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Inspection Summary

Overall summary & rating


Updated 19 October 2018

This inspection took place on 21 and 23 August 2018 and was unannounced. Marshlands is a ‘care home’ for people who may have a learning disability or autistic spectrum disorder. 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. The care home accommodates up to 18 people in one adapted building. Two people had their own personal flats external from the main house. All people had access to two communal lounge / dining areas, kitchen and shared bathrooms. There was a large garden which people could access. At the time of our inspection, there were 14 people living at the service.

Marshlands was last inspected on 12 May 2017 and was rated as Requires Improvement in the safe and well-led domain, and Requires Improvement overall. Shortfalls identified at that inspection included tools being left unattended within the service placing people at potential risk, actions identified by the fire service had not been implemented, and work was needed on the structure of staffing and their understanding of their responsibilities. At this inspection, the provider had made improvements in these areas and worked through an action plan of the issue we identified during our inspection. Environmental risk assessments had been put into place, and staff were aware of the risks of leaving tools unattended. The provider had installed a ramp at the front of the building as recommended in the risk assessment completed by the fire brigade. Following concerns raised at the previous inspection, staff received the support they needed from a structured management team. This service has been rated Good overall.

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. A new manager had been appointed and was in the second week of the induction when we visited. The new manager was in the process of submitting an application to take over the management and registration of the service from the registered manager. They are referred to throughout this report as the manager.

The care service had not 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.

Marshlands was designed, built and registered before this guidance was published. The provider has not developed or adapted Marshlands in response to changes in best practice guidance. Had the provider applied to register Marshlands today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability and/or Autism should be operated to meet their needs. The service accommodates more than the recommended number of people, and is not based within a community setting with easy access to local amenities. However, the service was working within the principles of promoting choice and impedance, and was in the process of reviewing the service with the goal to create a more person-centred service, which would meet the guidance for registering the right support.

People told us they were safe at the service. Staff were trained in safeguarding and knew how to report any concerns.

Risks to people and the environment had been assessed and minimised and people were supported to take positive risks such as accessing the community independently, a

Inspection areas



Updated 19 October 2018

The service was good.

People were protected from potential harm and abuse by staff who knew how to recognise and respond to abuse.

Risks to people and the environment had been assessed and minimised.

There were sufficient staff to meet people�s needs.

People received their medicines when they needed them and in a safe way.

People were protected by the prevention and control of infection.

Improvement plans were implemented when things went wrong.



Updated 19 October 2018

The service remains effective.

People�s needs had been assessed in line with good practice.

Staff received the training they needed to complete their roles.

People were supported to maintain a balanced diet.

Staff worked internally and externally to provide people with access to healthcare professionals.

Staff understood the importance of gaining consent and giving people choice.



Updated 19 October 2018

The service remains caring.

People were supported by a staff team that knew them well, and were able to provide emotional support when required.

People were encouraged to express their views.

Staff respected people�s privacy, and dignity and encouraged independence.



Updated 19 October 2018

The service was not always responsive.

End of life planning was in early stages, and more work needed to be completed in this area to ensure people�s wishes and beliefs were met.

People received person centred care responsive to their needs.

People knew how to raise concerns and complaints.



Updated 19 October 2018

The service was well-led.

There was a positive empowering culture.

The registered manager understood their regulatory responsibilities.

Quality assurance audits had been completed to a good standard.

People�s views were sought and used to drive improvement at the service.

Staff and the registered manager worked in partnership with other agencies.