CQC report explained · a nursing home
What the CQC found at Marion Lauder House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People felt safe and risks were identified and managed. However, recruitment checks were not always complete, the staffing calculation tool was not always suitable, and some cleanliness improvements were needed.
- Effective?
- Requires improvement
- People received health care, training and support with food and drink. Fluid records were not always accurate, and advocacy had not been considered for one person's end-of-life decision.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People were supported to make choices and maintain their independence.
- Responsive?
- Good
- Care plans described people's needs and complaints were investigated. However, people on the nursing unit had little stimulation, and people and families were not always involved in care plan reviews.
- Well-led?
- Requires improvement
- There was a new manager, an action plan and regular management meetings. However, quality checks had not identified problems with recruitment, records, medicines and advocacy, so the home remained in breach of Regulation 17.
What inspectors found, June 2023
Rated Requires Improvement; inspectors found kind care and good responses to people, but weaknesses in records, recruitment and quality checks remained.
Inspectors visited unannounced on 27 April, 10 May and 16 May 2023. They reviewed care, medicines, staff records and audits, and spoke with people, relatives, staff and health professionals.
People generally felt safe and said staff were kind and caring. Risks were assessed, medicines were mostly managed safely, infection control was well managed and people received health care and support with food. However, staff recruitment checks were not always complete, fluid records were inaccurate and some covert medicines records needed correction.
Care was respectful and people could make choices. The home had activities and responded to complaints, but there was very little stimulation on the nursing unit. Care records did not always show people's involvement, and advocacy had not been considered for one person's end-of-life decisions.
The overall rating is Requires Improvement. Safe, effective and well-led were rated Requires Improvement, while caring and responsive were rated Good. The home remained in breach of Regulation 17, although it was no longer in breach of Regulation 12 from the previous inspection.
Kind and dignified care
Inspectors saw staff treating people respectfully and speaking kindly. People and relatives also gave positive feedback about the care.
“We observed people being supported with dignity. Staff spoke kindly and sensitively to people and were able to use strategies to calm people when they were becoming distressed.” from the report
Risks were managed
The home recorded risks such as falls, skin damage and swallowing problems. Equipment and care plans were used to reduce these risks.
“Risk management strategies to support people's health, safety and welfare were recorded.” from the report
Access to health professionals
People received regular input from health and social care professionals. The local GP surgery visited weekly to review people's health.
“The GP surgery completed a weekly visit to the home to review people's health and any new concerning changes to their wellbeing.” from the report
Open communication
Relatives said they were kept informed about changes and incidents. People and relatives knew how to raise concerns with the home.
“It was evident from speaking with relatives, they were continually kept informed of any changes to their relation.” from the report
Incomplete recruitment checks
seriousSome staff files did not contain full employment histories, and references were not always from suitable referees. This was amended during the inspection, but the provider needed to review all recruitment records.
“Employee application forms were not always fully completed with missing information on employment history.” from the report
Inaccurate fluid records
seriousRecords did not always agree about how much fluid people had received. This meant inspectors could not be assured that people were getting the amount they needed.
“The provider did not maintain an accurate, complete and contemporaneous records in respect of each service user, including a record of the care and treatment provided.” from the report
Quality checks missed problems
seriousAudits did not identify the recruitment, fluid, covert medicines and advocacy concerns found during the inspection. This was part of the Regulation 17 breach.
“Quality assurance audits to monitor the service were in place but were not highlighting the shortfalls found in the safe recruitment of staff, the recording of some covert medicines, the recording of fluids and where advocacy was not being considered as part of end-of-life planning.” from the report
Limited nursing unit activities
needs fixingThere was very little stimulation for people on the nursing unit outside care tasks. Inspectors recommended that activities there should be reviewed.
“On the nursing unit, there was very little stimulation with interventions only occurring during care tasks.” from the report
Care planning involvement
needs fixingThere was no evidence that people, their families or staff were involved in every care record review. Inspectors also recommended considering advocacy where people had no representative.
“However, there was no evidence people, their families or staff were involved in each review.” from the report
- 01What checks have you now completed on every staff member's employment history and references?
- 02How do you now check that fluid records are accurate and that people receive their assessed daily amount?
- 03What changes have you made to activities for people living on the nursing unit?
- 04How are residents and families now involved in reviewing care records, and when is advocacy offered?
- 05How do your audits now identify problems with recruitment, medicines records, fluid records and end-of-life planning?
This was an unannounced inspection covering all five CQC questions, including infection prevention and control; the report says safe and well-led remained Requires Improvement, caring and responsive remained Good, and effective changed from Good to Requires Improvement. This explanation was written from the published report of 8 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2021
Marion Lauder House is rated Requires Improvement; inspectors found kind care, but risks and management systems were not always handled reliably.
This was an unannounced focused inspection over three visits in May 2021. Inspectors looked mainly at safety, wound care, falls, infection control and leadership. They spoke with people, relatives and staff, and reviewed care, medicine, staffing and management records.
The home provided caring support. Staff were kind, treated people with respect and helped them stay in touch with family and friends during the pandemic. Staffing levels, premises checks, medicines systems and infection control were generally satisfactory.
However, electronic care plans did not always show people's current risks. Some referrals to health professionals were delayed. Management checks had not found these problems. The overall rating fell from Outstanding at the previous inspection to Requires Improvement. Safe and Well-led were Requires Improvement, while Caring was Good.
Kind and respectful care
People and relatives described staff as caring and compassionate. Inspectors observed warm relationships, respect for privacy and support for people's independence.
“People were well supported. Staff had people's best interests at heart and treated people as individuals.” from the report
Family contact
Staff helped people maintain important relationships during the pandemic, despite the restrictions in place.
“Staff had helped people maintain important relationships with family and friends throughout the pandemic.” from the report
Staffing and premises
Inspectors found enough staff to provide shared and one-to-one support. Premises checks, maintenance records and safety certificates were up to date.
“Staffing levels were appropriate and able to meet the needs of people living in the home.” from the report
Infection control
The home had measures in place to prevent and manage infection, including appropriate use of protective equipment and arrangements for testing and visits.
“Good measures were in place in relation to the prevention and control of infection.” from the report
Care plans did not always show current risks
seriousThe electronic care planning system did not always accurately record risks. One person at high risk of falls did not yet have an electronic falls or mobility care plan.
“The electronic care planning system did not always accurately reflect the risks posed to people.” from the report
Delayed health referrals
seriousSome referrals to other health professionals were not made promptly. This could delay appropriate advice and support.
“Referrals to other services were not always made in a timely manner.” from the report
Weak management checks
seriousAudits and quality checks were in place but had not found or dealt with the care planning problems. The report says governance systems were not robust enough.
“Governance systems were not robust enough to demonstrate safety was effectively managed.” from the report
Inconsistent communication with families
needs fixingRelatives appreciated the home's efforts during the pandemic but said communication had suffered and was not always consistent.
“Communication with relatives had not always been consistent.” from the report
- 01How are you now making sure care plans accurately record risks such as falls, weight loss and mobility?
- 02How quickly are referrals made to services such as the falls clinic, tissue viability nurse and speech and language team?
- 03What checks now confirm that care plans and referrals are accurate and up to date?
- 04What wound care process is currently followed, and how do you check that it is being followed?
- 05How will you keep relatives informed and improve communication with families?
This was a focused inspection prompted by concerns about falls and wound care; Safe and Well-led were inspected, Caring was rated Good in the report, and the other ratings carried over from the previous comprehensive inspection. This explanation was written from the published report of 28 August 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Marion Lauder House
7 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2021Requires improvementdown from OutstandingSafe: Requires improvementCaring: GoodWell-led: Requires improvement
- February 2020Outstandingup from GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Outstanding
- June 2017Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2016Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- July 2015Inadequatedown from Requires improvementSafe: Requires improvementEffective: InadequateCaring: Requires improvementResponsive: InadequateWell-led: Requires improvement
- July 2015
Report published without a new overall rating.
- January 2015Requires improvementSafe: Requires improvementEffective: InadequateCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 26 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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