CQC report explained · a nursing home
What the CQC found at Marula Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Staff understood people's risks and medicines were managed appropriately. However, staff were not always present in communal areas in one unit, and relatives said people were not always watched carefully.
- Effective?
- Good
- People's needs were assessed before admission and staff had appropriate training and support. Food, drinks and healthcare were provided with attention to people's individual needs.
- Caring?
- Good
- People and relatives described staff as kind, patient and respectful. People were offered choices, supported to be independent and cared for in a dignified way.
- Responsive?
- Good
- Care plans included people's routines, preferences, health needs and life stories. Activities had improved and people were supported with outings and relationships, although activities were still developing.
- Well-led?
- Good
- The management team had a person-centred culture and used audits, feedback and incident reviews to improve care. However, the home's audits had not identified the staffing concern in one unit.
What inspectors found, August 2022
Rated Good overall; inspectors found kind, personalised care, but the Safe rating was Requires Improvement because staff were not always visible in one unit.
This was an unannounced inspection on 24 and 27 June 2022. Inspectors observed care, spoke with people, staff, relatives and a health professional, and checked care plans, medicines, recruitment files, training and other records.
People told inspectors they felt safe and were treated kindly. Care plans were detailed and personalised. Staff supported people with food, drinks, medicines and health needs, and worked with health professionals.
The main weakness was staffing in one of the two units. Staff were not always present in communal areas where people were, although the manager said an extra staff member was then being rostered. Activities had also improved but were still developing.
The overall rating was Good. Safe was rated Requires Improvement, while Effective, Caring, Responsive and Well-led were rated Good. This was a clear improvement from the previous Inadequate rating, and the home was no longer in breach of regulations.
Kind and respectful care
People and relatives said staff were caring, patient and respectful. Inspectors also saw reassuring and gentle interactions.
“Staff were kind, caring and respectful towards people and people told us they felt safe.” from the report
Personalised care plans
Care plans covered people's routines, preferences, health needs, communication and life stories. Staff used this information in their daily support.
“We found care plans to be very individualised, really person centred with a real clear overview of medical history, which was evidenced through the risk assessment.” from the report
Improved management
The leadership team had improved oversight and used audits, feedback and incident reviews to improve care. Staff said they felt supported and listened to.
“There was a robust system in place to assess the quality of care provided.” from the report
Health and nutrition support
Staff monitored people's food and fluid intake and contacted health professionals when needed. Inspectors saw evidence of visits from several health professionals.
“We saw evidence of visits from various health care professional including the GP, opticians, hospice nurse, community psychiatric nurse and occupational therapists.” from the report
Staff not always visible
needs fixingIn one unit, staff were not always present in communal areas where people were. This could mean people were not watched as carefully as needed.
“However, we observed the other section there were times where staff were not always present in the communal areas where people were.” from the report
Staffing audits missed the problem
needs fixingThe provider had increased staffing after the inspection, but its checks had not identified that staff levels were inadequate in one unit.
“We found staff levels were not adequate in one of the units and the providers audits had not identified this as a concern.” from the report
Activities still developing
minorAn activities coordinator had recently been recruited. Some relatives said their family members were bored and wanted more activities.
“Since the last inspection activities had improved but this was a work in progress as the provider had just been able to recruit an activities coordinator.” from the report
- 01What staffing levels are now in place in each unit, and how do you make sure communal areas are supervised at all times?
- 02How do you check that your staffing audits identify gaps quickly?
- 03What activities are currently available, how often do they take place, and how are they matched to each person's interests?
- 04How will you keep us informed if our relative's health, mobility, eating or drinking changes?
- 05How are relatives involved in reviewing and updating their family member's care plan?
This was an unannounced planned inspection following the previous Inadequate rating, and it covered all five CQC questions, including infection prevention and control. This explanation was written from the published report of 17 August 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.
What inspectors found, January 2022
Rated Inadequate and placed in special measures; inspectors found serious risks involving restraint, staffing, care planning and management oversight.
This was the first inspection since the home registered. It was unannounced and took place on 21 October 2021. Inspectors spoke with relatives, staff and healthcare professionals, observed care, and checked care plans, medicines records, training, recruitment and management records.
The inspectors found that people were not always protected from unlawful restraint, abuse or avoidable harm. Risks linked to distressed behaviour, falls, nutrition and staffing were not managed well. Staff were not always deployed effectively, and some lacked training for people's mental health, dementia and end of life needs.
The home was not designed well for people living with dementia. Care plans did not always give staff enough accurate, personal guidance. People did not always receive enough meaningful activity, choice or support with independence. There were also failures to follow the Mental Capacity Act and to report some safeguarding incidents.
There were some positive findings. Staff sometimes supported anxious people kindly, people were offered drinks and had healthcare support, and relatives gave some positive feedback about the care and food. However, the overall rating was Inadequate. The home was placed in special measures, and the provider was asked for an action plan and told that the service would be monitored and re-inspected.
Support during distress
Inspectors saw an example of staff calming an anxious person in a kind way. A relative also said staff handled distressed behaviour well.
“Staff are handling it really well, know how to de-escalate, they are getting it right.” from the report
Food and hydration
People were offered drinks and requests for food were met. Staff monitored fluid intake for people at risk of dehydration, and a relative gave positive feedback about the food.
“(Family member) seems happy with food, what is served is good and nutritious.” from the report
Healthcare support
People had contact with several healthcare professionals, including doctors, community nursing and dietetic services. Staff also used handovers to share information between shifts.
“We saw evidence of involvement from the GP, community psychiatric nurse, community matron and dietician.” from the report
Recruitment checks
The home used references and Disclosure and Barring Service checks when employing staff.
“The provider operated effective and safe recruitment practices when employing new staff.” from the report
Unlawful restraint and safeguarding
seriousInspectors found people being restrained, including by preventing movement and restricting access. Some safeguarding concerns were not reported to the local authority.
“People were not protected from unlawful restraint. Prior to the inspection three health care professionals fed back to us they had observed people being restrained by staff” from the report
Staffing and training
seriousStaff were not deployed effectively to keep people safe. Training did not cover all the complex needs of people living at the home, including mental health and end of life care.
“Staff were not deployed effectively around the service to ensure people's safety.” from the report
Dementia environment
needs fixingThe home lacked clear signs, suitable colours, destinations and separate areas to help people living with dementia feel orientated and occupied. Loud call bells and privacy screens could also cause distress.
“The design of the environment was not set up to meet their needs.” from the report
Weak management checks
seriousThe provider's audits failed to identify important problems. Records of falls, incidents and behaviour did not provide enough information to learn lessons and reduce future risks.
“There was a lack of robust oversight from the provider to ensure the quality and safety of care being provided to people.” from the report
- 01What evidence can you show that people are no longer being unlawfully restrained, and how are less restrictive options recorded?
- 02How do you now calculate staffing levels from each person's needs, and how do you make sure the right staff are present on each shift?
- 03What training have staff completed for dementia, mental health needs, modified diets and end of life medicines?
- 04What changes have been made to the dementia environment, including signage, colour, activities, call bells and access to communal areas?
- 05How are care plans, safeguarding incidents, falls and behaviour now audited, analysed and acted on?
This was the first comprehensive inspection of the newly registered home and covered all five key questions, as well as infection prevention and control. This explanation was written from the published report of 25 January 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 Marula Lodge
2 rated inspections over a year: the service has improved, from Inadequate to Good.
- August 2022Goodcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2022InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2021
Registered with the Care Quality Commission on 5 May 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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
77 live-in carers within about an hour of Surrey
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 £1,250 a week. 66 can care for a couple. 11 years' experience on average.
“Without his support we wouldn't have been able to navigate bringing and keeping Dad at home.”
“Not only has she looked after him beautifully, she has also been great company for him with lively conversation, kindness and humour.”
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.