This inspection took place on 13 and 14 November 2018 and was unannounced. At the last inspection completed on 20 March 2018 we rated the service Requires Improvement.

At this inspection we found improvements had been made, but more were needed and the service remains rated as Requires Improvement.

Marlyn House is a Residential 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.

Marlyn House accommodates up to 18 people in one adapted building. At the time of the inspection there were 10 people using the service.

There was a manager in post at the time of our inspection, they had made an application to register with us however this had not yet concluded. 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 were not always safeguarded from abuse. The provider did not always notify us of incidents at the home. Quality audits were not always used to drive improvement.

People were not always supported by sufficient safely recruited staff. People were not always supported to live in an environment which was suitable to meet their needs.

People were not always supported to maintain their health and well-being. People were not supported by staff that were consistently caring. People’s preferences were not fully understood by staff. People had access to a range of activities, but lacked engagement in the community and the ability to follow their individual interests.

We have made recommendations about person centred care and support, meaningful activities and the environment you can see more about this in the full report.

People’s medicines were administered as prescribed. Risks to people were assessed and planned for to keep people safe. People were protected from the risk of cross infection. The provider learned when things went wrong.

People had their needs assessed and plan were in place to meet them. Staff were supported in their role and had access to an induction and training. People received consistent support. People could choose their meals and were supported to eat and drink.

People had choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice.

People were supported to make choices and staff promoted people’s independence. People’s communication needs were assessed and planned for. People had their privacy and dignity protected.

People understood how to make a complaint and there were systems in place to respond to these. Nobody was receiving end of life care so this was not considered. People and their relatives were engaged in the service and felt able to approach the manager. Staff felt supported in their role and were involved in the service.

The location has previously been rated as Requires Improvement. At this inspection the provider had made improvements to those areas, but other areas were found to require improvement. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

We carried out an unannounced inspection at Marlyn House on 20 March 2018. Our last inspection was on 6 March 2017.

Marlyn House 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. The care home accommodates 18 people in one adapted building. At the time of our inspection, there were 14 people living there, some of whom were living with dementia. There is a communal lounge and separate dining room on the ground floor and a garden area that people could access with the support of staff.

There was a registered manager at the service. 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.

At our last inspection, we rated the service as ‘requires improvement’. We found the provider was not meeting the regulations because applications had not been made for legal authorisation when people were being deprived of their liberty. Improvements were also needed to ensure staff were deployed to meet people’s needs at all times, that people’s medicines were always managed safely and that there were effective systems in place to identify shortfalls and drive improvements at the service. The provider submitted an improvement action plan to show what they would do and by when to address the breach of the regulations and to improve the service to at least ‘good’ in the key questions safe, effective and well led.

At this inspection we found the provider had met the legal requirements when people were being deprived of their liberty. However, we found that further improvements were needed and identified new breaches of the regulations. This is the third consecutive time the service has been rated as ‘requires improvement’.

We found that people’s rights were not always being upheld when they were unable to make certain decisions for themselves. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

We were unable to satisfy ourselves that the provider followed safe recruitment procedures. The registered manager was unable to provide us with records for staff who had been recruited since our inspection and the information they provided after the inspection did not demonstrate that all the necessary pre-employment checks had been carried out. Staff received training but the registered manager did not have suitable systems to ensure this was kept up to date and in line with best practice.

Staff were available to meet people’s physical care needs but people’s emotional needs were not always met and care was often task focused. People did not feel involved in the planning of their care and their diverse needs were not always respected. People were not always offered choices and were not supported to follow their interests and engage in activities that interested them. Improvements were needed to ensure people could access the garden areas safely to promote their wellbeing. Procedures needed to be developed to ensure the home environment was consistently clean and hygienic and people were always safe from the risk of infection.

Staff understood people’s needs and knew what action to take to protect them from avoidable harm. However, risk management plans needed to be more detailed to ensure new or temporary staff always had the information they needed to support people safely. People received their medicines when needed but improvements were needed to ensure medicines were always reviewed regularly

Marlyn House provides accommodation and or personal care for up to 18 people, some of whom maybe living with dementia. On the day of our inspection 17 people were living in the home.

There was a registered manager at the home. 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 deployment of staff needed to be improved to ensure people were always supported to have a positive mealtime experience. Further improvements were needed to ensure people’s medicines were consistently managed in a safe way. Action was still needed to the systems used to assess and monitor the quality and safety of the service, to ensure shortfalls were consistently identified to bring about the required changes.

Staff sought people’s consent before providing care and supported people to make choices over their daily routine. However, the registered manager and staff did not always follow the legal requirements to ensure people’s rights were protected when they lacked the capacity to make their own decisions. The provider had failed to act on concerns raised at the last inspection. The registered manager had not understood their responsibility to identify people at risk of having their liberty restricted to ensure this could be assessed and legally approved. People were offered opportunities to engage in group social activities but were not always encouraged to follow their individual interests to maintain their wellbeing.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and registered manager. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. The provider followed recruitment procedures to ensure staff were suitable to work in a caring environment. Staff received training and support to meet people’s needs.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people. Staff promoted people’s privacy and dignity and encouraged them to maintain their independence. People were able to access the support of other health professionals to maintain their day to day health needs. People’s care was regularly reviewed to ensure it continued to meet their needs.

People were happy with the care they received and regular reviews were carried out to ensure it remained relevant. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes.

There was a positive, inclusive atmosphere at the home. People and their relatives were asked for their views on how the service could be improved. Staff felt supported by the registered manager and were encouraged to give their views on the service to improve people’s experience of care.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 20 April 2016 and was unannounced. At the last inspection, the service was rated overall as ‘Good’ but Requires Improvement in Well-led. We asked the provider to make improvements to their accident and incident and quality monitoring systems and to provide staff with regular opportunities, through supervision, to discuss their performance and personal development. At this inspection, we found some improvements had been made but further improvements were still required.

Marlyn House provides accommodation and or personal care for up to 18 people, some of whom maybe living with dementia. On the day of our inspection 16 people were living in the home.

There was a registered manager at the home. 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.

There were insufficient staff to meet people’s needs at all times and people had to wait for assistance during busy times. The provider followed procedures to ensure staff were suitable to work with people.

Further improvements were needed to ensure the systems to assess and monitor the quality and safety of the service were effective in identifying shortfalls and driving continuous improvement. The registered manager did not always notify us of important events that happened in the service to ensure we could check that appropriate action had been taken.

People received their medicines when they needed them but improvements were required to ensure medicines were stored, recorded and managed effectively. Staff gained people’s consent before providing care but there was a lack of understanding of the legal requirements where people lacked the capacity to make their own decisions.

Staff were provided with training and support to meet people’s individual needs. Staff knew people well and encouraged them to have choice over how they spent their day. Staff were kind and caring, promoted people’s privacy and dignity and encouraged them to maintain their independence. People were supported and encouraged to eat and drink enough to maintain a healthy diet. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was a positive atmosphere at the home. People and their relatives knew how to raise concerns and complaints and were confident they would be resolved to their satisfaction. The provider sought people’s views on the service and this was acted on where possible. Staff felt supported by the registered manager and provider and were encouraged to give their views on how people’s experience of care could be improved.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 14 May 2015. This was an unannounced inspection. At our inspection in September 2014 we identified concerns about the way the home was maintained and kept in good repair. At this inspection we found that improvements had been made and there was an ongoing refurbishment programme place.

The service was registered to provide accommodation and personal care for up to 18 people, some of whom maybe living with dementia. At the time of our inspection 14 people were using the service.

The service had a registered manager. 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.

Some quality management programmes were in place but the registered manager was not using the information from audits to improve the delivery of care to. Staff were not offered individual supervision to support their care and development.

People told us they felt safe living at the service. Staff understood their role in providing safe care and the actions they should take whenever they had concerns.

Staff received appropriate training to provide them with the skills they needed to care for people living in the home. There were sufficient numbers of suitable staff to meet people’s diverse needs and keep people safe.

People were given a choice of suitable food and were encouraged to take adequate fluids to promote their health. People’s health and wellbeing needs were monitored. People received additional support from health care professionals whenever specialist care was required.

People were treated kindly. Staff promoted people’s independence and respected their individuality. People were supported to make choices for themselves and staff respected their preferences.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Deprivation of Liberty Safeguards are for people who cannot make a decision about the way they are being treated or cared for and where other people are having to make this decision for them. People were asked for consent before their care was provided. Some people were unable to make choices or consent to their care. Staff understood the requirements of the MCA and the DoLS and ensured that when necessary, decisions affecting people’s health and safety were made in their best interests.

People were provided with opportunities to share their views about the service and action was taken based on people’s comments. People understood how to complain or raise concerns and there was a process in place to ensure any complaints were managed appropriately.

This inspection was carried out by a CQC inspector. We spoke with six people who used the service, five relatives, three members of staff, the registered manager, the provider and a visiting health care professional. We also reviewed records relating to the management of the home which included four care records, medication records, staff training records and minutes of meetings for staff and people who used the service. We used the information to answer the five questions we always ask:

Is the service safe?

Care records contained detailed information for staff about people's needs and the support needed to ensure they were safe. Risk assessments identified risks in daily living and the measures in place to reduce those risks. Risk assessments had been reviewed regularly. This provided a current profile of risk for each person.

People received effective and safe support to take the medicines they had been prescribed because detailed records had been kept and evaluated by the manager. Staff had training and regular assessments of their competency to administer medicines. This meant people were protected against the risks associated with the unsafe use and management of medicines.

Improvements had been made in relation to cleanliness and the control of infection in the home since our last inspection. We saw that following an outbreak of infection the manager had taken appropriate steps to control and prevent the spread of infection. The manager had consulted medical and specialist infection control staff to ensure appropriate actions were in place to prevent the spread of infection in the home.

We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to hospitals and care homes. This usually involves a restriction in a person's liberty to ensure their safety or the safety of others. Authorisation has to be sought from the local authority that may authorise the DoLS. We saw that since our last inspection one person had been made subject to a restriction under DoLS to ensure their safety and welfare.

Is the service effective?

People's health care needs had been recorded in records. Where health needs had changed, timely referrals had been made to a range of health professionals. We spoke with a visiting health professional who told us, "The home provides excellent care to the letter. Early referrals are made if staff have concerns. We can be confident that staff will follow instructions."

People who used the service and relatives we spoke with did not have any concerns or complaints about the service. It was clear from what we saw and from speaking with staff that they understood people's care and support needs.

Is the service caring?

A person using the service told us, "The staff are very good. I like to spend time in my room and they are happy with that. I need to use the lift and staff always help me."

A relative told us they were very happy with the care provided and told us, "X needs a lot of care. Staff understand exactly what is needed. They have helped (the person) through very difficult times. I have no complaints".

Staff were able to tell us in detail about people's needs and how they supported them. This knowledge matched the information we had seen in care records. We saw that staff showed patience and gave encouragement when supporting people.

Is the service responsive?

When people's health care needs changed external health professionals were contacted. Their actions and recommendations had been recorded in care information and acted upon.

We saw from the review of people's care needs that plans of care had been adapted when there had been a change in the person's needs or wishes,

A relative told us that when they had made a suggestion about a practical issue relating to their relative that staff had responded positively to the suggestion.

Is the service well-led?

Staff were clear about their responsibilities. They told us that they were supported by managers, they were listened to and could approach managers at any time for advice or support. This helped to ensure that people received a good quality service.

The provider and registered manager shared an office and both worked daily in the home. Lines of responsibility were clear. The manager makes daily decisions about matters relating to care and support. The provider supported the manager and was responsible for finance, the environment and matters relating to the operation of the home.

We found that the provider was not monitoring the quality of the service relating to the environment. Better auditing and recording of the maintenance of the environment is needed. We have asked the provider to tell us how they will make improvements.

Regular staff meetings had been held. Staff told us they felt able to raise any concerns in meetings or to make suggestions for improving the service. This was reflected in the minutes of meetings we saw.

On the day of our visit we spoke with four people who lived at the service, one visiting relative and three members of staff. We also spoke with the registered manager and the provider.

We found that the care people received was planned with them and their relatives to meet their needs. We were told: “If my relative is happy I am happy. My relative is very happy here”.

There were clear arrangements in place to ensure that if people required support from another provider that this was managed safely.

We had some concerns about the cleanliness of some areas of the home and the proprietor was positive about the improvements that they would make. Whilst we were at the home the proprietor arranged extra hours for the domestic staff to ensure that the areas that required attention were remedied.

We saw that recruitment processes meant that only people of suitable character were employed to look after the people who lived at the home. The manager told us they rarely had to advertise.

We found that suitable steps were taken to monitor the running and maintenance of the home. The proprietor told us that they would review arrangements for monitoring cleanliness and infection control.

We spoke with eight of the people who lived at the home, one visiting healthcare professional, one visitor and three members of staff. We also spoke with the proprietor.

When we last visited in September 2012 we had concerns with three outcomes. At this visit we reviewed these three areas, and found improvements in two of the three areas, the third area was being updated at the time of our visit.

One person we spoke with told us: “They prompt me with what I need and support me to be independent”. Another person who lived there told us: “They have time to come and chat with me. They come several times a day”.

We saw four different choices of meal served at lunchtime, and a variety of hot and cold drinks on offer throughout the day.

We saw that the records for each person who lived at the home were in the process of being updated. However these records provided sufficient information for staff to provide suitable and safe care to meet the needs of each individual person.

We found that staff records were in the process of being updated at the time of our visit. We saw that the staff folders had clear information about their training needs. However, only the newer folders contained all of the information about staff and the recruitment process.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of an inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

During this visit we spoke with ten people that lived in the home, the relatives of two people, two care staff, the cook, the manager and the owner of the home. We spent some time observing how people were cared for.

About half of the ten people living in the home we spoke to thought that their care could be improved. They thought that there needed to be more activities, more choice of food and that some of the care staff could be nicer. Others thought that the care staff were wonderful.

We found that there was little choice in food, activities and involvement of people in how their care was given. The home could not demonstrate how they helped people to have individualised care that respected their preferences.

During our visit people were spoken to with respect and generally were supported and assisted when needed. The meals provided were sufficient to maintain people's weights. Arrangements were made to take into account people's health conditions where this affected their diet and care staff had knowledge of the effects of these conditions. People were encouraged to have appropriate amounts to drink.

People's care records needed some improvement to ensure that nutritional risks were appropriately assessed. Where risks to people changed their records needed to be updated.