This inspection took place on 4 and 13 December 2017 and was unannounced. Marlborough Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Marlborough Court provides care for up to 78 older people requiring residential or nursing care, some of whom may be living with dementia. The service is provided over three floors. Thames unit on the ground floor provides nursing care for 21 people, the Union Jack unit on the first floor provides residential care for 28 people who live with dementia and King George unit on the top floor provides residential care for 29 people. At the time of this inspection the home was providing care and support to 66 people.

Marlborough Court did not have a registered manager in post. The registered manager had resigned their post just prior to the inspection. 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. The deputy manager was in day to day charge of the home and was being supported by senior managers. The regional manager told us they were in the process of recruiting a new manager to run the home.

There were safeguarding procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure in place and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. There were enough staff on duty to meet people’s needs. Risks to people had been assessed and reviewed regularly to ensure their needs were safely met. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals. The home was clean, free from odours and was appropriately maintained.

The deputy manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work, they had received regular supervision and training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.

People’s privacy was respected. People and their relatives, where appropriate, had been consulted about their care and support needs. People received appropriate end of life care and support when required. Care plans and risk assessments provided guidance for staff on how to support people with their needs. There was a range of appropriate activities available for people to enjoy. People knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

There were appropriate arrangements in place for monitoring the quality and safety of the service that people received. The provider took into account the views of people and their relatives and visiting professionals through surveys. The results were analysed and action was taken to make improvements for people living at the home. Staff said they enjoyed working at the home and they received good support from the deputy manager and senior managers.

This inspection took place on 6 and 7 December 2016 and was unannounced. Marlborough Court provides care for up to 78 older people requiring residential or nursing care, some of whom may be living with dementia. The service is provided over three floors. Thames unit on the ground floor provides nursing care for 21 people, the Union Jack unit on the first floor provides residential care for 28 people who live with dementia and King George unit on the top floor provides residential care for 29 people. At the time of this inspection the home was providing care and support to 53 people.

At our previous inspection on 26, 27 and 28 April 2016 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that action had not always been taken to support people where risks to them had been identified. Staff did not assess risks to people using the service in a timely way following a fall. Staff were not updating some people's care plans to reflect their current or changing needs. Staff had not received the appropriate support, training and supervision to enable them to carry out their duties. Untrained staff were administering medicines to people using the service. Some staff were not aware of their responsibility to report abuse. Staff were not always aware of people's care needs. People using the service were not always treated in a dignified manner. The provider's systems for monitoring the quality of the service provided to people were not operating effectively as we found some issues with care plans and risk assessments that the provider had not identified.

Following that inspection we imposed urgent conditions on the provider’s registration at the home. We told the provider to not admit any new people to the home without the prior written agreement of the Care Quality Commission. We told the provider to undertake audits of the training and supervision provided to all staff working at the home. We asked the provider to send CQC a report of the result of these audits and any action taken or to be taken as a result of the audit. We also placed the home in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

The provider had not admitted any new people to the home since the last inspection. They sent us reports from the result of the audits they carried out. They also sent us regular weekly updates regarding the training and supervision of all staff working at the home. As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five key questions, it is no longer in special measures. We have removed the urgent conditions from the providers registration at the home as the Commission no longer feels they are necessary.

At this inspection we found that risks to people using the service were assessed, reviewed and managed appropriately. People’s medicines were managed appropriately and they were receiving their medicines as prescribed by health care professionals. There were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks were being carried out before staff started working at the home and there were enough staff to meet people’s needs.

All staff had completed mandatory training in line with the provider’s policy; they were receiving regular formal supervision and, where appropriate, an annual appraisal of their work performance. The manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. People were being supported to have a balanced diet and they had access to health care professionals when they needed them.

Staff had a good understanding of peoples care and support

This unannounced inspection was carried out on 26, 27 and 28 April 2016. The inspection was undertaken to check on serious safety concerns we had received about the service. We identified breaches in legal requirements in relation to safe care and treatment and monitoring the quality and safety of the service. We took action to impose a condition to restrict new admissions to Marlborough Court without the prior written agreement of the CQC. We also imposed conditions that the provider undertakes audits of the training and supervision of all staff at Marlborough Court and send the CQC written reports of the results of these audits and any action taken or to be taken as a result of the audits. The provider must continue to provide us with such reports following each and every audit undertaken in respect of these matters. You can see what action we told the provider to take at the back of the full version of the report.

Marlborough Court provides care for up to 78 older people requiring residential or nursing care, some of whom may be living with dementia. The service is provided over three floors. Thames unit on the ground floor provides nursing care for 21 people, the Union Jack unit on the first floor provides residential care for 28 people who live with dementia and King George unit on the top floor provides residential care for 29 people. We last inspected Marlborough Court in June 2015. At that inspection we judged that the home was outstanding in the key questions effective and well led. The overall rating for the home was “Outstanding”.

At the time of this inspection, a number of changes had taken place in the home, which negatively impacted on the quality of care provided to people. The overall rating of the home dropped from outstanding to inadequate. The primary reason for the decline in quality and rating is the changes in management and staffing.

The home did not have a registered manager in place. The previous registered manager left the home in December 2015 and the previous deputy manager left the home in February 2016. Twenty one other staff had left employment at the home from 28 December 2015 to 24 April 2016 including two senior health care assistants and seven health care assistants. Some regular bank staff had also stopped working at the home. The current manager started working at the home on 1 February and a deputy manager had been appointed on the 1 April 2016.

At this inspection we found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014 in relation to safe care and treatment and staffing. Action had not always been taken to support people where risks to them had been identified. Staff did not assess risks to people using the service in a timely way following a fall and Staff did not respond appropriately and in good time when a service user had a fall. Staff were not always following the guidance as recorded in some people's care files and staff were not updating some people's care plans to reflect their current or changing needs. Staff had not received the appropriate support, training and supervision to enable them to carry out their duties. We found that untrained staff were administering medicines to people using the service.

Some staff were not aware of their responsibility to report abuse. Staff were not always aware of people's care needs. Some staff had not had the time or the opportunity to read care files and risk assessments or get to know the people using the service. People using the service were not always treated in a dignified manner. The provider's systems for monitoring the quality of the service provided to people were not operating effectively as we found some issues with care plans and risk assessments that the provider had not identified.

We found that appropriate recruitment checks took place before staff started work. People received their medicines as prescribed by health care professionals. There were arrangem

People we spoke with told us that she had been in the home for about a year and enjoyed trips to a local theatre, the seaside, the coffee and bingo mornings. A relative also told us they were happy with his mother’s care – and said that there were no concerns.

We spoke with a person who had recently moved into the home who told us the food was good and a friend had been at the home `for a long time and that the staff were patient and `good people’.

Some relatives told us that the staff were very busy at lunch times and not always able to provide assistance as promptly as they needed to and their relatives had to wait for long periods of time before help was given.

We found that care plans had been re written and reviewed on a monthly basis although there were concerned about aspects of the care individuals had received. There are systems in place to report safeguarding incidents and the provider has implemented a quality assurance programme.

People told us that personal care was delivered behind closed doors and that staff protected their privacy and dignity. We were told that staff always called the by their name and that they felt staff respected them.

People we spoke with on our visit said they felt generally safe at the home.

People told us the food was ‘alright’. They said the decoration of the home had been recently improved.

People said they were able to see a doctor when they needed to.

One person told us that their clothes sometimes went missing at the home and that sometimes staff forgot to place the telephone within reach of a person with limited mobility.

We gathered evidence of people’s experiences of the service by reviewing comment cards and the complaints log. We found that relatives stated there had been an improvement in the facilities provided at the home, particularly around the furniture and decorations and that people were generally happy with the new manager and service provider.

Comments we saw included ‘staff are excellent’ and ‘the residents and relatives meeting was reassuring as it outlined the improvements particularly for the people living with dementia’

This inspection took place on 25 and 29 June 2015 and was unannounced.

Marlborough Court provides care for up to 78 older people requiring residential or nursing care, some of whom may be living with dementia. The service is provided over three floors. Thames unit on the ground floor provides nursing care for 21 people, the Union Jack unit on the first floor provides residential care for 28 people who live with dementia and King George unit on the top floor provides residential care for 29 people.

We last inspected Marlborough Court in February 2014. At that inspection we found the service was meeting all the regulations that we assessed.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and their visitors were positive about the care and support provided at Marlborough Court. Staff knew people well and understood how to meet their individual needs. We observed positive relationships between staff and people at the service and their relatives or carers. Visitors were welcomed and people were supported to maintain relationships with those who matter to them.

The Union Jack unit had been accredited as a Positively Enriching And Enhancing Residents Lives (PEARL) dementia service. Staff had received additional specialised training in dementia as part of this organisational accreditation process and the staff members spoken with were proud of the specialised service being provided on the unit. Our observation was that this unit had lots of interaction, conversation and activity going on throughout our inspection visits. Numerous signs of individual wellbeing were observed with people positively engaging with each other and with the staff working on the unit.

The environment on the Union Jack unit was designed and arranged to promote engagement and wellbeing using decoration, signage and other adaptations. A specially designed sensory garden for people living with dementia was also opened at Marlborough Court in 2014 with its own water features, wall chimes, plants and seating areas. Rails and raised beds helped people use and interact with the garden and sensors triggered different noises when people walked nearby.

Risk assessments were in place that reflected current risks for people at the service and ways to try and reduce these. Care plans were being regularly reviewed to ensure the care provided met people’s changing needs.

Staff received training to help them undertake their role and were supported through regular supervision and appraisal. Staff had training in working with the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in thesafe administration of medicines and kept records that were accurate.

People told us that they felt able to raise any issues or concerns and these were dealt with promptly and satisfactorily. There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these.

The service sought different ways to enable people, their relatives or carers and others involved with the home to be empowered and voice their opinions. There were effective systems to regularly assess and monitor the quality of service provided. Audits were carried out and, for areas where issues were identified, action been taken to ensure people’s welfare and safety.

There was strong leadership at Marlborough Court. An experienced registered manager communicated a strong ethos focusing on person centred care and ensuring a good quality of life for the people staying there. Staff told us they felt valued and appreciated for the work they did by the management team. The home had made sustained improvements over time and had achieved recognition from other professionals within the sector. The registered manager and staff working at Marlborough Court had won a number of Great British Care and National Care Awards which are a series of regional and national awards throughout the UK.