This comprehensive inspection took place on the 30 October 2018 and was unannounced.

Marquis Court Tudor 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 up to 52 people in one adapted building, arranged over two floors. There is a floor for residential care and a floor for nursing care. At the time of our inspection, there were 31 people living there, some of whom were living with dementia. There is a communal lounge and separate dining room on each floor and a small garden area to the front and side of the home.

There was a registered manager in post. They were unavailable during our 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.

At the last inspection we asked the provider to take action to make improvements to staffing within the home. At this inspection the provider has not made the necessary action.

There were not enough staff available for people and they had to wait for support. We raised this as a concern at our last inspection and the provider has not taken the necessary action to comply with this regulation. This is the fifth consecutive time this service has been rated as requires improvements.

The lack of staff in the home meant people were not always encouraged to be independent or supported in a kind and caring way. This was because staff were rushing and did not always have time to spend with people to ensure they received the support they needed. This included a condition of one person’s DoLS authorisation not being met. We also found people’s capacity had not always been assessed when needed. At this inspection people are 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 do not support this practice

People felt there could be more to do in the home and there was not always the opportunity for people to participate in activities they enjoyed. People did not always receive care that was responsive to their needs and care records were not always accurate completed.

People were happy with the staff that supported them and the provider had ensured they were suitably recruited. Staff understood safeguarding and how to protect people from potential harm. People were encouraged to make choices and their privacy and dignity was considered. People were happy with the food and drink that was available. There were infection control procedures in place and these were followed.

Risks to people were considered and reviewed and medicines were managed in a safe way. Staff received an induction and training that helped them support people. The home was decorated in accordance with people’s needs and preferences.

Staff offered consistent care and knew people well. When people complained they were happy with the outcome, there were complaints procedures in place that the provider followed. People were supported to access health services when needed. Staff felt listened to and knew who the registered manager was. Relatives and friends could freely visit the home. The provider worked jointly with health professionals who came into the home. The provider was displaying their rating in line with their requirements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been

We carried out an unannounced inspection at Marquis Court Tudor House on 20 March 2018.

Marquis Court Tudor 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 up to 52 people in one adapted building, arranged over two floors. At the time of our inspection, there were 30 people living there, some of whom were living with dementia. There is a communal lounge and separate dining room on each floor and a small garden area to the front and side of the home.

The service had 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.

The service has been rated as ‘requires improvement’ at the four comprehensive inspections carried out since 2014 and there have been repeated breaches of the regulations. Our last comprehensive inspection of this service was on 22 February 2017. We found the provider was not meeting the regulatory requirements because people were not always protected from the risks associated with their care, there were insufficient staff to support people in a timely way and people were not always treated with dignity and respect. The provider’s quality assurance systems were not effective in identifying shortfalls and ensuring that regulatory requirements were met. We rated the service as ‘requires improvement’. Following the comprehensive inspection, we issued a warning notice and told the provider to take action to ensure people received safe care and treatment by 24 April 2017. The provider sent us an action plan saying how and by when they would meet the legal requirements. On 15 May 2017, we undertook an unannounced, focused inspection to check that they had followed their plan and taken the relevant action needed to meet the requirements of the warning notice. We found that the required improvements had been made to the way risks were managed and that people were protected from avoidable harm. This meant the warning notice had been met.

At this comprehensive inspection, we checked that the provider had met the remaining legal requirements and had improved the key questions of safe, effective and well-led to at least ‘good’. We found some improvements in the management and oversight of people’s care and we saw significant improvements in the staff culture, reflected in people’s views that staff were consistently kind and caring. However, further improvements were needed to ensure people received timely, personalised care and that systems to monitor the quality and safety of the service were effective in ensuring the service is consistently well led and meeting all legal requirements.

We found there were not enough staff to support people in a timely, person centred way that promoted their dignity at all times. Systems used to set staffing levels were not effective in ensuring there were sufficient staff available to meet people’s individual needs and preferences at all times. People were protected from the risk of abuse and staff knew what actions they should take to minimise the risks associated with people’s care. However, we could not be assured there were sufficient staff to support people to stay safe at all times.

People did not always feel involved in planning their care and people’s individual needs were not always identified and met. People were not always supported to access activities that interested them and were relevant to their needs and preferences. We have recommended that the provider seeks guidance in this area to ensure people are supported to

We carried out an unannounced comprehensive inspection of this service on 22 February 2017 and found four breaches of the legal requirements. On 14 March 2017 we issued a warning notice to the provider in Regulation 12 HCSA (RA) Regulations 2014 Safe care and treatment. This was in relation to the management of risks to the health, safety and wellbeing of service users. We told the provider to take action before the 24 April 2017. After the warning notice was issued, the provider wrote to us to tell us what action they were taking.

We undertook this focused inspection on 15 May 2017 to check that they had followed their plan and taken the relevant action needed to meet the requirements of the warning notice. This report only covers our findings in relation to those requirements set out in the warning notices. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marquis Court Tudor House on our website at www.cqc.org.uk

There was 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.

At the focused inspection on 15 May 2017, we found that the required improvements had been made to the way risks were managed. Where risks to people’s health and safety had been identified, plans were in place to guide staff on the actions they should take to minimise these risks. We saw staff followed the guidance to protect people from avoidable harm.

The provider had increased staffing levels and we saw that people received timely support. However, further action was needed to demonstrate that the provider had acted on all the concerns raised at the last inspection to demonstrate there were sufficient, suitably trained staff available at all times. This meant there was a continued breach of the legal requirements.

People were safe because the provider followed recruitment procedures to ensure staff were suitable to work in a caring environment. Staff understood their responsibilities to protect people from the risk of abuse. Systems were in place to audit medicines to ensure any errors could be identified and rectified.

Marquis Court (Tudor House) provides accommodation for up to 52 people who require nursing or personal care, divided into a nursing and a residential unit over two floors. Some people have complex medical conditions and some people are living with dementia. On the day of our inspection visit, 28 people were living at the home. We had previously inspected the home in September 2016 and rated the home as Requires Improvement overall with specific concerns about the management of risks associated with people’s care and medicines and that people were not always treated with dignity.

We received an action plan from the provider in October 2016 which said the improvements would be made by January 2017. At this inspection, we found some improvements had been made but further action was still needed to ensure the legal requirements were being met. We also found improvements were needed to ensure there were sufficient, suitably qualified staff available to meet people’s needs and the effectiveness of the provider’s quality assurance systems.

There was a registered manager who had started working at the service in October 2016 and had registered with us in February 2017. 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.

We found improvements were still needed to ensure risks associated with people’s care were always managed safely. The registered manager had made improvements to ensure medicines were administered, stored and recorded safely. However, there were insufficient, suitably qualified staff and people’s medicines were sometimes delayed and people’s care needs were not always met in a timely fashion. Staff were busy which meant interactions with people were limited and at times, staff did not always treat people with dignity and respect. People were not always supported to have an enjoyable mealtime experience and some people’s individual needs were not met. The activities co-ordinator had been absent from the service for some time and people were not always offered opportunities to join in social activities and follow their hobbies and interests

People and their relatives had told the provider on a number of occasions that there were insufficient staff to meet their needs. However, the provider had failed to act on their feedback and had not effectively assessed, monitored and mitigated risks to ensure there were sufficient suitably qualified staff to meet people’s needs at all times. Quality assurance checks were not always effective in identifying shortfalls and driving improvements in the service.

Improvements were needed to ensure staff received effective training and support to meet the needs of people they cared for. The provider followed procedures to ensure staff were suitable to work in a caring environment.

People felt safe living at the home and staff understood their responsibilities to protect people from the risk of abuse. People accessed the support of other health professionals when needed and were encouraged to keep in contact with family and friends. Visitors were able to visit without restriction. Relatives felt involved in people’s care and were kept informed of any changes.

The registered manager and staff understood their responsibilities to support people to make their own decisions as much as possible. Where people lacked the capacity to make decisions for themselves, decisions were made in people’s best interests which followed legal guidance. Where people were being restricted of their liberty in their best interests, the registered manager had applied for the required legal approval.

People felt confident raising concerns and complaints. The provider was open and transparent and kept people inf

This inspection took place on 20 September 2016 and was unannounced.

Marquis Court (Tudor House) provides accommodation for up to 52 people who require nursing or personal care, divided into a nursing and a residential unit over two floors. Some people have more complex medical conditions and some people are living with dementia. On the day of our inspection visit, 36 people were living at the home.

We inspected the home in November 2015 and rated the home as Requires Improvement overall with specific concerns about the sufficiency of staff to meet people’s needs and the effectiveness of the systems used to assess, monitor and improve the quality of the service. We received an action plan from the provider which said the improvements would be made by July 2016. At this inspection, we found some improvements had been made but further action was still needed. We also found improvements were needed in the administration and management of people’s medicines and the risks associated with people’s care.

There was a registered manager but they had recently left their employment with the provider and were no longer working 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. The management of the service was being overseen by the regional manager and a nurse consultant, who had been brought in to deliver improvements at the service. The regional manager told us the provider was arranging for an interim manager whilst a permanent manager was recruited.

At the last inspection we asked the provider to ensure there were sufficient staff to meet people’s needs at all times. At this inspection we found there were sufficient staff to meet people’s needs but further action was needed to ensure staff were effectively deployed to provide timely support to people in communal areas and during mealtimes.

At the last inspection we asked the provider to make improvements to their quality assurance systems to ensure the quality and safety of the service was maintained. In the absence of the registered manager, some of the systems being used to monitor the quality and safety of service provided were not up to date and we found shortfalls in the management of people’s medicines and the systems used to monitor the accuracy of care records. We found there was a lack of management oversight which meant that some people did not receive their medicines as prescribed and staff did not always take action when people’s needs changed. Risks associated with people’s care were not always well managed and some people did not receive care and treatment that met their individual needs and ensured their safety and wellbeing.

Whilst some staff were observed to treat people in a kind and compassionate manner this was not always demonstrated by other staff, who did not always treat people with dignity and respect. Staff did not always interact with people when they were supporting them. Staff and they encouraged people to make choices about their daily routine to promote their independence.

People told us they had enough to eat and drink but some people weren’t happy about the quality and variety and meals and this was being addressed by the provider. People told us they received the support of other health professionals when needed.

Staff told us they received an induction and training to fulfil their role and the provider was taking action to ensure staff received all the training they needed to provide effective care. Staff felt supported by the management team overseeing the service but were concerned that the improvements that had been made would not be sustained.

Staff gained people’s consent before providing care and support and understo

This inspection took place on the 22 December 2014 and was unannounced.

At our previous inspection of April 2014 we found that the provider was delivering care that was safe and met people’s needs.

Marquis Court (Tudor House) Care Home is registered to provide care and treatment for up to 52 people who may have Dementia, require nursing and residential care and who may have physical disabilities.

The provider did not have a registered manager in post at the time of our inspection. This meant the provider was in breach of the conditions of registration. ‘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.’

We identified that improvements were required to ensure people received their medicines safely and safe storage arrangements were in place.

Some people were unable to make certain decisions about their care. The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) set out requirements to ensure where appropriate; decisions are made in people’s best interests when they are unable to do this for themselves. We found that the staff did not have an up to date understanding of the DoLS to manage the restrictions they placed on people.

Risks associated with infection control and cross contamination were not effectively managed.

Staffing numbers were not always sufficient to meet the needs of people who used the service.

People’s risks were assessed and managed, but staff did not always understand how to keep people safe and report safety concerns.

The staff had received training that enabled them to meet people’s needs safely. Care was usually provided with kindness and compassion and people’s independence and dignity were promoted.

People’s dietary needs were met. People chose the food they ate and specialist diets, such as; diabetic diets were catered for.

People’s health and wellbeing were monitored and staff worked with other professionals to ensure people received medical, health and social care support when required.

People were involved in an assessment of their needs and care was planned and delivered to meet people’s individual care preferences. People had access to activities but some felt they did not meet their individual needs.

People knew how to make a complaint and complaints about care were managed in accordance with the provider’s complaints policy.

There had been a recent change in the management team and people and staff told us the new manager was approachable.

There was a need for the provider to review the effectiveness of the tools they used to monitor and improve quality as these were not always effective.

We found a number of breaches of regulations you can see what action we told the provider to take at the back of the full version of the report.

We visited Marquis Court (Tudor House) on a planned unannounced inspection which meant that the service did not know we would be visiting.

We are changing how we inspect services in the future and also making changes in how we report our findings. Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us that Marquis Court (Tudor House) was a good place in which to live and the staff cared and supported them well.

Sufficient staff were provided to deliver people’s care needs and they received the training they needed to provide the necessary care and support.

There were systems in place to analyse accidents and incidents in the home, to ensure lessons were learned and improvements were made to protect people.

Is the service responsive?

People’s health, social and support needs were assessed and reviewed at regular intervals.

The service had a complaints procedure for people to use where they were unsatisfied with the care provided. People told us and we saw the manager took all concerns and complaints very seriously and acted swiftly to resolve issues.

Is the service caring?

People told us they were happy and liked living at Marquis Court (Tudor House). One person told us: “It is very good here; staff do all they can to help. We have plenty to eat and drink. I have no concerns it’s lovely”.

People who were unable to comment or did not wish to speak with us looked comfortable, well groomed and cared for.

Is the service effective?

People’s health and care needs were assessed, recorded and reviewed, but people and/or their representatives were not always included. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People told us they received the support they needed.

Is the service well led?

People who used the service and the staff we spoke with all told us that the current manager was supportive, approachable and friendly.

We previously had concerns about the monitoring of the quality and safety of the service. We saw that some improvements had been made. The provider must now continue with sustaining and further improving the service to ensure a quality service is provided.

We spoke with ten people who lived at the home and three relatives.

The majority of people said that they were treated with respect and had their privacy and dignity promoted. One person said: "They are always respectful and ask me before they do anything". Another person said: "They are very good about making sure they respect your privacy. They always knock and wait to be invited to come in".

The majority of people we spoke with told us they received care when they requested and needed it. One relative said: "She is always clean and tidy whenever we come". There was a need to ensure that people consistently received timely care, support and treatment to maintain their health and wellbeing.

We found the home was clean although this will be further improved when the updating and replacement of the carpets had been completed. There were appropriate systems in place to reduce the risk of cross infection. People who lived or visited the home told us they found the home to be clean. One person told us: "It’s always been alright here in my book, good home, very clean and good carers”.

People generally told us that staff were caring. One person said: "I can’t knock the girls here- I call these girls my family". A relative said: "All the staff are warm and welcoming and take time to talk to us when we visit. We found that improvements were needed to ensure that staff were appropriately supervised and people were protected against inappropriate care.

There were systems in place to assess the quality of the service provided, however these systems were not always effective.

This inspection was undertaken to review actions taken since our previous inspection and assess the service's compliance with the regulations.

We spoke to two people who lived at the home and one relative. People we spoke with told us that they or their relative received the care they needed. One person told us, "It’s ok here, and better than where I was before".

People were consulted about how and where they spent their day. One person said that they got up and went to bed when they choose. They told us that their friends and relatives were able to visit them.

We found that additional staff had been recruited and were available since our previous inspection. We found that additional monitoring was needed to check that there were sufficient staff to provide care and support to people on an ongoing basis.

We found that the home had made improvements which demonstrated that it was compliant with the regulations we assessed.

We carried out this inspection as part of our planned programme of inspections. The visit was unannounced and neither the staff nor the provider knew that we would be visiting.

The inspection included the observation of care experienced by people living at the

home, talking to people who were living in the home, talking with the manager and staff on duty, looking in detail at all aspects of care for five people some of whom had complex needs, viewing people's rooms and discussing their care with staff. This process is known as pathway tracking.

Marquis Court (Tudor House) shares the site with its sister home Marquis Court (Windsor House) which is managed separately.

The home provided both nursing and personal care and support for people. We found that the home was arranged to accommodate people with personal care needs (also referred to as residential care needs) on the lower ground floor and ground floor and nursing care needs on the top floor.

We met with the manager, area manager, four staff, two visitors and five people who lived at the home. People we spoke with were all generally positive about the care and support they or their relative received. One person told us; "It’s a good home, it's my home, the carers are good, the food is good and its' clean". Another person said, "Yes it's very nice here".

We found that people's bedrooms were spacious and had the specialist equipment that people needed to keep them safe and comfortable. For example people who were at risk of sore skin all had special air mattresses to reduce this risk.

We saw how people spent their day. People were generally given a choice of where they spent their time, however there was not much, for people who were less able to do. People who were fully dependent and had nursing needs mostly remained in bed, there is a need to ensure that these people have more social interaction. People told us that they got up and went to bed when they wanted and that there was always a choice of what they had to eat and drink.

We found that the service had responded positively to any concerns and had appropriate systems in place to protect people from harm.

Residents and visitors all told us that they felt there were not enough staff, comments we received included, "Staff are very stretched", and "Staff do their best but they are always busy and I often have to wait for them (staff) to come". Staff generally were seen to provide people with the assistance they needed although improvement was needed and there was a delay in care being provided. Staffing levels needed to be improved to ensure that people receive the care they need in a timely manner.

This inspection took place on 19 and 23 November 2015 and was unannounced. At the last inspection on 22 December 2014 the provider was not meeting the legal requirements. We judged there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 including safe care and treatment, assessing and monitoring the quality of the service, consent to care and treatment and staffing. We asked the provider to make improvements and they sent us an action plan, which said that the legal requirements would be met by the end of June 2015. We found that some improvements had been made, but further improvements were still required.

Marquis Court (Tudor House) is registered to provide care and treatment for up to 52 people who may have Dementia, require nursing and residential care and who may have physical disabilities. At the time of our inspection there were 44 people living at the home.

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.

The provider had made improvements and recruited more staff. The provider determined staffing levels by assessing people’s needs but some of these assessments were not up to date and staffing numbers were not varied to take into account the busiest times of the day. This meant staffing levels were not being reviewed appropriately to ensure there were enough staff available to meet people’s needs at all times.

Staff received an induction and ongoing support which enabled them to meet the needs of the people they were caring for. Most of the time we saw that staff were kind and caring but we saw examples where staff did not respond to support people because they were busy with other tasks.

People’s needs were assessed and reviewed on a regular basis to ensure they remained relevant but improvements were needed to ensure people’s views about how they wanted to receive their care were responded to. People were offered opportunities to take part in social activities but improvements were needed to ensure people were supported to follow interests that met their individual preferences. People were supported to maintain the relationships which were important to them.

Staff understood how people might be at risk of abuse and knew how to take action to protect people. There were systems and processes in place to protect people from the risk of harm. We found that improvements had been made to the management of medicines and people received their medicines as prescribed. However, further improvements were needed to ensure unwanted medicines were disposed of safely in line with legal requirements.

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. People and their relatives knew how to make a complaint and were encouraged to express their views about the service and where appropriate, changes were made in response to their feedback.

Improvements had been made to ensure the registered manager and staff acted in accordance with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments and best interests records had been completed to show how people who were unable to make important decisions had been supported to do so. Appropriate referrals had been made for DoLS approvals where people needed to be deprived of their liberty in their best interest.

People received food and drink that met their nutritional needs and received support from other healthcare professionals to maintain their day to day health.

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