Marlin Lodge

We found the following examples of good practice.

¿ Processes were in place for visitors to reduce the transmission of COVID-19 in the home. These included providing a negative lateral flow test, proof of COVID-19 vaccination and wearing of Personal Protective Equipment (PPE) in line with government guidance when visiting.

¿ People had been supported to maintain contact with friends and family during the COVID-19 lockdowns through use of telephone and video calls. Other visiting opportunities had been provided during the COVID-19 pandemic which included window visits, garden visits and pre booked appointments for screened visits in a visiting pod at the home.

¿ The provider held workshops for people and staff in the safe use of PPE and additional infection prevention control measures to be taken to reduce the risk of transmission of COVID-19. People and staff were observed wearing PPE correctly during the inspection.

¿ Regular COVID-19 testing was completed by staff and people using the service in line with government guidance. The results of all COVID-19 tests were shared with the registered manager.

¿ The care home was clean and free from mal odours. Enhanced cleaning was completed by staff of frequently touched areas. The registered manager completed quality assurance checks of the environment to help ensure effective levels of hygiene and cleanliness were being maintained.

Marlin Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 17 people with learning disabilities or autistic spectrum conditions, in two separate buildings. At the time of the inspection, the service was providing care and support to 16 people.

The service had an overall rating of 'requires improvement' when we inspected it in November 2017, with two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider needed to improve all key questions to at least good. At this inspection, we found they had made the required improvements and the overall rating has improved to 'good'.

There was a registered manager in post. 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 now effective risk assessments and systems to keep people safe from harm. Staff had been recruited safely and there were enough staff to support people safely. Staff took appropriate precautions to ensure people were protected from the risk of acquired infections. People’s medicines were managed safely, and there were systems to help staff learn from incidents.

People’s needs were regularly assessed so that they continued to receive effective care. Staff had been trained and supported to meet people’s individual needs effectively. Records of staff competence assessments were now being kept. Staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. People were supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when required.

People were now consistently supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice.

Staff regularly reviewed the care provided to people with their input to ensure that this continued to meet people's individual needs, in a person-centred way. The provider had an effective system to handle complaints and concerns. End of life care plans detailed people’s wishes.

The provider had quality monitoring processes in place and the registered manager carried out regular audits. People, relatives and staff were happy with the quality of the service. The provider had now employed an external auditor to carry out annual checks of the service on their behalf. The registered manager worked well with others to continually improve the quality of the service.

We inspected this service in July 2015 and rated the home as Good overall. When we inspected the service on 22 and 23 November 2017 we rated the service as Requires Improvement overall. This is the first time Marlin Lodge has been rated as Requires Improvement overall. This inspection was announced the day before we visited. This was to ensure a member of staff would be present to let us into the home.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Marlin Lodge provides personal care and accommodation for people who have a range of learning and physical disabilities. Marlin Lodge can provide care for up to 17 adults. At the time of the inspection 15 people were living at the home. Marlin Lodge comprises of two houses next to each other.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

There was a registered manager in place. 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.

When we visited the home we found there were issues with the culture of the service. How people were spoken to and how staff interacted with people was not conducive to a caring and friendly culture. Staff were direct with people, or treated them in a way which was not adult like. Audits which were to test the quality of the service were not always effective. The provider was not completing any additional quality monitoring checks to support the registered manager to identify issues and offer a subjective view of the service.

These issues constituted a breach in the legal requirements of the law. There was a breach of Regulation 17 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we asked the provider to take at the back of the full version of the report.

Staff had a good understanding of what would constitute abuse and harm. People were supported to be safe with elements of day to day living and when they accessed the local community. People had risk assessments in place which generally gave information for staff about how to manage people’s needs.

Allegations of potential verbal harm were not investigated in a way which was open with actions taken to learn from mistakes made. Some people’s medicines and confidential information was not always stored in a safe way. We also identified some hygiene issues in some people’s bedrooms and bathrooms.

The practice of staff when supporting people with sensory needs and the way they sometimes engaged with people and supported them was not always effective. Training and the competency of staff was not robustly monitored and evidenced.

Healthy lifestyles and what this means was promoted by the service and some people had been successful in achieving their goals of being a healthier weight. . People’s meal experiences lacked a social input.

We concluded that staff did not intend to be direct and task focused with people, but this culture had developed and was not monitored. Staff practice was sometimes disrespectful and people were spoken to in an infantilised way at times. Staff were not chatty and comfortable with people. Meaningful relationships had not been formed with people. Despite most people and the staff had been at the home for a long time.

People’s aspirations were being identified by staff who set goals with people and met with them to discuss their care on a weekly basis. However, these were often limited in scope. Time and thought had not always been applied to see how some people’s goals and ambitions could be fulfilled. Social opportunities were taking place but most people were not able to access their interests because they lacked the funds to do so. However, creative ways were not considered and staff did not always advocate for people to access these.

The staff said they felt supported by the registered manager and people were familiar with them. When we raised issues with the registered manager they sent us an action plan identifying some of the key issues we found.

We saw that most of the premises was clean, suitably designed, and adequately maintained. In general, processes designed to prevent and control the risk of infection were well implemented. The provider took immediate action to make any necessary improvements during our inspection. We found the service carried out regular safety checks and maintained well completed records on those checks. We also found that arrangements were in place to deal with foreseeable emergencies.

We found the service had a complaints system in place. Information about the procedure was readily available to people who use the service in a format that met their needs. We found that people had their complaints responded to appropriately.