed. We also observed, where medication had been prescribed on an 'as required' basis, the reason why medication had been given and whether it had been effective had not been routinely recorded.

A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'They look after us well'. A relative said, 'I would not like to put my family member anywhere else'.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People had meetings with heads of department to discuss their views and opinions of the service provided. We saw minutes of meetings which demonstrated that positive responses had been made to suggestions put forward to improve the service.

Is the service well-led?

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We spoke with three people who lived at Marriott House. We also spoke with some relatives who were visiting. Every one we spoke with told us they received the care and support they needed. They confirmed that their needs had been discussed with them and assessed prior to admission. They also confirmed that care plans had been discussed with them. Everyone we spoke with confirmed their satisfaction with the care provided and the hygiene standards maintained within the home.

One person told us, 'Everything is absolutely A1!' Another person said, 'Generally speaking, everything is excellent.' A relative informed us, 'The staff are lovely. They are very competent; they know what they are doing.'

Staff on duty we spoke with were very knowledgeable about the needs and preferences of individual people. They knew what was expected of them to ensure identified needs had been met.

Overall the atmosphere with Marriott House was warm and homely. We observed care staff and other staff engaging with people. They conducted themselves in a friendly but professional manner, taking time to listen carefully to people to ensure they understood what was needed of them.

The registered manager of Marriott House and Lodge had delegated some duties and responsibilities for Marriott Lodge. This senior member of staff was called the care manager.

We talked to three people who lived at Marriott Lodge. They told us they received the care and support they needed. They confirmed that they have given their consent to this and have had their care plans discussed with them. One person told us, 'We are getting the care that we agreed to.'

Everyone we spoke with confirmed their satisfaction with the service provided. One person told us, "The girls (care staff) are very nice!" They also told us they felt safe.

We asked if they believed there were enough staff on duty to deliver the care they needed. One person told us, 'I wouldn't know. I just call and they come to help me.' Another person commented that the staff are very busy, especially at mealtimes.

People we spoke with could not recall if they had been given a written complaint procedure. One person told us, 'I have had no complaints. I would not know what to do.' Another person told us they would speak to the care manager. They also said they found the care manager was approachable and would listen to their concerns.