We carried out a comprehensive inspection of Marsden Grange on 30 and 31 August and 4 September 2018. The first day was unannounced.

Marsden Grange is registered to provide accommodation and personal care for up to 40 older people. Accommodation is provided in two separate buildings. One is the main house which accommodates 23 people over two floors and the other is a separate single storey building called Pendle Suite, which accommodates 17 people. At the time of our inspection there were 34 people living at the home.

The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and we looked at both during this inspection.

At the last inspection on 28, 29 and 30 June and 7 July 2017, we found three breaches of the regulations. These related to the provider’s failure to assess and take appropriate action to reduce people’s risks, failure to comply with the Mental Capacity Act 2005 and a failure to monitor and improve the quality and safety of the service. Following our inspection, the provider sent us an action plan and told us that all actions would be completed by 31 October 2017.

At this inspection we found that the necessary improvements had been made and the provider was meeting all regulations reviewed.

We received mixed views about staffing levels at the service. Most people felt that there were times when the service was short staffed. The registered manager told us she had struggled to maintain appropriate staffing levels in recent months due to staff sickness, retirement and staff leaving. She showed us evidence that she had recently recruited two members of staff and was in the process of recruiting more staff to ensure that people’s needs were met at all times.

Most people felt that activities at the home needed to be improved. We saw evidence that the registered manager had recently sought people views and suggestions about activities and improvements were being made.

Records showed that staff had been recruited safely and the staff we spoke with understood how to protect people from abuse or the risk of abuse.

Staff received an effective induction and appropriate training. People who lived at the service and their relatives felt that staff had the knowledge and skills to meet people’s needs.

People told us the staff who supported them were caring and respected their right to privacy and dignity. They told us staff encouraged them to be independent and we saw evidence of this during the inspection.

People received support with nutrition and hydration and their healthcare needs were met. Referrals were made to community healthcare professionals to ensure that people received appropriate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People told us that they received care that reflected their needs and preferences and we saw evidence of this. Staff told us they knew people well and gave examples of people’s routines and how they liked to be supported.

Staff communicated effectively with people. People’s communication needs were identified and appropriate support was provided. Staff supported people sensitively and did not rush them when providing care.

The registered manager regularly sought feedback from people living at the home and their relatives about the support they received. We saw evidence that she used the feedback received to develop and improve the service.

People living at the service, relatives and staff were happy with how the service was being managed. They found the registered manager and staff approachable.

A variety of

We carried out a comprehensive inspection of Marsden Grange on 28, 29 and 30 June and 7 July 2017. The first day of the inspection was unannounced.

Marsden Grange provides accommodation and personal care for up to 40 older people. At the time of our inspection there were 32 people living at the home. The accommodation consists of two separate buildings. One is the main house which accommodates 23 people and is set over two floors. The other is a separate single storey annex called Pendle Suite which accommodates 17 people. The service is situated in Nelson in East Lancashire

At the time of our inspection the service had a registered manager who had been registered with the Care Quality Commission (CQC) since 2010. A registered manager is a person who has registered with the 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.

During a previous inspection on 15, 16 and 17 March 2016, we found two breaches of the regulations relating to the management of medicines and a lack of staff supervision at the home.

During this inspection we found that some improvements had been made to the management of medicines. However, further improvements were needed. We found that staff had received regular supervision.

During this inspection we found three breaches of the regulations relating to the management of people’s risks, a failure to comply with the requirements of the Mental Capacity Act 2005 and a failure by the provider to monitor and improve the service. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we have also made a recommendation about the night time staffing arrangements at the home.

People who lived at the home and their relatives were happy with staffing levels. However, two staff raised concerns about staffing levels at night. The registered manager told us that she planned to review staffing levels at the home.

We found that people were not always supported appropriately with their nutritional needs. Care plans and risk assessments were not always updated when people’s needs changed. This meant that it was difficult to ensure that staff were managing people’s needs and risks effectively.

People’s mental capacity had not been assessed when appropriate. The service had not taken appropriate action where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe.

Records showed that many aspects of the service were audited regularly. We found that the audits completed had not identified the issues we found during our inspection. We also found that the provider did not assess or monitor the services provided at the home.

We saw evidence that staff had been recruited safely. The staff we spoke with understood how to safeguard vulnerable adults from abuse and were clear about the action to take if they suspected that abusive practice was taking place.

Staff told us they received an appropriate induction, effective training and regular supervision. They found the registered manager and the deputy managers approachable and felt well supported by them.

People who lived at the home liked the staff who supported them and felt that staff had the knowledge and skills to meet their needs

Most people who lived at the home were happy with the meals provided.

People received support with their healthcare needs and we received positive feedback from community health care professionals about standards of care at the home.

We observed staff communicating with people in a kind and respectful way. People told us staff respected their privacy and dignity and encouraged them to be independent.

People were supported to take part in activities at the home. People living at the home a

We carried out an unannounced inspection of Marsden Grange home on the 15 and 16 March 2016 and we contacted staff via telephone calls on the 17 March 2016.

Marsden Grange care home is registered to provide accommodation, personal care and support for 40 people. Marsden Grange care home is set in its own grounds and is located in the area of Nelson in Lancashire. The accommodation consists of two separate buildings. One is the main house which accommodates 23 people and is set over two floors with single and twin bedrooms and a separate annex which is named as the pendle suite which accommodates 17 people and is set over one level. There is also a car park for visitors and staff. At the time of the inspection there were 36 people accommodated at the home.

The service was managed by 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.

The service was last inspected in April 2014 and was found compliant in all areas inspected.

During this inspection we found the provider to be in breach of two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. These breaches relate to the provider failing to provide staff with up to date refresher training in medicines management, not following best practice around the safe administration of medicines and not providing staff with frequent effective supervision sessions. You can see what action we told the provider to take at the back of the full version of this report.

We also spoke with the registered manager about the importance of allowing fire doors to close without obstruction in the case of a fire. The registered manager assured us she would install electric door closers as a matter of priority. These closers enable people to have their door open safely should they wish to.

People told us they felt safe living at the service. We received positive feedback about the service Marsden Grange provided. Relatives told us they felt secure in knowing their relatives were safely and effectively cared for by professional staff. Comments included, “The care could not be better. Staff really know what they are doing and I always observe good safe care towards my [relative], “I have nothing but good reports. I speak to other residents and their families and they all think it is wonderful here”. A visiting health professional told us how they thought “It was one of the better homes”.

We noted the service had contingency procedures and processes in place to maintain a safe environment for people using the service, visitors and staff. Environmental risk assessments covering areas such as use of stairs, and appliances were also evident.

People had care plans tailored to individual need with appropriate risk assessments covering areas around daily living, health and nutrition. Care plans contained PEEP (personal evacuation plans). All staff showed a good understanding of procedures to follow in the event of an emergency or fire.

We noted the service had robust policies and procedures in place to recognise and protect people for the risk of abuse. Staff displayed a good understanding around this and were aware of the various signs and indicators of abuse.

Over the two days of inspection we noted adequate staff presence. Staff told us they did not feel rushed in their daily duties. People using the service told us staff took time to sit and talk with them and look at photo albums. People also told us staff responded to them in a timely manner.

People were recruited safely and in line with current guidance. All staff had been subject to a DBS (Disclosure and Barring Service) check. The DBS carry out a criminal record and barring check on individuals who int

The inspection was undertaken by the lead Inspector for Marsden Grange. We gathered evidence against the outcomes we inspected to help us answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service and three relatives. We also spoke with the manager, staff members and we looked at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Comments made to us included, “I feel safe because there is always someone around if I need help” and “I feel safe here because the staff are kind and attentive.” Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to record and review complaints, accidents and incidents. This should help reduce the risk to people and help the service to continually improve.

The home had policies in place in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Staff understood the need to seek consent from people before they provided any care. This should help ensure people’s rights were safeguarded.

Recruitment procedures were safe and thorough. Staff were supported to gain appropriate skills and knowledge for their role. This should help ensure people received safe and appropriate care.

Is the service effective?

Most of the people we spoke with told us they were happy with the care they received and their needs had been met. It was clear from our observations and discussions with staff that they knew people well and had a good understanding of their care and support needs. One person who used the service told us, “They come quickly when I ring the bell, I get on with all of them they are all nice girls." Staff had received training to meet the needs of people who used the service.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. Risk assessments were regularly reviewed and care plans amended to reflect people’s changing needs.

Is the service caring?

People were supported by kind and attentive staff. We observed staff took care to support and protect people while assisting them to mobilise around the home.

We spoke with three visitors. They told us they considered the quality of care provided by staff was good. Comments they made to us included, “The service is wonderful. They are committed and caring staff”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records we looked at showed us people had the opportunity to meet with their key worker to review their care.

Systems were in place to ensure staff had access to up to date information regarding people’s needs. This should help ensure they were supported to respond appropriately to any changes to a person’s condition.

Is the service well led?

The service worked well with other agencies to make sure people received care in a joined up way. This information helped to ensure the person was provided with the care they required when they were away from the home.

Quality assurance processes were in place in the home. Records we looked at showed us people had completed a satisfaction survey.People who used the service were regularly asked their opinion about the service. Regular meetings were held with staff. These provided the opportunity for staff to discuss any concerns or practice issues in the home.

We spoke with four people living in the home who told us they were happy with the care and support they received. Comments included, “It's a lovely place; I'm very comfortable", "I can do what I want to do and can get help if I need to" and “I'm very well looked after; they are lovely caring staff”.

People told us they enjoyed the food. Comments included, "The food is very good; I've really enjoyed my meals since coming here. I had lost my appetite for food," "We get plenty to drink through the day with cakes and biscuits" and "I like the food; I can choose what I want".

Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found that the care plans were accompanied by risk assessments and risk management plans to ensure people were protected from unsafe care practices.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from inappropriate staff.

People told us they were satisfied with the quality of care and support they received. We were told the staffing levels were sufficient to meet the needs of people living in the home and that the staff were professional, caring and friendly.

People made various positive comments about the staff team.

Comments supporting this view included: "They talk to me about my day to day care and ask if anything has changed or do I want things doing differently."

"I feel really well looked after here."

People were provided with care plans which were reviewed regularly and updated when

required. People said they felt safe living in the home and were able to discuss concerns

or issues with the staff if they wished to. We were told that the service provided enjoyable and varied activities for people.

There were comprehensive auditing and reviewing procedures in place to identify any

areas where improvements could be made.