Marlborough House

On this page

• 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 assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff assessed people's care needs and risks prior to their admission, to determine if they could be met safely. Professionals told us the registered manager was clear about who they could accommodate and balanced the needs of people already supported with new people's needs when completing assessments.

People had a monthly review of their needs through the provider’s ‘Resident of the Day’ process. This involved staff from all departments contributing to the person’s review. Staff contacted the person’s relatives with their permission to update them as part of the review.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider's national trainer ensured nursing staff had the opportunity to update and develop their skills and knowledge through both internal and external training. Staff used a range of nationally recognised tools to assess, identify and monitor people's care needs and risks.

People had a choice of main meal and alternatives and snacks were available. Overall people were satisfied with their meals and this was also reflected in feedback from the provider’s last resident mealtime experience audit. Staff offered people drinks regularly.

The registered manager had processes to ensure people's weight was monitored monthly and any required action was taken. Staff knew who required a modified diet and their competency at preparing modified drinks for people was assessed. We saw staff ensured people were safely positioned before assisting them to eat.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Health and social care professionals told us staff worked with them very effectively. They said staff escalated concerns appropriately; they told us people’s records were clear and up to date and that any guidance they provided was shared with staff and acted upon.

The provider had processes in place to ensure information from professionals was shared effectively with staff and required actions taken. A person’s care plan said staff were to support a person with eating their modified meal which we saw staff followed.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had care plans related to the management of their health conditions, such as diabetes, to guide and inform staff. Staff completed people’s physical observations regularly which enabled them to identify and escalate any emerging concerns for people. Staff told us, “We get to know their [person’s] baseline. If they are not eating or drinking, or not as awake as usual, they are less reactive or unsettled. We escalate this to the nurse on shift who refers them to the GP if required.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People's care plans set out the expected outcomes and goals from the delivery of their care which were reviewed monthly. Staff told us people’s planned outcomes depended on the aspect of their care and what the person and their family wanted to achieve.

There were also a range of other processes in place to monitor people's outcomes from their care. These included people and relatives feedback, complaints and compliments, safeguarding concerns, incident reporting, audits, staff observations and quality assurance reviews.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff engaged people who had the capacity to make decisions about their care in discussions about their wishes, and they then signed their consent. Where people lacked the capacity to make specific decisions about their care legal requirements were met. People's mental capacity care plans informed staff about how to support people with their decision making. If people had a power of attorney for health and welfare or finances, then this was verified.

Staff documented the outcomes from any Mental Capacity Act (MCA) 2005 assessments and the outcomes of best interest discussions. For example, if people used monitoring devices to alert staff in case they fell and could not consent to their use then an MCA assessment and best interest decision was in place. Staff had completed relevant training.