About the service:

Marwa Nursing Home is a care home with nursing that provides personal and nursing care for up to 38 older people. At the time of the inspection, there were 22 people living at the service.

People’s experience of using this service:

People who were able to communicate with us told us they felt safe. People who were not able to tell us about their experiences looked comfortable and relaxed in the presence of staff. They were cared for by a consistent staff team who had received sufficient training to carry out their roles. People received assistance to take their medicines as prescribed.

People were supported to access health care services and weekly visits were undertaken by the GP. People’s dietary needs were assessed and where needed, people received support to eat and drink.

People received care that was kind, respectful and responsive to individual needs. Care plans were comprehensive and reviewed each month. People and their relatives knew how to complain, although no complaints had been received in the last 12 months. No people were receiving end of life care at the time of our inspection visit.

The registered manager had a clear vision about the quality of care and service they aimed to provide. They worked in partnership with other organisations to make continuous improvements and develop best practice.

More information is in detailed findings below.

Rating at last inspection:

Good (report published in August 2016).

Why we inspected:

This was a planned inspection based on the rating from the last inspection. The service remained rated Good overall.

Follow up:

We will monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

This inspection was unannounced and took place on 21 and 23 June 2016.

Marwa Nursing Home provides accommodation and personal and nursing care for up to 35 older people who are frail or living with dementia. Accommodation is provided over two floors. At the time of our inspection 34 people were using the service.

When we last inspected the service on 20 and 22 January 2015 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponded to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people’s medicine and care records required improvement. The provider had not effectively identified shortfalls in the service and had not always taken action to make the required improvements.

Following the inspection in January 2015 the provider sent us an action plan telling us how they would be addressing the concerns we found and that they will be compliant with the regulations by June 2016. At this inspection we found the provider had effectively implemented their inspection action plan. Improvements had been made and sustained over time and these regulations had been met.

The service had a 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. The service is required by a condition of its registration to have a registered manager.

The management structure in the home provided clear lines of responsibility and accountability to all staff. The registered manager was enthusiastic and motivated to provide the best level of care possible. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people and worked as a team focussing on the people they cared for.

There were effective quality assurance processes in place to monitor care and plan ongoing improvements. There were systems in place to share information and seek people's views about the running of the home. The service gained feedback from people, relatives and staff and people's views were acted upon.

Staff were able to demonstrate their understanding of the risks to people's health and welfare and people told us they received care that met their needs. Risks were well managed with a good balance between promoting people's independence and minimising identified risks. People's care records were up to date and sufficiently detailed to provide staff with the information they needed to know how to keep people safe and meet their needs, wishes and preferences.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

Staff sought people's consent before they provided their care and support. They were still developing their understanding of the legal process and the nature of the required recording they needed to complete. Time was needed for the home to embed this learning in their practice to ensure mental capacity assessments and associated best interest decisions would always be completed in accordance with current best practice guidance.

Staff had good knowledge of people including their needs and preferences. Staff had received training to support them to effectively meet the individual needs of people. Staff understood their responsibilities to keep people safe from abuse. People said the home was a safe place for them to live. All staff were clear about how to report any concerns. There were enough staff to meet the needs of the people that lived at the home.

People li

This was a follow up visit to check if the provider had become compliant with the regulations following our previous inspection on 29 October 2013. We spent most of our visit observing care and found that generally people had positive experiences. Staff interacted well with people and they responded in a positive manner. We noted staff and people walking around the home together in conversation and whilst sometimes the people presented challenges to staff these were addressed in a kind and considerate manner.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare.

The provider had an effective system in place to identify, assess and manage the risks to the health, safety and welfare of people using the service and others.

Some people’s records were illegible and not fit for purpose.

This was a responsive inspection visit following information of concern we received from health and social care professionals about the care and welfare of one person living at the home. Many of the people at Marwa Nursing Home were unable to tell us about their experiences in a meaningful way. To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. "SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us."

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences. We spent most of our visit observing care and found that generally people had positive experiences. Staff interacted well with people and they responded in a positive manner. We noted staff and people walking around the home together in conversation and whilst sometimes the people presented challenges to staff these were addressed in a kind and considerate manner. However not all people had the opportunity to take part in meaningful activity.

Care and treatment was planned however not always delivered in a way that ensured people’s safety and welfare. Infection control practices had improved and people had a more pleasant environment to spend time in.

Staff recruitment procedures had improved and staff had been properly vetted prior to starting work. People’s health and welfare needs are met by competent staff.

The provider did not have an effective system in place to identify, assess and manage the risks to the health, safety and welfare of people using the service and others.

We spoke with two people who could express a view and they told us they were happy at the home. One person said “I have only been here a couple of weeks and I think the staff are really good.” Another person told us “It’s really good here, sometimes though there could be more to keep me occupied. I see the staff trying really hard to involve everybody in doing activities, but not everyone is interested.” We spoke with relatives visiting the home and they told us they were happy with the care provided at the home. One relative told us “My mother is really well looked after here. The staff are lovely and very kind.” Another relative said “X has only been here a short time but so far she has no complaints and nor have I.”

Many of the people at Marwa Nursing Home were unable to tell us about their experiences in a meaningful way. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. "SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us."

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences. We spent time on each of the floors observing care and found that generally people had positive experiences.

People were treated respectfully and their views were taken in to account by staff. Risks to people's health and welfare were assessed and care was planned and delivered according to people's needs.

People who could express a view told us they enjoyed the food, and that if they did not like what was on the menu, the cook would provide an alternative. We spoke with people about whether or not they had a choice of food, some said they did, others said that they did not. People said the food was lovely and there was lots of it.

Some infection control practices at the home were unsatisfactory and would benefit from more stringent monitoring.

People's health and welfare needs were not met by staff who had been properly vetted.

The quality of the service at the home was monitored frequently and effectively. People expressed a high level of satisfaction with the quality of service at the home. For example, “I have always found the staff to be helpful and friendly”, “Dad was only at the home for a short while but he was well cared for and I was kept well informed” and “Excellent home love them to bits. All the staff are great.”

Many of the people at Marwa Nursing Home had dementia and therefore not everyone was able to tell us about their experiences. However we observed care being given, we spoke with five members of staff and four relatives visiting the home.

People who could express a view told us they liked living at the home. They said that the staff were good.

One person told us "this is my home and I am well looked after"

Another person told us 'staff keep an eye on me, I can do my own thing'

Relatives told us they felt able to raise any complaints and they were confident that there concerns would be responded to and dealt with quickly. They said staff were kind and caring.

People told us they knew the manager well and that she was always around to speak with.

This inspection took place on 20 and 22 January 2015 and was unannounced.

Marwa Nursing Home provides accommodation and personal and nursing care for up to 35 older people who are frail or are living with dementia. Accommodation is provided over two floors. At the time of our inspection 34 people were using the service.

A registered manager was in post at the time of our inspection. 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. The registered manager was available in the home on the day of our visit.

At the last inspection carried out on 30 June 2014 we found the provider was not meeting the regulations in relation to people’s care and welfare, consent to care, nutritional needs, safeguarding people, managing medicines safely, having sufficient numbers of staff, monitoring quality and safety and maintaining people’s records. We served three warning notices relating to people’s care and welfare, records and staffing numbers. These warned the provider that we would take further action if they did not make changes to ensure people were safe.

Following that inspection the provider sent us an action plan telling us about the improvements they were going to make. They told us they would make these improvements by 16 December 2014. During this inspection we found that the provider had taken action to address most of these issues. However, we found some improvements were still needed in relation to medicines, people’s daily records and monitoring quality and safety.

The provider had introduced some systems to monitor the safety and quality of the service provided. However, we found improvements were still needed to ensure these systems were effective in identifying issues of quality and safety and ensuring robust action would be taken to manage the identified risks. People, relatives and staff acknowledged there had been progress towards a stable management team in the home, and spoke with confidence about the manager in post at the time of our inspection. They told us they had seen improvements in the care provided.

People and their relatives told us they felt safe in the home and thought people received safe care. Although we found no medicine administration errors, people’s medicine records were not always sufficiently robust to prevent errors from occurring. Risks associated with people’s care were identified and managed to help keep them safe. Recruitment practices were robust to protect people as far as possible from individuals who were unsuitable to deliver care to people. The provider had employed more nurses and we found there were enough staff, based on people’s needs, to keep people safe.

People and their relatives were encouraged to be involved in the planning of people’s care. A new comprehensive care planning system had been introduced. People had care plans in place to support them to stay healthy with input from appropriate professionals. Daily records still did not accurately reflect the care people received and therefore nurses could not judge from people’s daily records whether the care plans they had instructed staff to implement, had been effective.

Where people lacked the capacity to agree to the restrictions the provider placed on them to keep them safe, the provider made sure people had the protection of legal authorisation instructing them to do so. Records did not show restrictions were only placed on people as a last resort after less restrictive approaches had been exhausted. We recommend the provider seeks guidance on how to record the best interest decisions that lead to Deprivation of Liberty Safeguards (DoLS) applications being made for people.

People were cared for by staff who were kind and respectful of their needs and wishes. Their dignity was promoted through thoughtful consideration by staff. The provider’s complaints process ensured people’s concerns were addressed appropriately. Since our previous inspection in June 2014 structured staff supervision had been re-introduced. Staff told us they received sufficient support and guidance to enable them to fulfil their roles effectively.

People and relatives were encouraged to give their views about the home and their feedback was used to make improvements. People and their visitors and relatives were complimentary about the quality of care provided. They liked the friendliness of staff, and the homely atmosphere.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 these now correspond to 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.