Marlow

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity, and respect.

At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy, and compassion, or respect their privacy and dignity.

Relatives gave us varied opinions. One relative, talking about respecting a person's property told us, “[Loved one] has an iPad and when we visited, the iPad had been accessed by staff to look at various websites for themselves such as news websites." This was raised with the provider and an investigation is underway. Another relative told us, “They [staff] are great. They are so attentive.” Other relatives told us that their loved ones were well cared for by individual staff members. We observed a mixed interaction between staff and people. For example, 2 staff sitting at the dinning table with 3 people did not talk or interact with them for approxamatly 5 minutes, a more senior staff member intervened and started to engage with people. Other staff were seen to take some time to engage people in a friendly and supportive way.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The ground floor accommodation is for 10 people, most people have 1:1 staffing. This creates a busy environment. For some people we observed to be enjoying the company of several others, but this was not the case for everyone. Efforts were made to support people as individuals; however, the size and complexity of the service made it difficult. Staff told us, continued albeit reduced agency use and a lack of staff able to drive meant organising individual activities for people were difficult to plan. The difficulty obtaining drivers was confirmed by managers, however they did say some people were able to acess public transport and some things were within walking distance. Some support plans lacked details of meaningful goals or aspirations. For example; a goal to improve a person's use of Makaton sign communication was described as "To watch signing video's." This would need to be supported by staff understanding and use of Makaton in everyday communication with the person in order for the goal to be meaningful.

We saw people’s rooms were personalised, clean and inviting. We were told following to the assessment visit, two people were supported to go on holiday to eurodisney. We received mixed feedback from relatives which reflected our observations and staff feedback.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment, and wellbeing.

Experiences were mixed for people living at Marlow. Some people led the lives they expressed they wanted, while others were not supported to express their preferences due to the lack of support for staff to understand and use communication tools. For example, a person who knew Makaton (a simplified type of sign language) was not able to use it to communicate with staff because staff did not know what the signs meant. The lack of training and guidance in the area of communication meant the provider could not be assured the choices they were offering were things people actually wanted to choose from.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern, or distress.

There were varied outcomes for people, for example, people who experienced distress didn’t all have a clear plan to guide staff how to support them. Self-injury was not being clearly recognised as a behaviour of concern, and this meant some people did not have a positive behaviour support plan (PBS). PBS plans are designed to identify the function of the behaviour for the person, what can trigger it and how to support the person to manage those situations. This meant the provider could not be assured all staff knew what to do when people became distressed.

Staff didn’t always understand people’s communication needs unless they knew the person well. We observed distinct differences in response to people which appeared to be dependent on the individual knowledge of staff and not guidance or communication support tools.

Feedback from people, relatives and professionals reflected the varied outcomes we observed, and staff told us about.

We also observed interactions between some staff and people which demonstrated relationships were caring and compassionate, enabling staff to anticipate and meet people’s needs quickly and in ways that reduced and mitigated people’s discomfort and distress.

Managers told us, the staff were due to receive some additional training around different communication approaches soon.

The provider did not always demonstrate that they cared about and promoted the wellbeing of staff. They did not always support or enable staff to deliver person-centred care. Feedback from staff, families and managers told us there had been a lot of change in the management structure, this had resulted in some staff feeling they were not always supported well. A new senior manager structure had been put in place in April 2024, and a new interim manager had been in post 3 weeks, although was very new at the time of the assessment visit, staff were reporting feeling better supported. Processes to support staff such as 1:1 supervision meetings and staff meetings had improved and the interim manager was welcomed by staff and families. because they were visible and accessible. A member of staff told us they are optimistic for the future and feel the service had turned a corner.