The inspection took place on the 18 and 19 January 2017 and was unannounced. At the last inspection on 2, 3 and 7 September 2015 we found the provider had breached two regulations associated with Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014). These breaches related to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). The provider had not always ensured people’s medicines were managed safely and that complete and contemporaneous records were maintained in respect of each service user to ensure risks to their health and wellbeing were managed appropriately.

We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulation. At this inspection we reviewed whether or not these actions had now been taken and found the provider was meeting the requirements of the HSCA 2014. We found improvements had been made regarding the storage and administration of medicines and the completion of documentation relating to the delivery of people’s care.

Marnel Lodge Care Home, to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 62 older people who have a range of needs, including those living with Parkinson’s disease, sensory impairments as well as epilepsy and diabetes. The first floor of the home provides specialist care to people living with dementia. The home is purpose built to meet people’s needs and is situated in a residential area on the outskirts of the town of Basingstoke. Facilities includes two dining rooms and two lounges on both floors with a secure rear garden and patio area as well as a café area for people, visitors and relatives on the ground floor of the home. At the time of the inspection 58 people were using the service.

The home has a registered manager in post. 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 using the service told us they felt safe, relatives agreed they felt their family members were kept safe whilst living at the home. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. Appropriate risk assessments were in place to keep people safe.

Overall, sufficient numbers of staff were deployed in order to meet people’s needs in a timely fashion. The registered manager was addressing unplanned staff absence, which at times had caused a staff shortage. Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence required to support people safely.

People were protected from the unsafe administration of medicines. Nurses were responsible for administering medicines and had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Nurse’s skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.

People were supported by staff who had relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

People, where possible, were supported by staff to make their own decisions about their care and treatment. Staff were able to demonstrate that they complied with the requirements of t

We spoke with seven people living in Marnel Lodge, one relative and two friends of people living in the home. We also spoke with three staff.

We saw that people were spoken to and treated with respect and dignity. We observed staff giving people choices and encouraging them to make decisions. We looked at four care plans and saw that people and their family members were involved in writing them. One person’s relative we spoke with said “the communication is very good, they keep me informed”.

People’s needs were assessed. The care and support plans we looked at held information for staff on how to best support people. We saw that these were regularly reviewed and updated as people’s needs changed. People we spoke with told us that they enjoyed living in Marnel Lodge. They said “the staff are lovely”. Friends of one person told us “we tell all our friends about this place, it’s amazing. One of the nicest homes we’ve been to”. We saw that there was a schedule for daily activities. During our inspection there was a game of bingo, a trip to a garden centre and a visit from a pets as therapy dog.

We saw that people were offered food and drinks throughout the day. People were assisted by staff where appropriate. There was a system in place to ensure that risk of malnutrition was monitored.

There were sufficient staff to meet the needs of the people living in Marnel Lodge. One person said “I don’t have to call for staff, they are just there”.

There was an effective process for assessing and monitoring the quality of the service.

We spoke with five residents of Marnel Lodge and they all told us that they were happy and they enjoyed living there. One person said “it’s not the same as home, but you are not likely to find a better place”. Another said “there’s not much to trouble about”. The residents told us that they could get up and go to bed when they chose and there was always help available if they needed it. They told us that they were involved in their care and could tell the staff if there was a problem.

Residents that we spoke to were generally satisfied with the care that they received.

One resident, for example, said “its not bad here, staff give me help and I like to be independent”. One person confirmed that they had been able to visit before they moved in and another resident said that their privacy was always respected

Residents we spoke with said that the home was always very clean.

One person told us that they were well looked after and that the nurse gave their medicines to them which were locked in a cupboard in their room.

This inspection was unannounced and took place on the 2, 3 and 7 September 2015.

Marnel Lodge is a care home which provides nursing and residential care for up to 62 people who have a range of needs, including those living with epilepsy and diabetes. The care home comprised of two floors. The first floor of the home provided specialist care to those living with dementia. At the time of the inspection 57 people were using the service.

Marnel Lodge has a 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.

People were not always protected from the unsafe administration of medicines. The provider did not always follow national guidance regarding the storage and administration of medicines. Topical medication charts for creams prescribed to be used directly on people’s skin were not always completed fully. As a result it could not always be identified whether people had received their medicines at the correct time and whether they had been administered as prescribed. Nurses responsible for supporting people with their medicines had received additional training to ensure people’s medicines were being administered, stored and disposed of correctly. Nurses skills in relation to medicines management were reviewed on a regular basis by appropriately trained senior staff to ensure they remained competent.

People were supported to eat and drink enough to maintain a balanced diet. People told us they were able to choose their meals and they enjoyed what was provided. Records showed people’s food and drink preferences were documented in their care plans and were understood by staff. People at risk of malnutrition and dehydration were assessed to ensure their needs were met. However, records for people who required food and fluid chart monitoring were not always completed fully. As a result it could not always be identified whether people were eating and drinking sufficient to maintain their health.

People using the service told us they felt safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and managed. People were supported by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Robust recruitment procedures were in place to protect people from unsuitable staff. New staff induction training was followed by staff spending a period of time working with experienced colleagues to ensure they had the skills required to support people safely.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such fire or floods. Fire drills were documented, known by staff and practiced to ensure people were kept safe.

People were supported by staff make their own decisions. Staff were knowledgeable about the requirements of the Mental Capacity Act (MCA 2005). The service worked with people, relatives and social care professionals when required to assess people’s capacity to make specific decisions for themselves. Staff sought people’s consent before delivering care and support. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

People’s health needs were met as the staff and the registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been submitted to the relevant supervisory body to ensure people were not being unlawfully restricted.

Staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the care provided. The registered manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times. People were encouraged and supported by staff to make choices about their care including how and where they spent their day.

People had care plans which were personalised to their needs and wishes. They contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. Relatives told us and records showed that they were encouraged to be involved at the care planning stage, during regular reviews and when their family members’ health needs changed.

People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager as well as the completion of customer satisfaction questionnaires.

The provider’s values and philosophy of care were communicated to people and staff. Staff understood these and people told us these standards were evidenced in the way that care was delivered.

The registered manager and staff promoted a culture which focused on providing individual person centred care. People were assisted by staff who were encouraged to raise concerns with the registered manager. The provider had a routine and regular monitoring quality monitoring process in place to assess the quality of the service being provided.

Staff told us they felt supported by the registered manager.

We found breaches 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 this report.