CQC report explained · a residential care home
What the CQC found at Marsh House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People generally felt safe, staff were safely recruited and risk assessments were in place. However, some controlled medicines were not managed safely, and two people's medicine records did not match the amounts stored.
- Effective?
- Good
- Staff had completed induction and training, and people's care needs were assessed and reviewed. People received support with food, drinks, healthcare and legal consent arrangements.
- Caring?
- Good
- Staff treated people with kindness, patience, dignity and respect. People's communication needs, preferences and independence were supported.
- Responsive?
- Good
- Care plans reflected people's needs, goals and preferences. People could maintain relationships, take part in activities and raise complaints.
- Well-led?
- Requires improvement
- People, relatives and staff described a positive culture and accessible management. However, governance checks did not consistently identify or address problems with medicines, records and emergency plans.
What inspectors found, March 2023
Marsh House rated Good overall; inspectors found kind, responsive care but weaknesses in medicines records and quality checks.
This was an unannounced inspection on 9 January 2023. Inspectors spoke with people living there, relatives and staff. They observed care, looked around the home and checked care, medicine and management records.
The home was rated Good overall. Safe, effective, caring and responsive care were all rated Good. Inspectors found people were treated kindly, supported with their health needs and involved in their care.
Well-led was rated Requires Improvement. Checks by the provider had not found problems with controlled medicines, medicine records or some emergency evacuation plans. The inspectors made recommendations about controlled drugs and record-keeping.
The previous overall rating was Requires Improvement. The report says improvements had been made, and the home was no longer in breach of regulations about safe care and treatment or staff training.
Kind and respectful care
Inspectors saw staff being compassionate and patient. People were supported with dignity and their individual choices were respected.
“We observed staff being compassionate and patient when people were upset.” from the report
Personalised support
People's care plans included their preferences, goals and communication needs. Staff adapted how they communicated with each person.
“The service ensured people's care and support plans focused on people's goals and abilities and their preferences in managing their support needs.” from the report
Staff training and support
New staff completed induction and shadowed experienced colleagues. Staff said they felt well supported and had opportunities for further training.
“All new staff completed an induction process when they started working at Marsh House.” from the report
Positive relationships
Relatives were welcomed, and people were supported to maintain relationships and take part in activities if they wished.
“Family members were welcomed to provide informal support to loved ones within Marsh House.” from the report
Controlled medicines
seriousOne person's controlled medicines were still recorded as being on site even though they were no longer needed and should have been disposed of. The inspectors recommended that the provider update its practice.
“One person's controlled dugs were not recorded as being on site.” from the report
Medicine records
seriousThe amount of medicine stored for two people did not match their records. Management found this was an administrative error and said people had received their medicines as prescribed.
“Two people's medication stored at the home did not match the amount shown in their records.” from the report
Quality checks
needs fixingThe provider's audits and checks did not consistently identify the problems found during the inspection. The inspectors recommended a review of governance and record-keeping systems.
“The registered manager and provider did not consistently operate governance systems effectively.” from the report
Emergency evacuation plans
needs fixingSome personal emergency evacuation plans did not contain all the required information. These were reviewed and updated during the inspection.
“Not all the PEEPs had all the relevant information required.” from the report
- 01How do you now check that controlled medicines are stored, recorded and disposed of safely?
- 02How do you make sure the medicine records match the medicines held for each person?
- 03How often are care records and personal emergency evacuation plans checked and updated?
- 04What changes have you made to your quality audits since inspectors found they had not identified these problems?
- 05How will you show that the Requires Improvement rating for well-led care has improved?
This was an unannounced comprehensive inspection covering all five rating areas, including infection prevention and control, and checking improvements made since the previous inspection. This explanation was written from the published report of 3 March 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, February 2022
Rated Requires Improvement; inspectors found risks in medicines, staffing, training, dignity and care planning.
This was an unannounced inspection over three visits in November 2021. Inspectors spoke with people, relatives, staff and a health professional. They observed care, checked the building and infection control, and reviewed care, medicines, recruitment and management records.
The home was not always safe. Medicines were not consistently stored, recorded or given as prescribed. Some staff lacked timely training, staffing was stretched, and parts of the home were visibly unclean. Inspectors also found gaps in emergency evacuation plans and risk management.
There were positive areas. People said they felt safe, staff supported people to make everyday choices, and healthcare support was available. Most care records reflected people's preferences, but dignity was not always protected, activities were limited for a period, and one person's care plan lacked important behaviour strategies.
All five areas were rated Requires Improvement. This means inspectors found some aspects of care were not consistently safe, effective, caring, responsive or well-led, with an increased risk that people could be harmed. The provider had taken some action and was required to send an action plan.
People felt safe
People told inspectors they felt safe with staff supporting them.
“People told us they felt safe with staff that supported them.” from the report
Choice and consent
People were supported to make everyday decisions, and the provider had made the required applications for people who needed formal liberty safeguards.
“Staff knew how to support people in making decisions and how to offer choice with day to day decisions and activities.” from the report
Healthcare support
Staff referred people to specialist professionals and shared person-centred information with health professionals in emergencies.
“Staff referred people to specialist professionals for support and guidance.” from the report
Recruitment checks
The provider carried out criminal record checks and obtained references when recruiting staff.
“The provider followed robust recruitment procedures. Criminal record checks with the Disclosure and Barring Service were carried out and appropriate references were sought.” from the report
Communication needs
People's communication needs and sensory aids were recorded, and staff adapted how they communicated.
“The service met people's communication needs. These were considered and documented to ensure staff could meet people's individual needs and preferences.” from the report
Medicines were not consistently safe
seriousSome medicines were missing from records, stored incorrectly or out of stock. Administration guidance was not always followed, creating a risk of harm.
“Medicines were not always administered as prescribed as some medicines were out of stock.” from the report
Risks and emergency plans
seriousNot all staff had fire safety or safeguarding training. Some people did not have a complete personal emergency evacuation plan, and some staff did not know where these plans were kept.
“Not all PEEPs contained the correct information needed to support someone to a place of safety.” from the report
Staffing and training
needs fixingThe home relied on agency staff while recruiting. Staff were sometimes expected to cover several roles, and not everyone had received suitable training and support at the start of employment.
“Ongoing recruitment led to a reliance on agency staff with contracted staff completing multiple roles within the home.” from the report
Dignity and independence
needs fixingSome staff used labels that did not respect people's individuality. Inspectors also found that people's independence and opportunities for interaction were not consistent.
“Some staff did not always promote people's dignity and individuality through the language they used and what was documented.” from the report
Cleanliness and activities
needs fixingSome areas were visibly unclean, with no housekeeping staff working during the visit. Activities had also been limited after the activity coordinator left.
“The provider was recruiting additional housekeeping staff and the home was visibly unclean in some areas.” from the report
Care planning gap
needs fixingOne care record did not contain strategies and documentation needed to manage a person's unique behaviours.
“One care record did not have strategies and documentation in place to manage one person's unique behaviours.” from the report
- 01What changes have you made to ensure every medicine is in stock, stored correctly, recorded and given as prescribed?
- 02How many permanent and agency staff are usually on each shift, and how do you ensure agency staff know each person's care guidance?
- 03Have all staff completed fire safety, safeguarding and role-specific training, including end of life care?
- 04How do you check that every person has an accurate personal emergency evacuation plan and that staff know where to find it?
- 05What activities and support for independence are now available, and how do you make sure staff use respectful, person-centred language?
This was an unannounced first comprehensive inspection of the newly registered service, covering all five key questions; the previous provider's rating was Good in 2018. This explanation was written from the published report of 12 February 2022 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 Marsh House
7 rated inspections over 8 years: the service has improved, from Requires improvement to Good.
- March 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2022Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2020Inspected but not ratedSafe: Inspected but not rated
- March 2018Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2016Inadequatestayed InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- April 2016Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- March 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- July 2021
Registered with the Care Quality Commission on 19 July 2021.
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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85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
“She understands the needs of an elderly person in the early stages of dementia and has treated my mother with great kindness and skill.”
“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.