Archived: Marland Court

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• 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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.At our last inspection we rated this key question requires improvement. At this assessment the rating has remained requires improvement.This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent. There was a lack of understanding in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) process. Consent records within electronic care plans were incomplete. We were not assured people’s rights were protected.

This service scored 42 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them, or appropriate representatives.

People’s care records did not reflect involvement from their relatives and friends in their development, to ensure their individual needs, wishes and preferences were reflected. Our findings were confirmed by feedback we received from people’s relatives.

On our second day of assessment a person had been newly admitted to the home. No compatibility assessments had been completed in respect of the new admission. There was no consideration given as to how their needs might impact or affect existing residents, nor were any risk assessments in place.

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

The provider did not always work well across teams and services to support people.Records of supervisions we saw carried out in December 2024 indicated there was conflict within the staff team in the home. It wasn’t clear what steps had been taken by the manager to resolve these staffing issues.

The service was not always working in partnership with health and social care professionals. We noted delays in referrals into other services, for example the physiotherapist. This meant one person was nursed in bed for longer periods of time, as a result of this delay.

The provider did not support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. We saw no evidence that people were encouraged to live healthier lives, or where possible, reduce their future needs for care and support.

Feedback gained from relatives was negative in relation to staff meeting people’s personal hygiene needs. They judged that people were not shaved or showered often enough. A shower rota was in place; this indicated institutionalised practice. One person had been approached 6 times in 2 months by staff with the offer of a shower; their care plan and daily notes reflected this. We saw 4 refusals were recorded by staff; the person received 2 showers, 1 in December 2024 and another in January 2025. The low frequency of washing and showering did not promote good personal hygiene.

The Waterlow tool is used routinely in clinical practice to assess the risk of pressure sore development. This had been completed electronically for a person in September 2024, and a score of 23 applied; this meant the person was deemed very high risk of developing pressure ulcers. This score was reviewed in November 2024 and scored 17, denoting high risk of developing pressure ulcers. There had been no further review of the risk at the time of this inspection, despite skin integrity identified as ‘very high risk’ on the person’s care plan. At the time of the assessment district nursing staff were attending to treat the person for ulcerated legs; there had been no escalation to the GP or other health professionals when creams were refused.

A relative we spoke with told us the home contacted them and asked them to support their family member to a hospital appointment on the day of the appointment. As this could not be facilitated by the relative or by the home the appointment was cancelled. People were not supported to live healthier lives.

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.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.People’s abilities to consent to care and treatment were not being consistently assessed, reviewed or monitored. Where assessments of mental capacity were being completed, these were found to be of poor quality. People’s equality, diversity and human rights were not being upheld, due to poor implementation and understanding by staff and leaders of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

From speaking with staff, both on site and by telephone, we concluded that staff were not implementing their training on mental capacity and DoLS into practice, and demonstrated a lack of understanding in relation to the process. Staff were unaware of those people who had conditions imposed as part of their DoLS, and the impact this might have on the approaches to care. This was due to the lack of recording of DoLS conditions within people’s electronic care records.

There was no evidence of any mental capacity assessments or best interest decisions for anyone who lacked capacity, either hand-written or recorded in electronic care plans. We saw no evidence of consent forms or signed requests where people with capacity had made decisions. We could not be assured that people’s individual rights were being upheld.

Relatives were not involved in care reviews or any decisions made in people’s best interest, where they lacked capacity. There were no records relating to any relatives having Lasting Power of Attorney. It wasn’t clear how decisions were being made on behalf of people, or whether the right people were being consulted.