Marlborough House

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified one breach of the legal regulations. We found the registered manager and the provider did not always ensure all of the issues we found during this assessment, that are described throughout the report, were identified through their own quality monitoring systems. Governance systems were not consistently effective in identifying and addressing areas for improvement. However, we also received positive feedback professionals, staff, people and relatives about the service and the work they had been doing which had a positive effect on the service. The registered manager worked together with the staff team and sought support and advice from external partners to ensure good outcomes for people. People's, relatives', and staff’s feedback were sought and used to make improvements to the service. Most staff and relatives said they could approach the registered manager and any staff with any concerns. Most staff felt they were fairly treated, their wellbeing was considered and the registered manager encouraged the culture of supportive team. The registered manager appreciated staff contributions and efforts to ensure people received the care and support.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The staff provided mixed feedback regarding the service management and working as a team. Some staff felt their work and efforts were not always recognised by the management team. Some staff felt the staff team was not always treated equally including some favouritism shown amongst the team. Most of the staff felt listened to, supported and they could approach the registered manager or other senior staff. Some staff also added any animosity or discrimination in the service would be managed appropriately and in a timely manner. Some staff said the atmosphere in the service was good most of the time however not all staff agreed the registered manager/the management team was visible to staff, people, and their relatives. Some staff noted, “There are splits [in the team] thus there is some resentment, so it is not always a happy team. But mostly [staff] work as a team, it is just harder some days. It does not greatly affect the quality of care, and we always provide the best possible care” and “Not enough done by the management team. We are just a number to them. Sometimes they are lovely to us, but it can change quite quickly.” However, the staff agreed they all worked as a team to support people and ensure their needs were met safely and effectively. Some staff were positive about their experience working at the service. They said, “Everyone is looked after really well. The care workers work really hard. I like working there, it’s friendly, I enjoy talking to residents and it is a rewarding job” and “My team are so friendly, we have good relationships - we look after each other and we get on so well.” Staff also agreed they collaborate with relevant external stakeholders and agencies that contributed to better outcomes for people, their relatives and staff team. The registered manager told us how they had been working with the staff team and senior leadership to oversee the service but also involved the staff for their input to ensure any changes needed.

The registered manager told us about issues and priorities for the quality of services and some changes they have been making throughout the year. The registered manager said they encouraged integrity, openness and honesty in the service to ensure any issues or concerns were addressed quickly. The registered manager added she felt supported by the provider and their staff team to manage the service and to ensure people continued receiving care and support they needed. The registered manager said, “[The staff team] is the best. I am exceptional lucky to have them, and the [deputy manager] is exceptionally capable RGN." People and the staff team had good relationships with each other. We observed staff and the managers were respectful towards people and each other. Relatives said staff were happy working at the service. Several relatives relayed they had never seen any staff member looking unhappy. Relatives considered there was a positive, warm, friendly and welcoming atmosphere at the service. Laughter and chatting were said to be heard frequently but also relatives relayed that it was quiet and peaceful at the service. The staff team told us about provision of care and support to people as their needs and health were changing. The management team was available and approachable to relatives, visitors or professionals. They felt comfortable to approach the team whenever they needed support or ad hoc conversations. Relatives noted the service and other professionals were working well together to look after people. Relatives told us from their observations, the managers valued their staff team and they observed very positive interactions between staff and the management and considered these to be pleasant and respectful. People had the choice to decide where they wish to be, and staff respected their decisions.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The registered manager explained how they oversaw and managed the service and care provided, staff culture and performance. The registered manager said they communicated with staff to share information, act on the best information about risk, performance and outcomes, involved the staff team not only in people’s care, the service welfare and management. They said, “We have action plan to share with staff so they can help to implement those actions. Embedding the culture with staff to remind the staff why we are doing things – make people safe, to ensure we capture and think of ways to support people; continuously striving to improve the service, make small changes and that people receive the care they need.” Staff understood their role and responsibilities and were mostly positive about the management of the service. There was mixed feedback from staff regarding approaching the registered manager or other management team with any concerns. Staff said, “We work well together – very good referrals for residents’ needs to outside professionals. They liaise well and promptly, and good in response”, “I would go to the nurses, who could take it forward, but not the manager or deputy manager. As I would not expect to be listened to” and “The manager is available for advice about managing staff. Yes, there is better communication, listening, and staff are involved in decisions. [There is] respect”. Staff said they had regular meetings to discuss various topics about the people, the service and any other matters arising. Staff said, “Regular all clinical staff in meetings but all staff meetings are not frequent. We make up for it with all the other meetings – no shortfall in sharing information.” People also had some meetings to have discussions. However, the evidence we have collected demonstrated the provider did not always ensure there was effective and clear oversight of the service and its quality.

The registered manager did not always ensure the issues we found during this assessment, that are described throughout the report, were identified through their own quality monitoring systems. The registered manager did not monitor recruitment checks were carried to ensure all required information was gathered before staff started, to ensure they were suitable staff. Where we found issues with medicine management, this was not always identified during quality assurance checks. For example, oversight of medicine administration and related records, PRN protocols and reviews, management of homely remedies and topical creams, lack of risk management in medication care plans when people were taking specific medicine for blood. Where record keeping was delegated to staff members, it was not always clear if the registered manager checked and reviewed these were done correctly and accurately. For example, we reviewed people’s daily notes and found incorrect names in the entries. Risk assessments and care plans were not always kept up to date to accurately reflect peoples’ changing needs and requirements. For example, one person’s continence assessment stated they did not have a catheter, when we reviewed this person’s daily notes we noted there was a catheter in place. It was not clear if mattress and weight checks were recorded to ensure accurate settings and support good skin integrity. One staff noted it would be part of monthly people’s review but otherwise there were no regular checks recorded to ensure people’s devices supported good skin integrity. Staff did not always have clear guidance in care plans and risk assessments to ensure people could receive the care tailored. We identified some incidents that were not recorded as per provider’s process or not notified to CQC. Relatives were asked for feedback verbally however most relatives told us they have not been asked to feedback formally via forms or questionnaires.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.