Marlborough House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified two breaches of regulations. The registered manager did not always ensure the principles of Mental Capacity Act 2005 (MCA) were fully understood and promoted so that peoples’ rights were recognised, protected, and upheld when giving consent and making decisions about their care. People were not always supported to have maximum choice and control of their lives. Although staff supported them in the least restrictive way possible; however, the policies and systems in the service did not always support this practice. Care plans and risk assessments did not always clearly identify what support people required. People’s records did not always include all the relevant information. The registered manager needed to improve oversight of people’s nutrition and hydration needs and records kept for it. There was an activities programme but there were periods when staff did not ensure people were engaged in activities to avoid social isolation. People and relatives were mostly involved in planning their care and were informed of any changes in health or wellbeing. Relatives were positive about the staff and the service. People were able to access healthcare professionals such as their GP and other services specific to their needs. The service worked well with other health and social care professionals to provide care for people. Professionals were positive about the service and support to people provided.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A few relatives noted they were not always invited to review people’s care and support need. However, relatives noted they were able to talk to staff about care and support needs informally. One person told us they felt the home had “gone downhill over the last year” and felt people “just sit here all day.” Some people did not feel there was enough activity provided to meet their individual needs, including requests for days out. Relatives felt people’s needs were assessed to ensure their needs were understood and supported appropriately by staff. Relatives said, “Yes, [person’s] needs are assessed, and the staff are able to support [the person] as they need”, “Yes, I think [person’s] needs are assessed and I think the staff understand their needs. [The person] is a real book reader and staff bring books to read” and “Yes, [person’s] needs are assessed, and the staff understand how to support [the person] appropriately.” Relatives agreed they were involved in supporting people to make decisions. Staff communicated in a way that people understood, and people were given time to make decisions.

The registered manager told us how they assessed, reviewed and accepted people into the service. The registered manager said they assessed and reviewed people’s care and treatment, their health, care, wellbeing and communication needs with them. They communicated daily to ensure any information or changes about people’s needs had been noted and actioned. If people’s needs or risks changed, the registered manager said different health and/or social care professionals were involved to ensure good outcomes for people. The registered manager said, “When people are in the service, we have ‘Resident of the Day’ monthly review of all aspects of care, full overview of their care and environment; and anything in between we review if needed.” Staff said people’s needs and risks were assessed and reviewed regularly using different assessment tools to ensure their needs were reflected and understood. Staff provided information about people and any changes to support their reviews and assessments. They said people, professionals and families were involved in those processes. Staff said they shared information during meetings and daily communications to be aware of any changes. Staff felt supported and they were encouraged to share any issues or concerns with senior staff. However, we found some issues relating to assessing and reviewing people’s needs that did not reflect the feedback we gathered from the management team and staff.

People had care plans describing their needs and support required. However, there was also some inaccurate or contradicting information recorded. For example, people’s care plan noted they were able to use the call bell but in other parts it was noted they were ‘not compliant’ with it. There was contradicting information recorded on how people wanted their bed rails to be used to ensure safety. Another care plan noted the person had capacity to make decision and to keep them involved. However, the assessment lacked detail how the person was involved and steps taken to ensure the assessments were meaningful and accurate. Third person’s care plan set out requirements for checks to be done every 30 minutes on the person, but this was not always completed. Another person had communication passport to support them. However, the information in the document was basic and did not provide detailed information how to communicate with the person effectively. Although assessments and reviews considered the people’s health, care, wellbeing, and communication needs, such discrepancies in the records were not picked up to ensure people were able to receive care or treatment that would have the best possible outcomes.

A few relatives noted the communication and response to specific queries could be better as they were not always able to get information they needed. However, relatives mostly considered the staff and managers responded to health changes or deterioration in a timely manner and sought support as necessary. People were supported to remain as healthy as possible. Relatives agreed people’s health needs were looked after well and they were informed what was going on with their health or wellbeing. People were referred to different health professionals to address any health issues or changing needs. Relatives said, “[The person] has complex medical needs and the health is much better, [the person] looks better than they have done in years” and “[Staff] look after [the person] well and they are very kind and welcoming and knows that the home is a safe space to be.” People’s nutrition and hydration needs were mostly met in line with current guidance. People and relatives were positive about meal times and choices. One person said, “Food can be mundane but it is ok for options and I get a choice”. Relatives were kept up-to-date with people’s care and support and informed about any changes. People, and their relatives as appropriate, had been included in discussions around their care and how this was to be delivered. A relative added, “[The person] is more than impressed, [the person] is eating properly now…There is a choice of meals, the menu is good and always a choice.” People could have a drink or snack at any time. We observed people had drinks available to them and were encouraged to have those. People received support with meals and drinks to maintain a balanced diet. During mealtimes, we observed people were not rushed to have meals.

However, further evidence demonstrated people’s care, treatment and support was not always in line with good practice standards and not achieved good outcomes for people.

The registered manager said they worked with the staff team and sought support from different stakeholders to ensure the care was in line with legislation and current evidence-based good practice and standards. The registered manager was motivated to plan and deliver people’s care and treatment, including what was important and mattered to them. They said this was disseminated to the staff team regarding approach to care provision so they could ensure it had a positive effect on people and the service. The registered manager told us how people were supported to manage their health and wellbeing, but also to ensure people had as much choice and control as possible. The registered manager said they worked with the staff team to monitor and oversee people’s needs, preferences and look after their health, care and wellbeing needs. The registered manager explained how they supported, monitored and reviewed people’s nutrition and hydration needs including seeking support from professionals if they identified any risks or issues. Staff told us they received training, shared information, reviewed relevant guidance to ensure they were up-to-date with required standards to help them care for people in this service. Staff told us they worked together to help people look after their health and respond to any concerns or deterioration related to their health. Staff told us about people’s meals and drinks management and support they provided to people to ensure good nutrition and hydration intake. They said they shared information regarding any issues and escalate further if needed. Kitchen staff were able to support variety of people’s dietary needs and worked with the rest of the team together to ensure they had all the information needed. However, we found some issues relating to people’s needs including activities, consent, nutrition and hydration needs that did not reflect the feedback we gathered from the management team and staff.

The registered manager and staff did not always ensure people’s nutrition and hydration needs were followed according their plans of care. For example, a few people had to be observed while they were eating due to risk of choking or aspiration. We observed at least on 2 occasions this was not done. We asked a staff member about person’s support with meals. They told us they would monitor them as they walked past the room but not stay with the person. Staff’s lack of knowledge regarding people's nutritional needs put them at risk of choking and harm. We raised this with the registered manager and they took action promptly to address this with the staff team. However this was not identified as part of the care and support oversight. The registered manager and staff did not always communicate with people, their relatives and partners about their care and treatment according to current good practice, relevant to people’s care. For example, we identified 2 people who had monitoring devices installed to support falls monitoring. However, the registered manager did not ensure people’s consent was sought prior to installing the devices to monitor them. The senior staff were unable to explain clearly how they managed this process including having detailed assessments for capacity to support the person understand the need for such devices. A few staff commented the activities and variety of it could be managed better by the management team to ensure staff were not overwhelmed with such additional tasks. We observed the staff did not relay information well to people about what activities were planned for during the week. For example, the staff came into one person’s room who was really sleepy, read the information quickly and left the sheet on the side table. Staff did not always ensure people were engaged in meaningful activities to ensure they avoided social isolation and had quality of life. The daily notes did not reflect this support was provided consistently.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.