OSJCT Marden Court 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. Marden court accommodates up to 28 people in one adapted building. At the time of our inspection 26 people were living at the home.

The home was last inspected in February 2017 and we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was not meeting the requirements of the regulations relating to managing risks as a result of people’s challenging behaviours. At this inspection we found the registered manager had taken action necessary following the last inspection. However, other areas of the service had deteriorated and the provider had not ensured everyone received a consistently good service.

This inspection took place on 22 February 2018 and was unannounced. We returned on 26 February 2018 to complete the inspection.

There was a registered manager in post 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 and associated Regulations about how the service is run.

Action was not always taken to learn from mistakes in managing people’s medicines, to ensure similar mistakes were not repeated. We identified three incidents in which people did not receive the medicine they had been prescribed. Staff discovering the errors had reported it to the person’s GP, to check whether any further action was needed. On each occasion, the person suffered no ill effect from the missed dose and the GP instructed staff to administer subsequent doses as planned. Whilst action had been taken to ensure people were safe following these incidents, there had been no action to ensure staff had learned from the mistakes and the medicine management systems were suitable to meet people’s needs.

The management systems did not always identify the need to report certain incidents to CQC. Allegations of abuse had been reported to the safeguarding team at Wiltshire Council, but had not always been reported to us in a timely way. Once the provider became aware the allegations had not been reported to us, appropriate legal notifications were submitted. The provider had taken action to ensure all staff undertook additional training and knew their responsibilities to report incidents and allegations.

The registered manager and area manager acknowledged during the inspection that there were shortfalls in the management systems in the service. They reported this was being addressed through support for some senior staff to take on additional responsibilities, ensuring action could be taken if the registered manager was not at the service. The registered manager understood the improvements that were needed in the service and had worked with the area manager to develop plans to implement them.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for assistance. People told us they felt safe when receiving care and were involved in developing and reviewing their care plans.

There were sufficient staff available to provide the care people needed. Staff understood the needs of the people they were providing care for and had the knowledge and skills to meet their needs.

Staff received a thorough induction when they started working at the home. They demonstrated a good understanding of their role and responsibilities. Staff had completed training relevant to their role, wh

Marden Court is a residential home providing care and accommodation for up to 28 people. At the time of our inspection 25 people were living in the home. The inspection took place on 7 and 8 February 2017 and was unannounced.

A registered manager was in post when we inspected 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 registered manager was present and approachable throughout our inspection.

Information around risks was not always available for staff to follow to ensure safe and effective care was given to people. This included appropriate assessments around behaviour that may challenge and pressure area care.

Infection control was not always managed appropriately to reduce the potential of risk. For example, two communal toilets were seen to be in an unclean condition. In addition the cleaning trolley was left unattended on two occasions with chemicals accessible to people.

People told us they felt safe living at Marden Court and were well looked after by kind staff who were available to help them. Comments included “I feel very safe. If I need anything at night they always arrive quickly”. Staff knew how to identify signs of abuse and their responsibilities in reporting and taking action around this.

We observed the mealtime experience for people which was unrushed and provided people with the appropriate support from staff that were available throughout. People told us they liked the food and were able to make choices about what they had to eat commenting “A good choice of food. A cooked meal every day” and “I have a bit of a job swallowing after being ill, I can’t manage hard food. The chef makes sure I have stuff I can eat”.

We saw that interactions between people and staff demonstrated person centred care was being given. People praised the staff describing them as kind, humorous and professional. Comments included “Staff are very caring, absolutely lovely”, “There is a very good atmosphere, you are not in the way but feel part of it”.

The recording in care plans and monitoring charts did not always detail the actions that staff had taken to support a person when a concern had been identified. For example, some people had been prescribed topical medicines. Administration charts were in place to record when these had been applied. However we saw that these were not being completed in line with what had been prescribed.

There was a mixed response to the activities provided. Some people spoke positively about the events on offer with comments including “Never bored, there are lots of things to do if you want them”. Some observations however showed that people were not always engaged in meaningful ways, however an additional new activity co-ordinator had been recruited.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home. However not all of the concerns we identified had been picked up by these quality monitoring systems and action taken to minimise the risks to people.

People and their relatives spoke positively about the registered manager’s leadership and told us she was available if they needed to see her. Comments included ‘The manager is very hands on, any problems get sorted” and “The manager is very good. She drops in and chats to me most days”. Staff also told us they felt supported by the registered manager who was approachable if they had any concerns to discuss.

We found one breach 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 the report.

OSJCT Marden Court is a care home which provides accommodation and personal care for up to 28 older people, some of whom have dementia. At the time of our inspection 24 people were resident at Marden Court.

This inspection took place on 3 October 2014 and was unannounced. We returned on 9 October 2014 to complete the inspection.

At the last inspection on 1 March 2014 we identified that the service was not meeting Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was due to a lack of supervision and support for staff. The provider sent us an action plan and said they were taking action to provide staff with suitable support, which would be completed by May 2014. During this inspection we found that staff received the support they needed to provide effective care to people who use the service.

There was a registered manager in post 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 and associated Regulations about how the service is run.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments from people included, “Staff have the right skills” and “They provide good support and encouragement. They respond well when (my relative) refuses care and try again at another time”.

People told us they felt safe when receiving care and were involved in developing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were supporting. People told us that care was provided with kindness and compassion.

Staff were appropriately trained and skilled. They received a thorough induction when they started work at the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. Comments from relatives included “They (provided my relative) with a different room after I requested it because it was more suitable for them” and “I am able to raise any issues about (my relative’s) care with the manager and something always gets done”.

The registered manager assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One staff member said “I would ask open ended questions ‘Would you like me to do this?’ and encourage them to do as much as they can for themselves. I would try gesture and other ways of communicating”.

One person living at the home said “staff are very good”.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were not cared for by staff who were fully supported to deliver care and treatment to an appropriate standard.

The provider did have an effective system in place to identify, assess and manage potential risks to the health, safety and welfare of people who use the service.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Everyone we spoke with said that they enjoyed the food at the home and had plenty of

choice. One person told us "the food is lovely. It is the type of food that I would cook myself.”

We saw that people's needs around nutrition and hydration were assessed and plans put in place to meet these needs.

Throughout the day we observed staff addressing people by their name and knocking on doors before entering people's rooms. Staff we spoke with were clear about promoting people's dignity and treating people with respect.

People told us they liked living in the home. One person said “all very nice here” and another that they thought the home was “good, very good”. People’s relatives also said they liked the home. One relative told us the home was “a decent place to be” and another, “I think they do a very good job”. People told us they liked the staff. One person said they thought staff were “very nice” and another, “the girls are all very well trained”.

We observed that staff respected people’s wishes about where they spent their days. Staff treated people with respect and supported them appropriately, for example when they needed help with standing and moving. Staff told us about the support they were given, both by training and supervision, to enable them to meet people’s needs. The home’s quality audit was detailed, however it did not document all areas which could have benefitted from action by the provider.