Marchfield House is a residential care home for 26 older people with dementia. There are two floors with the first floor having access via a passenger lift, stairs or a stair lift. There is a large open plan communal living and dining area on the ground floor.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of falling or skin damage staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their families described the staff as caring, kind and friendly and the atmosphere of the home as homely. People were able to express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. Staff spoke positively about the management and had a clear understanding of their roles and responsibilities. An awards programme was in place which staff told us boosted morale and good team work. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below

We were unable to speak to most people who lived in the home due to their complex needs. We spoke with one person who lived in the home. We spoke with another person who lived in the home in the presence of a relative who was on a visit, and spoke with two other people who were visiting relatives who lived in the home.

A person who lived in the home told us they understood the care choices available to them, and could have their views taken into account in the way their care was delivered. The person told us, "They always ask my permission before they do anything. They explain things to me.”

We found that people's needs were assessed, and care was planned and delivered to meet people's needs. A person’s relative told us, "I’ve seen Mum’s care plan and discussed it." People's care was regularly reviewed and their personal information was held securely.

We looked at people’s medication records. We saw that people were protected from the risks associated with the unsafe use and management of medicines, as the home had medication management procedures in place.

We viewed a selection of staff records, and saw that relevant checks had been carried out when the home employed staff. Staff records also contained full employment histories. The provider told us, “We’ve done a lot of work on staff records.” We saw that staff had opportunities to gain appropriate qualifications.

The home had an appropriate system in place to deal with comments and complaints.

Our inspection of 18 June 2012 found that the home did not operate effective recruitment procedures. Not all the information required, such as a full employment history, was present at the time of inspection. We asked the provider to supply a plan detailing how they would make the required improvements with their recruitment procedures.

We inspected the home again on 27 September 2012 and found that sufficient improvements had not been made. We served a warning notice requiring compliance with the standard by 31 October 2012.

During this inspection we found that improvements had been made and all required pre-employment checks were carried out and effective recruitment procedures were in place.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We used SOFI2 (Short Observational Framework for Inspection) tool to help us see what people’s experiences were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 30 minutes during the morning observing people’s experiences. Staff engaged with people and their interactions were both considerate and appropriate.

We spoke to three relatives of people whose family member's were living at the home. People's relatives told us that they had been involved in the assessment and planning of their family member's care and felt that the care delivered was appropriate to meet their needs. We saw that people were treated with dignity and their privacy was respected. For example we saw staff support a person to move to a more private area to entertain their visitors.

Staff were knowledgeable about safeguarding and how to raise concerns. Checks were undertaken prior to staff starting employment. However, details of staff employment history was not fully recorded as is required by the standards.

Systems were in place to monitor the quality of the service. Relatives felt able to make comments about the running of the service to the provider. They were also confident that feedback would be listened to. Although the feedback about care was good, records relating to people's care and the management of the service were not always fully completed or accurate.

The inspection took place on 17 November 2015 and was unannounced. The inspection continued on 19 and 20 November.

The service is registered to provide personal care with accommodation for up to 22 adults. The service has 22 ensuite bedrooms some with walk in showers and others with baths. The service has a large open plan living and dining area that people are free to use at any time. The living area overlooks a patio area which leads into a level access garden. The accommodation is over two floors and the first floor can be accessed by two stair lifts or a passenger lift. Each room has a call bell so that people can call for help when needed. There is a fully equipped hairdressing salon situated on the ground floor.

The service has a registered manager in place. 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.

People told us that they felt safe living at the service, one person told us, “I’ve had a lovely life and now I’m here which is great”. A health professional told us, “People are safe here due to staff attention, retention and their caring nature. It makes a difference and I can see that”. Staff were able to tell us how they would recognise if someone was being abused and what they would do. Staff told us that they had received safeguarding training and the training records we reviewed confirmed this.

There were policies in place for a number of areas such as safeguarding, complaints, behaviour that challenges the service and whistleblowing however, they were reflective of the old Essential Standards and Regulations. We raised this with the registered manager who agreed to review and update the services policies.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they choose to live their lives. Each person had a care file which also included individual assessments and guidelines to make sure staff supported people in a way they preferred. Risk assessments were also completed, regularly reviewed and up to date.

Each person had a personal emergency evacuation plan in place which detailed how people were to be supported in the event of an emergency. These plans were regularly reviewed and up to date. There was also an emergency contingency plan in place which had details of what staff should do to keep people safe in the event of a failure of service for example a gas leak, numerous staff sickness and failure of electric to name a few.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example dementia, pressure area care, nutrition and diabetes. Some people staff were supporting presented behaviour which challenged the service however; only two out of 15 staff had received training in this. Staff told us that they would find this training useful.

People had a capacity assessment in place and care files we reviewed showed evidence of best interest meetings taking place. Staff were aware of the Mental Capacity Act. Deprivation of Liberty Safeguards applications have been completed for everyone and these have been sent off to the Local Authority.

People and relatives said that the food was good. One relative told us, “Food is brilliant. The chef is very good. There are certain things mum can’t eat, they accommodate this”. The majority of people ate their meals in the dining area and staff ate with them. People who were supported in their rooms had isolation charts in place which recorded their fluid and food intake. Most meals cooked are homemade and those cooked on the days of the inspection looked and smelt very appetising.

People and relatives told us that the service was caring. One person told us, “Staff are very good, helpful and have a friendly manner”. A relative told us, “The care for my mum is spot on”. Staff acknowledged people as they entered the room and communicated with them at eye level rather than standing over them. Staff told us how they liked to be able to spend quality time with people to have conversations and do activities with them. People’s privacy and dignity was respected, if people required support with personal care they were supported discretely back to their rooms and doors were closed. One relative told us, “they are always treating her with upmost dignity”.

Peoples care files had admission assessments in place and the information from these formed the foundation of their individual care plans, individual assessments and support guidelines for staff to follow. There was evidence that these were regularly reviewed in response to peoples changing needs. A relative told us, “Mum gets all the care she needs. It is a bit more difficult as she has dementia and can’t tell them. But staff pick up on it and respond to her”.

The service carried out annual feedback questionnaires which are sent to families, health professionals, staff and people who have capacity to understand them. Feedback is gathered and outcome letters are sent back out. There was no evidence of an action plan in response to feedback collected. The responsible individual told us that outcome and actions are generally discussed and acted upon informally and not recorded. A relative told us, “There is a survey once a year. We have informal discussions about results”. Overall the feedback reviewed during the inspection for 2014/15 was very good.

Complaints were recorded and acted upon quickly with an average turnaround of 48 hours from those reviewed. A relative told us “I have raised concerns once or twice and these issues have been sorted straight away”.

People, staff, relatives and health professionals all said that they felt the home was well managed. One relative told us, “The manager is always accessible and takes note of what I ask”. The manager encourages an open working environment for example, we observed on several occasions staff coming up to them or visiting the office to discuss matters with her.

The responsible individual carried out annual quality audits which covered areas such as health and safety, infection control, accidents and incidents, environment and a planned programme of maintenance and replacement. There has been a lot of investment put into the service making the living environment safer and homely for people to live in. A health professional told us, “I have been coming here for 10 years and have seen great transformation here”.