Marsden Heights Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. Whilst staff displayed a good understanding of safeguarding, incidents were not always shared appropriately or reviewed to ensure re-occurrences were prevented. People were not always protected from risk due to the lack of detailed information and guidance available to staff. Whilst processes were in place for the safe storage, management and disposal of medicines, these were not always embedded or reflective of best practice guidance. There was a good level of health and safety checks, but these had not identified concerns noted around the safety and security of the environment. The service had systems in place to help mitigate the risk of infection. Recruitment procedures were robust; and we received feedback current staffing levels, training and support were adequate. People were supported to have the maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were encouraged and supported to raise concerns. A relative fed back that a poor experience had been dealt with by the service, “It’s not a bad care home. [Person] did have a bad experience some months ago, but it was dealt with. The manager sorted it out.”

There was a culture of safety at the home. Staff spoke confidently about how they would respond to an incident or accident and gave examples of actions they would be expected to take afterwards.

Lessons were not always effectively learnt from safety incidents. Action had been taken in response to incidents, for example: additional checks, changes to the environment and appropriate referrals. However, there was little evidence of debriefs following incidents or accidents meaning opportunities to learn and prevent re-occurrence may have been missed.

A person living at the home fed back that they did not like the home at first but was settled now and staff understood their needs well.

Care was planned and organised with people and their relatives, in ways which ensured continuity. The registered manager advised a pre-assessment form was completed to ensure people could settle into the home safely, and relatives were involved as much as possible during the transition period. Staff confirmed they were provided with appropriate information about people’s needs and gave examples of how they got to know people’s preferences and routines.

The provider adopted a collaborative approach which involved partners. Partners confirmed the home worked with them to establish people’s healthcare needs when they initially moved in.

The approach to identifying and managing risks to people across their care journey was effective and helped keep people safe. The home provided people with trial visits, aimed at supporting safe transition; and a robust pre-admission form was used to gather detailed information about people’s diagnoses, health, needs and preferences.

People generally said they felt safe and made comments such as, “I feel safe and know I can let staff know if I’m worried about anything,” and “I feel safe here, I am treated so well.” A relative told us, “That’s why I wanted [person] to come here, it’s a safe place.” However, there were a couple of comments which indicated concerns with some staff and/or the culture at the home. A person living at the home said, “Sometimes the staff are a bit nasty.” Another told us, “Some staff are a bit strict .”

There was a strong understanding of safeguarding and how to take appropriate action. Staff confirmed they had training and could give examples of what they would report and who to. A staff member told us, “I would report neglect, physical or financial abuse; any concerns to do with the residents. We have to look after residents.” Following recent information of concern, the deputy manager confirmed appropriate action had been taken to address staff conduct and provide additional training and support.

People were supported to understand safeguarding, what being safe meant for them and how to raise concerns. We observed safeguarding posters displayed in the communal corridors; informing people, relatives and staff what to look out for and who to contact. We saw positive interactions between staff and people. People were treated well and seemed content in staff presence. Staff were considerate of The Mental Capacity Act 2005 (MCA) and sought consent prior to care interventions.

Staff were supported to understand safeguarding and how to raise concerns about the safety of people living at the home. Staff had access to the provider’s safeguarding policy, and safeguarding was discussed at recent team meetings and during staff supervisions. However, information had not been shared with the appropriate agencies following incidents between people living at the home. Steps had been taken to assess people’s capacity and record decisions made in people’s best interests. There was a clear understanding of the Deprivation of Liberty Safeguards (DoLS) and applications had been made for those who needed them, though these had not been updated to include additional restrictions such as sensors. The registered manager took prompt action to make the appropriate notifications and update DoLS applications following feedback.

People were informed about risks. A person living at the home said, “Staff sometimes help me in the shower, I don’t mind because it stops me falling over.”

When people communicated their distress, we were not assured staff could manage situations in a positive way that maximised learning for the future. Staff told us they felt adequately trained to manage behaviours that communicate distress, though it was unclear if approaches used were agreed; or the best approach given people’s dementia diagnosis or current guidance. The deputy manager and registered manager spoke about steps taken to analyse and learn from behaviours of distress. However, there seemed a lack of emphasis on learning from incidents; to identify potential triggers or determine what approaches did or did not work. Staff gave examples of how they supported people to monitor and manage clinical risk such as pressure injuries or weight loss.

We observed people being offered support and reassurance when they became distressed, though this was not always in line with best practice guidance. People were seen to be supported appropriately with transferring and mobility, to reduce the risk of falls or injury.

Risks were not always fully assessed or understood. We reviewed an incident relating to a fall in which healthcare had been delayed. This was in part due to a lack of information to guide staff on the need for timely intervention due to an underlying health condition. Inspectors noted that fluid levels recorded for 1 person were particularly low, so we could not be assured they were protected from the risk of dehydration. The provider had processes for assessing risks to people, but these did not always record detailed strategies to help staff provide appropriate support when people communicated distress; and sometimes information conflicted. One person’s care plan advised staff to offer reassurance, but there was no information to explain what this meant for the individual, and different sections of their care plan held different guidance.

Facilities and equipment were not always well maintained. A relative commented, “The furniture is tired, and it needs modernising. The staff are brilliant, but the place needs an uplift.”

Staff confirmed they had no concerns about the environment or safety of people living at the home. However, the registered manager acknowledged not all staff had taken part in a fire drill and there was a lack of trained fire wardens, which could hinder efforts to evacuate people efficiently in an emergency. Additional drills and training were scheduled immediately following our feedback. Equipment used to deliver care and treatment was used properly, staff told us they received face to face training to use mobility equipment safely.

Leaders and staff did not always consider how environments could keep people safe from physical harm. We observed bedroom doors to be propped open with furniture rendering fire doors ineffective in the event of a fire. People were at risk of entrapment as wardrobes were not fixed to the wall and access to the sluice room was not adequately secure. Following assessment, the registered manager advised bedroom doors were no longer propped open inappropriately, wardrobes had been made safe and more robust locks were fitted to sluice room doors.

There were arrangements to monitor the safety of the premises. Regular safety checks were conducted by a full-time maintenance person with oversight from the registered manager. The home had undergone an inspection from Lancashire Fire Rescue Service and recommendations had been made to improve fire safety measures, with appropriate action taken by the provider.

There were appropriate staffing levels to make sure people received good quality care that met their needs. We received no feedback from people or relatives to suggest any concerns with staffing levels or competence; and people said staff knew them well, indicating consistency amongst the team was good.

Staff received training appropriate and relevant to their role, and the support they needed to deliver safe care. Staff confirmed they received an induction when commencing employment at the home, adequate training and ongoing supervision. A staff member said, “Yes, I had an induction and shadow shifts. The induction covered everything I needed.” The deputy manager advised the provider encouraged staff to complete their care certificate and further qualifications such as Qualifications and Credit Framework (QCF) level 2 diploma. This helped ensure staff developed the necessary skills and competence.

We observed that staff were available throughout our visits, to support people with care and mobility needs. Call bells and verbal requests for support were generally responded too promptly. Inspectors witnessed the deputy manager and registered manager on-hand and available to offer support and guidance to staff as and when required.

There were robust and safe recruitment practices to make sure that staff were suitably experienced, competent and able to carry out their role. Application forms were completed in full, gaps in employment history were thoroughly investigated and appropriate recruitment checks were in place. Processes were followed, ensuring staff received a thorough induction and training appropriate to their role, to enable them to provide safe and good quality care.

No one raised concerns around the home’s cleanliness and hygiene though a relative commented that the home smelled. People confirmed they received support with personal care as per their preferences.

There was an effective approach to assessing and managing the risk of infection. Staff told us they had received Infection Prevention and Control (IPC) training and confirmed they had access to Personal Protective Equipment (PPE). The deputy manager told us measures taken to manage a recent outbreak at the home. They said, “People were isolated in their rooms until medication was in place. Additional PPE and cleaning was in place and separate bins for waste disposal.”

During visits inspectors noted an unpleasant odour and some furniture and fittings were scratched meaning thorough cleaning was more difficult, impacting good IPC. Despite this, the home was seen to be generally clean and tidy; and a housekeeper was working throughout. IPC measures such as signage promoting good hygiene, foot operated hazardous waste bins and PPE supplies were observed. The deputy manager took prompt action to have damaged furniture and fittings repaired or replaced following this assessment.

There were clear roles and responsibilities around IPC. The service had an infection control policy, and an infection outbreak management plan guided staff about what to do in the event of an outbreak. Cleaning schedules were in place for different areas of the home and equipment. The registered manager undertook infection control audits and kitchen inspections to ensure good standards of cleanliness and hygiene.

People had their medication administered safely, and in line with their needs and preferences.

The deputy manager spoke about the process for ordering, storage, management and disposal of medication and acknowledged additional measures were required to address concerns in these areas. People’s behaviour was not inappropriately controlled by medicines. A staff member commented that behavioural medication should only be used as a last resort. Another gave examples of how people had their medication reviewed to stop over-sedation. Staff confirmed they received training in medication administration and their competence was assessed regularly. Staff could tell us what action they would take if people refused their medication and the signs they would look for if someone needed as and when required (PRN) medication for pain.

The approach to medicines did not always reflect current and relevant best practice. The medication room was above recommended temperatures. Checks were not in place to assure us this concern was being monitored or escalated appropriately, meaning there was a risk medication in use could become ineffective or spoiled. Out of date topical creams were still in use, and the process for recording the administration of topical creams and transdermal patches was not robust. Medication Administration Records (MARs) for timely remedies did not include the time administered, so we could not be assured people always received their medication at the appropriate time. There were appropriate arrangements for the safe management, use and oversight of controlled drugs. Following the assessment, the registered manager implemented changes to processes for managing topical creams, transdermal patches and timely remedies. Additional checks and audits were implemented promptly.