Marlborough Lodge

Marlborough Lodge is a residential care home providing personal care to 6 people who have learning disabilities and complex support needs. The service can support up to 6 people. The home is a detached property situated in a residential area of St Leonards on Sea.

People’s experience of using this service and what we found

The service demonstrated an excellent commitment to providing outstanding responsive support, which put people at the heart of everything. The registered manager led the staff to deliver person centred care, which had achieved consistently outstanding outcomes for people.

Staff went above and beyond to ensure people’s needs and wishes were at the centre of everything they did. There was an extensive and varied range of social activities and opportunities. People’s care was very personalised and staff demonstrated an enthusiasm and responsibility to ensure that people’s individual needs and outcomes were met. Staff had individual roles and the service appointed a number of care champions who led on specific areas of support.

Staff took positive risks, and thought creatively, to ensure people could do what they wanted to and put strategies in place to overcome any barriers to accessing activities and new opportunities. One relative said, “We've experienced a lot of different placements. (The person) has never been happier anywhere. We are so grateful. We put this down to (the manager). She's a superb manager. They work so well together.”

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were safe at the home and protected from the risk of abuse. One relative said, “He is very vulnerable, but staff support him everywhere. I feel perfectly content that he's as safe there as he would be at home.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received kind and compassionate care. People’s independence was promoted by staff. People were treated with respect and dignity and supported to make decisions about their care. One person said, “They are very kind. They help me here.”

The registered manager and provider were well regarded and had a clear vision for the service which was understood by the staff and embedded within their practice. There were effective quality assurance systems in place that were used to drive service improvements. People, their relatives and staff were asked for their feedback about the home and meetings were held regularly. One family member said, “They’ve got a great bunch of people. The manager and her team are the best it has been. They do a brilliant job.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good. (Report published 3 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was last inspected in August 2014 and was compliant with the standards we inspected. This inspection was unannounced and took place on 12 December 2016.

There was a registered manager responsible for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were sufficient staff available to enable people to take part in a range of activities according to their interests and preferences. Staff duties were clearly allocated so people received the support they needed.

A safe recruitment procedure was in place and staff received pre-employment checks before starting work with the service.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe.

People received their medicines when they needed them. Staff had received training in the management and administration of medicines and their competency in this area had been reviewed to ensure their practice remained safe.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made.

Staff had built trusting relationships with people. People were happy with the care they received. Staff interactions with people were positive and caring. Staff morale was good and there was a happy and vibrant atmosphere in the home.

Routines in the home were flexible and were based around the needs and preferences of the people who lived there. People were fully involved in the planning and reviewing of their care.

People were able to plan their day with staff and they were supported to access social and leisure activities in the home and local community. There was an emphasis on enabling people to be as independent as they could be and to live a happy and fulfilling life.

Not all the relatives were aware of the provider’s complaints policy; however they were all confident the registered manager would respond to any concerns.

There were effective systems in place to monitor and improve the quality of the service provided. Staff felt supported by their managers. The provider had not notified us of all significant incidents in line with their legal responsibility.

Below is a summary of what we found. The summary describes what people using the service and staff told us, our observations during the inspection and the records we looked at. During our inspection, we spoke with each of the people who lived at the service, the care staff and the manager.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that care plans were sufficiently detailed to allow staff to deliver safe and effective care that reflected the support required in people's assessed needs.

People were protected from bullying, harassment, avoidable harm, abuse and breaches of their human rights. Staff we spoke with knew about safeguarding of vulnerable adults and what action to take if they needed to. Records showed that all staff had received training about this. People who lived at the service said that they felt safe. One person told us, 'I'm completely safe and have no concerns".

People lived in safe, well maintained accommodation which presented a comfortable environment.

Staff files contained the information needed by the Health and Social Care Act as well as details of the training they had received. This meant the provider could demonstrate that the staff employed to work at the service were suitable and had the skills and experience needed to support the people who lived there.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people to help keep them safe. Relevant staff had been trained to understand when an application should be made and how to submit one. We saw that these processes had been followed and reviewed where needed.

Is the service effective?

We asked people if they were happy with the support they received. People told us, or indicated through gestures, sounds and facial expressions, that they were happy with their care and felt that their needs had been met.

Our observations and discussions with staff showed that they had a good understanding of people's care and support needs and that they knew them well. This was reflected by the clear guidance in people's care plans and the support staff provided.

Is the service caring?

We asked people who used the service if staff were kind and gentle when they supported them. People told us or indicated that they were. Our observation found that staff knew how to communicate effectively with people. We observed staff communicating effectively with people. We saw that staff recognised different communication methods used by the people they supported. Care plans contained personalised information which helped staff to know the people they supported and how to meet their needs. We saw that staff showed patience, compassion and understood how to support people as individuals.

Is the service responsive?

People's needs had been assessed before they moved to Marlborough Lodge. This meant that the service had the skills, staff and facilities to meet their identified needs. We saw the people met with their key workers regularly to review what was important to them. We saw that people had access to activities that reflected their individual interests and preferences. They had been supported to maintain relationships with friends and relatives wherever possible.

Is the service well-led?

Staff had a good understanding of their role within the service and felt supported by the manager. The manager showed a good knowledge and oversight of the running of the service. There were quality assurance processes in place to maintain standards in the service. We saw that staff and people who used the service had been given opportunities to express their views. Throughout the inspection, the manager and staff demonstrated that they placed the needs of the people who lived at Marlborough Lodge at the heart of the service. Discussion with staff found that they had a good understanding of their responsibilities and of the values of the service.

People received care and support which respected their rights and choices and promoted their independence.

Individual needs of people had been assessed and were reviewed, with care plans updated in the light of changed objectives. People experienced care and support that met their needs and protected their rights.

People were protected from the risk of the unsafe management of their medication because there were systems in place to store medication safely and to ensure staff were appropriately trained and their competence assessed before administering medication.

From talking to staff and looking at records we found that people's care needs were met by competent and well supported staff.

We used a number of different methods to help us understand the experiences of people using the service, as they had complex needs which meant they were not always able to tell us their experiences. We spent time with people using the service and observed their interaction with each other and the staff. We saw that interaction between people in the home was positive and constructive.

Staff asked for people's consent before they provided any care or treatment. People who were able to, told us they were asked for consent before any care and support was provided. They told us they were happy living at the home and with the care and support provided.

We looked at the systems and processes that the home had in place to ensure the people using the service were protected from abuse. These processes ensured that staff knew what constituted abuse and what to do if it was suspected.

We saw there were enough appropriately trained staff in place to meet the needs of the people currently living in the home.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints could be raised and resolved to people's satisfaction.