We carried out a review of the data available to us about Marston Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Marston Court, you can give feedback on this service.
We found the following examples of good practice.
¿The service was clean and tidy. Regular cleaning took place throughout the service including touchpoint areas.
¿Suitable arrangements were in place to ensure that anyone moving in to the service, did so safely. This included a negative Covid 19 test before moving in, and isolating for a 14 day period within the service.
¿Staff had access to sufficient supplies of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser. The registered manager had been pro active in ensuring stock levels remained good for the staff. We observed staff using PPE correctly.
¿Staff followed guidelines with the donning and doffing of PPE, and had an area within the service where this could be done safely.
¿Procedures were in place to facilitate contact between people and their families. Garden visits from family had been arranged, and social distancing had been maintained at all times. Processes in place for any visitors were clear, and included questions around COVID 19, a temperature check, and appropriate PPE.
¿Regular testing was completed for staff and people living at the service. This meant prompt action could be taken should anyone test positive for COVID-19.
¿Regular checks and audits around infection control were completed to ensure the registered manager had oversight on the service, and could address any issues promptly if found.
Marston Court is a residential care home that supported people of all ages with learning disabilities, some of whom were living with dementia. The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 22 people. Twenty people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs, intercom, cameras, or anything else outside to indicate it was a care home.
People’s experience of using this service and what we found
People felt safe living at Marston Court. Staff knew how to keep people safe whilst supporting them. Staff supported people to take their medicines in a safe way. People felt there were enough staff to support them. Risks associated with people’s needs were assessed and managed appropriately.
People were positive about the food and drink they received at the service and staff supported people with their dietary requirements effectively. Staff supported people to access appropriate healthcare services in a regular and timely manner.
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 and their relatives spoke very positively about the staff, they felt they were caring, kind and respectful. Staff encouraged people to live as independently as possible. Staff maintained people’s privacy and dignity whilst supporting them.
People were involved in developing their plans of care, which were individualised and gave staff the information to care for people in a personalised way. People engaged in a variety of different activities and were supported to be part of the community.
People and their relatives felt the service was well-led and were very complimentary about staff and management. The registered manager had comprehensive monitoring systems in place, they were aware of their responsibilities and worked with other agencies to ensure people received quality care and support.
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.
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 (published 12 October 2016).
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.
Marston Court provides care and accommodation for up to 22 people with learning disabilities and autistic spectrum disorders, some of whom also have physical disabilities. On the day of our inspection there were 18 people using the service.
The service has a registered manager. 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.
People told us they felt safe using the service and trusted the staff. Staff were trained in safeguarding and understood their responsibilities to safeguard the people using the service. They used their knowledge of people, and the trusting relationships they had formed with them, to keep them safe.
Since we last inspected risk assessments and care plans had been re-written and improved. This meant that staff had up-to-date information to keep people safe whilst also ensuring that their freedom was respected. Staff used recognised de-escalation and distraction techniques to support people safely if they became distressed.
There were enough staff on duty to meet people’s care and support needs and enable them to take part in activities. Staff communicated well with the people using the service and had the training and support they needed to work effectively with them.
People told us they liked the food served. We observed the lunchtime meal. Staff sat with people while they ate and talked with them helping to make the meal a sociable occasion. If people needed assistance to eat, or adapted cutlery, staff provided this. Menus showed people had a varied diet, based on their preferences, with choices at every meal.
Staff supported people to maintain good health and ensured they accessed healthcare services when they needed to. Some people had complex healthcare needs so staff worked closely with a range of healthcare professionals including GPs, District Nurses, physiotherapists, and learning disability experts. Staff advocated for people to ensure their healthcare needs were met and accompanied them to appointments.
People and relatives told us the staff were caring. They were kind and patient in their approach to people. They knew people’s preferences and how they liked to communicate. They encouraged people to express their views and make choices about all aspects of their lives including what to eat and drink and whether or not to take part in activities.
Care plans focused on people’s strengths and abilities and how the person wanted to be supported. Their likes and dislikes were recorded and other key information staff needed to know. Staff understood the importance of activities to enrich people's lives and the activities organiser provided both group and one-to-one activities to meet people’s needs.
People and relatives told us they would speak up if they had any concerns about the service. Staff listened to people using the service and others if they had any concerns and took action to resolve these to people’s satisfaction. If people were unable to complain verbally or in writing staff advocated for them to ensure their complaints were heard.
People, relatives and staff told us the service was well-managed. They said the registered manager had had a positive impact and brought about many changes and improvements to the service. Staff said they felt valued and staff turnover had reduced giving people more continuity of care.
People using their service and relatives were asked to share their views about the service in a number of ways including at one-to-one and group meetings, open days, and through surveys. People were listened to and changes made in response to their suggestions and ideas.
The culture at the service was open and positive. If incidents or accidents occurred the registered manager and staff learnt from them and took action to reduce the risk of reoccurrence. They used the provider’s quality assurance system to evaluate the service to help ensure the people using it were providing high quality care.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.
The home provides care and accommodation for up to 22 people with learning disabilities, some of whom also have physical disabilities and/or mental health needs. The service is not registered to provide nursing care.
This was an unannounced inspection that took place on 15 July 2014. During the visit we spoke with nine people living at the home, five care staff, the registered manager, deputy manager, and the home’s regional services manager. Following our visit we spoke with two relatives of people who used the service and a local authority compliance manager.
On the day of our visit there were 19 people living at the home. There was a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.
People were safe at the home and staff knew what to do if they had any concerns about their welfare. Records showed staff had thought about people’s safety and how to reduce risk. They also knew how to protect people under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS).
People’s likes, dislikes and preferences were central to how their care was provided. Staff focussed on what they could do and how they could progress to become more independent. People had access to health care professionals when they needed it. Staff took prompt action if there were any concerns about a person’s health.
People interacted using both verbal communication and sign language and staff understood what they needed. People were treated with care and kindness and their privacy and dignity was respected. Their cultural needs were identified and met and they were encouraged to make choices about all aspects of their lives.
People were supported by appropriately recruited and trained staff who had the skills they needed to provide effective and compassionate care. People got on well with the staff who encouraged them to socialise and take part in a wide range of activities.
The premises were clean and fresh and people could move about the home and gardens freely. People’s bedrooms were respected as their own space and the décor and furnishings reflected their individual tastes and interests.
The manager had substantial experience in the care and support of people with learning disabilities. She was approachable and helpful. People were supported to share their views about the home in ways that took account of any communication difficulties they might have. Audits were in place to assess the quality of the service, and health and safety checks carried out to make sure the environment was safe.
Our inspection of 7 May 2013 found that some people were not protected against the risks associated with medicines because they had not received their medication at the time they needed it. We carried out this inspection to check that the provider had taken appropriate action. We found that people were now receiving their medication at the time they required it and the service was now meeting this standard.
We looked at the records of four people who used the service and found care plans were detailed and thorough and provided clear guidance to staff about how the persons’ care should be delivered.
People were supported to have adequate nutrition and hydration.
Staff we spoke with demonstrated a good understanding of the needs of people who used the service. Staff received appropriate professional development.
We found appropriate arrangements were in place for the obtaining, recording and administration of medicine. However, we found there had recently been a few occasions where lunchtime medication for two people had been missed. This meant that people may have been at risk as they had not received medication at the time they needed it.
The service had a robust quality assurance system in place.
Please see our previous report for further information.
During our visit we found the service had improved its practice and was now compliant with this standard.
We saw that people looked relaxed and comfortable. Brief observations showed staff were responding appropriately to people and were treating them with kindness and respect. The service was preparing for a Halloween party and we saw that people were involved with making decorations at the time of our visit.
All the interactions we observed between staff and people using the service were respectful and positive. We saw that staff were patient with people and gave them time to communicate their needs.
People were given a choice of meal using picture cards and we saw staff taking the time to explain the available options. We saw that one person was unable to choose their lunch option using the picture cards and so staff bought both meal options out and they were then able to make a choice.
We observed staff supporting people during lunch and saw that staff treated people with kindness and consideration.
We saw that the views of relatives and carers had been gathered in a recent survey. The results of the survey were positive and shared with participants. Where areas for improvement had been identified, the provider stated what they were going to do to address these.
We saw that the staff were attentive and respectful towards people living at the service. They noticed when people were not comfortable and offered them choices in terms of what they did, what they ate and what they drank. We noticed that they understood the ways in which each person communicated.
The staff assisted people discreetly and the interactions we saw between staff and people living at the service were good. Staff made sure they always sat with people and spent time doing things they enjoyed such as reading. Most of the people living at the service were out on a trip to the Sea Life Centre.
We also spoke to two care managers employed by the local authority who were visiting
people living at the home. They told us that they felt the service had improved significantly and they felt the quality of care and of people's lives had improved since our last visit to the service. The staff we spoke with told us people enjoyed a much better quality of life and they said the staffing levels had improved.
Although we observed two members of staff who had a very pleasant, open and friendly manner with people using the service which they responded well to, most of the interactions we observed gave us concerns. We saw all of the staff talk about people using the service and their needs whilst in communal areas. This was done consistently. It was not necessary as communication about people could have been done quietly and discreetly which would have protected people's personal dignity. Some of the staff we observed seemed frustrated when people did not do what they wanted them to do, and this was noticeable in the tone of voice they used to speak with people. Given that many of the people using the service did not communicate verbally the tone of voice and non verbal communication style staff used was important and could affect their mood and behaviour.
We observed that people in the same living space seemed to have opposing needs. For example, there were people who looked distressed when there was noise surrounded by people who were agitated, distressed and noisy. One of the people we observed reacted very strongly to another person living at the service as they approached and they started screaming. This went on for some time until the staff identified that she did not want the other person near her. They moved the person away and the screaming stopped. This showed the staff were unaware of the potential triggers for behaviour and were slow to identify what could have caused the response. As a result of this other people were visibly upset and agitated at the noise.
We saw evidence of people who live at the service coming and going out in to the community, for walks and to the shops. People were asked if they would like to go out and if they chose not to we saw this was respected. We saw people ask when they were going out and they seemed to be looking forward to this.
We found the home was not clean or hygienic and there were significant risks of people using the service getting or passing on infections because of this. We could find no evidence that the provider or manager had effective systems in place to make sure that risks to people living at the service were properly identified, assessed, managed and addressed.
People who were able to say, told us that they felt happy living at the home. One said 'the staff are nice here'. Staff training and knowledge keeps them safe from potential abuse although the environment that people live in does not fully protect them from the risk of infection.
People told us there were enough staff to care for them but were not always able to have a say in the running of the service because of a lack of systems to gain their views.