Marsh House provides personal care for up to 33 older people. At the time of our inspection there were 27 people living there. The home is situated in a rural area close to the towns of Chorley and Leyland. There is a large dining room, communal areas, hairdressing room and conservatory area. A substantial, well-maintained garden is available at the rear of the home for people’s leisure. These areas are accessible to people who use a wheelchair and there is also a stair-lift in place.

There was no registered manager in place. 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. However, we saw evidence the manager at Marsh House was in the process of registering.

At the last inspection on 13 December 2016, we rated the service as requires improvement. This was because developments undertaken by the provider needed to be embedded to demonstrate consistent good practice over time.

We additionally made recommendations for the provider to update their recruitment practices and to ensure staff received end of life care training. We further recommended the provider adapted the home's environment to support the independence of people who lived with dementia.

Marsh House 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, both of which we looked at during this inspection.

During this inspection, we found the provider had sustained improvements following our last inspection. One staff member said, “Since [the new manager’s] taken over it’s been a different home. She’s behind me and I’m flying.” They had additionally taken action to meet the recommendation we made about safer recruitment practices. The management team assessed gaps in employment history to ensure candidates were suitable to work with vulnerable adults.

Furthermore, the provider had developed the environment to enhance the experiences of people who lived with dementia. Bedroom doors had photographs of people from important life events, such as a picture of an individual when they worked in a public house.

Additionally, the manager had clearly documented people’s end of life care planning and related preferences. When we discussed end of life care with staff we found they had a good understanding of relevant principles.

However, care records we looked at contained limited information about the management of risks to people from unsafe or inappropriate support. Assessments to mitigate risks, such as malnutrition and medication administration, were not always completed or in place.

We have made a recommendation about improving risk assessment to protect people from unsafe or inappropriate care.

People we spoke with told us they felt safe and comfortable at the home. Staff had safeguarding training to enhance their skills to protect people from potential abuse, inappropriate support or poor care.

We reviewed rotas and found staffing levels and skill mixes were sufficient to help people with a timely approach. The manager checked staff learning with competency testing and question sessions, which covered multiple areas including personal care, infection control and the MCA.

We noted staff gave people their medicines with a safe and patient approach. All the staff who administered medication received training and competency testing to underpin their skill and knowledge. One person said, “The staff are very effective, good with your medication.”

Staff promoted lunch as a sociable occasion and ensured a welcoming atmosphere during mealtimes. They documented people’s preferences and special diets, whilst frequently checking their weight

This unannounced inspection took place on 13 December 2016. We last inspected Marsh House in July 2016. At that inspection, we found that people's safety was being compromised in a number of areas. This included how people's medicines were managed, the induction of new staff and temporary staff and how staff were supported to do their job through training and supervision. It also included how risk had been assessed and the guidance that had been provided to staff to reduce the risks to people, how emergency evacuation was planned and how people were protected from the risk of infections and contamination. At the last comprehensive inspection this provider was placed into special measures by the Care Quality Commission (CQC). The special measures framework is used to help make sure that registered providers found to be providing inadequate care significantly improve. It requires there is a timely and coordinated response from a provider where CQC has judged the standard of care to be inadequate. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Marsh House on our website at www.cqc.org.uk.

During this inspection 13 December 2016, we found the provider had made improvements to meet the fundamental standards inspected and had an overall rating of Requires Improvement. We saw that significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service and found no breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However we did find that the work being done was still in its early stages and needed to be sustained to ensure a consistent delivery of safe care and treatment that could be evidenced in the longer term.

As a result of the improvements made, the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in future inspections. You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we reviewed actions the provider told us they had taken to gain compliance against the breaches in regulations identified at the previous inspections in July 2016 and February 2016. We also looked to see if improvements had been made in respect of the breaches.

Marsh House provides personal care for up to 33 adults. Nursing care is not available at this location. The home is situated in a rural area close to the towns of Chorley and Leyland.Some of the bedrooms have en-suite facilities. There is a large dining room, communal areas, hairdressing room and conservatory available for people living at the home. The grounds are well maintained with seating and patio areas. These are accessible for those who use wheelchairs and there was a stair-lift and passenger lift in the home. Public transport links are available and there are car parking spaces for visitors and staff. At the time of this inspection there were 23 people living at Marsh House

The service had a registered manager in post and they had been in post since April 2016. 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 and associated Regulations about how the service is run. The registered manager had notified the CQC of any incidents and events as required by regulation.

People who lived at Marsh house told us that they felt safe in the home and that there were sufficient staff available to help them when they needed this. People living and visiting the home spoke highly of the registered manager and told us they were happy with the care and treatment.

Since the last inspection in July 2016 a new pharmacy system had been introduced into the home and thi

This inspection took place on 18 July 2016 and was unannounced.

The last inspection of Marsh House took place on 29 February 2016. At that time we found significant concerns in the service’s arrangements to safeguard people against the risk of; not receiving person centred care, inadequate nutrition and hydration, inadequate arrangements to identify potential risks in order to protect people from harm or injury, inadequate measures to assess and consider people’s consent to care, inadequate systems to identify or address issues that affected the quality of the service, poor medication management, lack of staff supervision and training, inadequate measures to deal with complaints and concerns and lack of governance and leadership.

The provider did not have suitable arrangements in place to ensure that staff were suitably qualified, supervised and competent to provide safe care and the provider was not notifying the Care Quality Commission of reportable incidents. As a result of our findings the service was put in special measures. Special measures ensure that providers found to be providing inadequate care, significantly improve and provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

As a result of our findings we ensured appropriate action was taken to keep people safe. We received from the provider an action plan on how they were going to meet the requirements of regulations Regulation 9 - Person centred care, Regulation 11 – Need for consent, Regulation 12 – Safe care and treatment, Regulation 13 – Safeguarding service users from abuse and improper treatment, Regulation 14- Meeting Nutritional and Hydration needs, Regulation 16 receiving and acting on complaints, Regulation 17 – Good governance, Regulation 18 – Staffing, and Regulation 20A – Requirement as to display of performance.

During this inspection we reviewed actions the provider told us they had taken to gain compliance against the ten breaches from the previous inspection in February 2016. We also looked to see if improvements had been made in respect of the additional shortfalls in people’s care we had identified. We found improvements had been made in respect of receiving and acting on complaints, sending notifications to the Care Quality Commission (CQC), reporting safeguarding incidents to the local authority, seeking people’s views on the quality of the service, and referring people to the local authority for deprivation of liberties authorisation.

Some minor improvements were noted with the information within people’s care files and seeking support from health professionals for people involved in accidents and falls. However, little in the way of improvements was found with respect to; managing medication safely, staff performance management, staff training , management of people’s risks from harm and risks of abuse and ill treatment, management of nutrition hydration, management of risks of infection and contamination, governance and quality assurance systems.

Marsh House provides personal care for up to 33 adults. Nursing care is not available at this location. The home is situated in a rural area close to the towns of Chorley and Leyland.

Some of the bedrooms have en-suite facilities. There is a large dining room, communal areas, hairdressing room and conservatory available for people living at the home. The grounds are well maintained with seating and patio areas. These are accessible for those who use wheelchairs and there is also a stair-lift in place. Public transport links are available and ample car parking spaces are provided.

The service had a new registered manager who had been in post since April 2016. This followed the departure of the previous manager who had been in post at the time of our inspection in February 2016. The registered manager was present throughout the inspection. A registe

This inspection took place on 17 and 29 February 2016 and was unannounced.

Marsh House provides personal care for up to 33 adults. Nursing care is not available at this location. The home is situated in a rural area close to the towns of Chorley and Leyland.

Some of the bedrooms have en-suite facilities. There is a large dining room, communal areas, hairdressing room and conservatory available for people living at the home. The grounds are well maintained with seating and patio areas. These are accessible for those who use wheelchairs and there is also a stair-lift in place. Public transport links are available and ample car parking spaces are provided.

The last inspection of Marsh House took place on 26 November 2014. At that time we found concerns in the service’s arrangements to safeguard people against the risk of inadequate nutrition and hydration and arrangements to identify potential risks, in order to protect people from harm or injury. The provider was not assessing and managing risks to people using the service and the provider was failing to effectively manage people’s food and fluid intake. As a result of our findings we requested the provider the provider to provide us an action plan on how they were going to meet the requirements of regulations 10, and 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which were in force at that time.

During this inspection we reviewed actions taken by the provider to gain compliance against the two breaches from the previous inspection in November 2014.We also looked to see if improvements had been made in respect of the additional shortfalls in people’s care we had identified. We found some improvements had been made in respect of choice meals and some environmental maintenance. However little in the way of improvements was found with respect to managing nutrition and hydration.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included; –the provision of person centred care, the need for consent, providing safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, receiving and acting on complaints, good governance, staffing, the lack of submission of notifications and the failure to display the rating from the last inspection in the service. You can see what action we have taken at the end of this report.

The registered manager was present throughout 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 and associated regulations about how the service is run.

At the time of this inspection there were 30 people who lived at Marsh House. We spoke with seven people living at the home, feedback varied due to some people having limited communication skills. We spent time observing care delivery and spoke with people who visited the service. People told us that they felt safe, however comments about a lack of staffing consistency infringed on the day to day experiences of care received.

We found that people were not protected against avoidable harm and quality assurance systems at the home failed to identify or resolve associated risk, therefore placing people at significant risk of harm and neglect. We communicated our concerns to the Local authority commissioning teams and ensured that the standard of risk management at the service was addressed by the provider before leaving the site on our first day of inspection.

We found people’s safety was being compromised in a number of areas. This included how people were assisted to eat and drink, how people were supported after experiencing falls, how well medicines were administrated and how staff were trained to support people aft

Marsh House provides personal care for up to 33 adults. Nursing care is not available at this location. The home is situated in a rural area close to the towns of Chorley and Leyland. However, Preston and Wigan are also within close proximity.

Some of the bedrooms have en-suite facilities. There is a large dining room, communal areas, hairdressing room and conservatory available for people living at the home. The grounds are well maintained with seating and patio areas. These are accessible for those who use wheelchairs and there is also a stair-lift in place. Public transport links are available and ample car parking spaces are provided. Marsh House is owned by Mark Jonathan Gilbert and Luke William Gilbert and is regulated and inspected by the Care Quality Commission.

This unannounced inspection was conducted on 26th November 2014 and was carried out by one inspector from the Care Quality Commission.

The registered manager of the home was on duty when we visited Marsh House. 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 and associated regulations about how the service is run.

At the time of this inspection there were 31 people who lived at Marsh House. We were not able to converse with some of those who used the service. However, we did manage to speak with eight people and three of their relatives. We asked people for their views about the services and facilities provided. We received some positive comments from those we spoke with. However, people on the whole were dissatisfied with the standard of food served. One person told us, “We are very, very, very lucky to be here. The staff are very helpful. It is near excellence, except for the food, which is alright I suppose, but it is nowhere near as good as it used to be; now they have gone onto this new food. It is delivered in packs. I don’t know why the chef can’t cook fresh food, like he used to. He is a great chef!”

Changes to the provision of meals had been made since our last inspection. This area was discussed with the management team and the chef at the time of our visit. We also found people who were at risk of poor nutrition were not always sufficiently monitored.

This was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

The staff team were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at the home. Recruitment practices were robust, which helped to ensure only suitable people were appointed to work with this vulnerable client group. However, Disclosure and Barring Service (DBS) checks were not routinely conducted again following employment. DBS checks help the provider to ensure people who are to be appointed are fit to work with vulnerable people in order to protect them from harm.

We recommend that DBS checks are conducted periodically for all staff members, to help to ensure people who live at the home are continuously protected from unsuitable employees.

The premises were reasonably safe, although some areas needed minor maintenance work doing. Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. This helped to protect people from harm.

We recommend that a full audit of the premises be conducted and any areas requiring maintenance work should be addressed, in order to enhance the environment for those who live at Marsh House.

We noted the domestic worker’s trolley containing substances hazardous to health, was left unattended in the first floor corridor. This area of risk needed to be addressed, as this could have had potentially had serious consequences, should someone who lived at the home ingested some of the easily accessible chemicals. We also identified some areas of risk within the environment, such as sloping bedroom ceilings and a sloping corridor floor. These areas of risk were not supported by risk management strategies, in order to reduce to possibility of harm or injury to those who used the service.

This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

One visiting professional told us, ‘During the time I was visiting Marsh House I never had any cause for concern. I only visited one patient but the lady concerned always seemed very content and got on well with the staff. Whenever I visited the unit always seemed fairly well staffed and there was always a member of staff available to chaperone during the visit, which was a big help if I needed any information regarding medications and it also made the lady I was visiting feel more relaxed. The staff were always very helpful and seemed to know the residents very well and the environment was generally clean and clutter free.’

The planning of people’s care was based on an assessment of their needs, with information being gathered from a variety of sources. However, evidence was not available to demonstrate that people who lived at the home, or their relatives, had been involved in making decisions about the way care and support was being delivered. We made a recommendation that systems be reviewed to ensure the manager could demonstrate people had been enabled to be involved in the planning of their care.

Regular reviews of needs were conducted with any changes in circumstances being recorded well. Areas of risk had been identified within the care planning process and assessments had been conducted within a risk management framework, which outlined strategies implemented to help to protect people from harm. People were supported to maintain their independence and their dignity was consistently respected. Staff were kind and caring towards those they supported and people looked comfortable in the presence of staff members.

Staff we spoke with told us they received a broad range of training and provided us with some good examples of modules they had completed. They confirmed that regular supervision sessions were conducted, as well as annual appraisals. They also told us they felt well supported by the manager of the home and were confident to approach her with any concerns, should the need arise.

We visited the home on 1st October 2013 and looked at outcomes 2, 4, 9, 12 and 16. We found the service compliant with these outcomes but reminded the service to note improvements in the care and welfare of people, medicine management and quality assurance.

People told us they were happy with their care and support. Their admission to the home had been handled well and they had discussed the support they needed beforehand. One person told us, “I was so lucky to get a bed here. When the hospital told me there was a bed available at Marsh House I could have run down here”.

We observed that staff interaction with people was very good. Staff engaged with them in conversations and asked people about and confirmed with them choices about daily routines and personal care.

We observed people in the home were relaxed around staff. They were able to express themselves freely and openly. People told us staff treated them well and they had no cause for concern. There were no rules to follow and no rigid routines.

People told us that staff supported them to manage and to take their medicines.

We saw the home was nearing the completion of a major refurbishment which had already improved the facilities and services available to people.