The Marbrook Centre

The Marbrook Centre is a care home with nursing. 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 Marbrook Centre delivers a service to up to 81 people.

The home is built on three floors: each floor can be divided into two separate units or used as one unit. Each unit has single bedrooms with ensuite facilities and shared lounge/dining/kitchenette areas. Each floor provides a service to people with specific issues. Mayfield (top floor) accommodates people living with dementia; Bray (middle floor) accommodates people with long-term rehabilitation and complex nursing needs; and Eden (ground floor) accommodates people with acquired brain injury, including stroke, who are funded for a short period of intensive rehabilitation.

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

People were safeguarded from harm by staff who were trained and knowledgeable about identifying and reporting any potential abuse. One relative told us how much difference it had made to their family member having enough skilled staff. Medicines were administered and managed safely.

Risks to people were identified and managed well. There were enough staff, who had been safely recruited and met people’s needs. Lessons were learned when things went wrong.

Medicines were managed safely, and the service had improved the processes for monitoring the administration of medicines. Care records were accurate and reflected the needs of people. Risk assessments were in place to help keep people safe.

Staff followed infection prevention and control policies. Due to the pandemic, additional processes and steps were taken by staff to keep people safe. Relatives told us that the service had actively engaged with them and they were assured that people were well looked after.

There were quality and assurance systems in place. The registered manager worked with the provider to monitor the safety and quality of care provided to people. Staff worked with other healthcare professionals to make sure people had the correct support they needed.

Staffing levels were appropriate to support people. There continued to be a robust recruitment process in place.

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.

The provider had ensured we were notified about events such as safeguarding. Audits in place were effective in identifying and driving improvements. People were involved in how the service was run. The provider worked well with others involved in people's care and support.

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 23 June 2018).

Why we inspected

We undertook a focused inspection to review the key questions of safe and well-led. This was because we received concerns in relation to the safety of people living in the service. Several safeguarding concerns had been raised with the local authority in relation to poor care. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. The provider had acted on safeguarding allegations and other concerns to help prevent the potential harm and risk of occurrences.

Please see the safe and well-led sections of this full report. The overall rating for the service has not changed from good overall but the safe domain has improved to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Marbrook Centre on our website at www.cqc.org.uk

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 home is built on three floors: each floor can be divided into two separate units or used as one unit. Each unit has single bedrooms with ensuite facilities and shared lounge/dining/kitchenette areas. Each floor provides a service to people with specific issues. Mayfield (top floor) accommodates people living with dementia; Bray (middle floor) accommodates people with long-term rehabilitation and complex nursing needs; and Eden (ground floor) accommodates people with acquired brain injury, including stroke, who are funded for a short period of intensive rehabilitation.

At our previous inspection in November 2016 and January 2017 The Marbrook Centre was rated Requires Improvement. During this inspection in March and April 2018 we found that improvements had been made in some areas and the service is now rated Good.

We visited The Marbrook Centre unannounced on 14 March 2018. We arranged with the registered manager that we would return on 11 April 2018. The registered manager sent us further information and we gave external professionals until 20 April 2018 to respond to our request for comments.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the home. 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 home is run.

During our first inspection visit we found some errors in the way people’s medicines were managed, which meant we could not be sure that people received their medicines safely and as they had been prescribed. During our second visit the registered manager told us that action had been taken to address the shortfalls: we will check this at our next inspection to ensure that improvements have been made and sustained.

There were almost always enough staff deployed on Mayfield and Eden. However, we concluded that were not enough staff deployed on Bray to make sure that people’s needs, including social and emotional needs were fully met at all times.

Staff had received training in safeguarding people and were competent to recognise and report any instances of harm or abuse. Some, but not all potential risks to people had been assessed and guidance put in place to minimise the risks. There was an effective recruitment process in place to reduce the risk of unsuitable staff being employed.

All aspects of health and safety were checked regularly and action taken to ensure that the home was a safe place in which to live and work. Staff adhered to the provider’s policies and procedures to ensure that people were protected from the spread of infection.

Assessments of people’s care, support and therapy needs were carried out to ensure that staff and equipment were available to meet each person’s particular needs in the way they preferred. Various technologies and equipment, such as call bells, pressure mats and tracking hoists were in place to enhance the care provided.

Staff received a thorough induction, which included several day’s training followed by shadowing experienced staff, so that they were equipped to do their job well. Mealtimes were social occasions, when people, relatives/friends and staff ate together. Healthy, nutritious and appetizing food was provided, with further choices available for people who did not want the choices being offered. Special diets were catered for and people supported to eat their meal if they needed support.

A range of external health and social care professionals worked with the staff team to support people to maintain their health and well-being. Staff worked closely with each other and with other professionals and organisations, such as the GP, hospitals, other care services and external health and social care professionals to ensure that each person received consistent care and support when they moved between services. A number of therapists were employed by the service and external professionals were called in when required, to support people to maintain their health and well-being.

The Marbrook Centre was very well designed to ensure that people received the care and support they needed in very modern, extremely well-equipped premises. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were cared for by kind, compassionate and caring staff. Staff showed empathy and understanding towards people and people’s emotional as well as physical needs were met. Staff made people feel they mattered and knew each person, and the details about the support the person needed, very well. Relationships between people and staff were based on respect and there was a lot of laughter and fun.

People and their relatives/friends were involved in planning their care and information about advocacy services was available if anyone wanted an independent person to assist them with their affairs. Staff respected people’s privacy and dignity and encouraged people to remain as independent as possible.

Staff made efforts to communicate with people in ways the person wanted and could understand. One person’s life had been transformed by the introduction of an eye-gaze system so that they could communicate their wishes and preferences. Confidentiality was maintained.

Care plans gave staff guidance on how to meet each person’s needs in an individualised way, although some details around the person’s care were missing. For people staying at the home for rehabilitation, care plans included detailed discharge planning so that wheels were put in motion early on to ensure services and equipment would be available when they returned home.

Statistics showed, and comments from people and relatives confirmed, that the service provided had supported a high percentage of people to attain their goal of improving so that they could go home.

The range of activities provided for people varied across the units. On Mayfield, people were kept occupied in whatever way they chose, whenever they chose and for as long as they wanted. People staying on Eden had therapy on five days each week so had little energy for other activities. However, trips out were arranged, including a shopper-hopper to local shops and markets and art and music therapy were arranged during people’s spare time. On Bray staff had little time to carry out activities with people.

A complaints process was in place and complaints were responded to and addressed. Processes were in place so that end-of-life care could be provided if it was needed.

Numerous positive comments about all aspects of The Marbrook Centre, including the staff, the building, the management and the service provided, had been made by people and their relatives and friends. The management team, including the registered manager, were approachable, visible and interacted well with everyone.

Staff were aware of their responsibility to provide the best quality service, upholding the provider’s values and ethos of the ‘3Cs’ – Compassion, Choice and Competence. Staff had a number of ways of putting forward their views and ideas for improvements. Staff felt valued and respected by the organisation, the management and each other and enjoyed working at the home.

The registered manager had strengthened the governance system so that she had up to date and verified management information available at all times. The provider’s quality assurance system included ways in which people, relatives/friends and other stake holders could put forward their views. Audits of all aspects of the service were carried out by various members of the staff team and actions put in place to address any shortfalls.

The home had a number of links with the local community and staff worked closely with other agencies and organisations, for the benefit of people using the service provided.

This comprehensive inspection took place on 9 and 23 November 2016 and 4 January 2017. We visited unannounced on 9 November 2016, announced on 23 November 2016 and unannounced on 4 January 2017. This was the first inspection of this care home, which opened in May 2016. There were 18 people living at the home when we visited. Nine people were living on Eden, the ground floor rehabilitation unit and nine people were living on Mayfield, the unit on the top floor for people living with dementia. Our visit on 4 January 2017 was carried out following concerns that were raised by someone who wished to remain anonymous. The concerns related to a number of issues, including staffing levels, particularly over the holiday period.

As part of its conditions of registration, this home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 home is run. There was a registered manager in place who was present on the first two days of the inspection. The registered manager told us that a new general manager had been appointed, who would be applying to be the registered manager. On 4 January 2017 the new General Manager was present during the inspection.

Whilst some people were receiving a good service, this was not the case across the home. The auditing and monitoring of the service had not been effective enough to identify and address the issues we found.

People had warm, caring relationships with the staff and staff showed that they cared about the people they were supporting. Staff treated people with respect for their privacy and dignity and encouraged people to maintain and develop their independence. Relatives/friends appreciated the care and support given by the staff team, to them as well as to their family members. Staff liked working at The Marbrook Centre and felt well supported by the management and by each other.

Staff had undertaken training and knew how to recognise incidents of harm and report any concerns to their managers. The management team worked well with local safeguarding teams and made appropriate referrals. Potential risks to people had been assessed and guidance given to staff to minimise risks so that people were kept as safe as possible.

There were not always enough staff on duty to make sure that people were kept safe and that their individual needs were met in a timely manner. Medicines were not always managed safely. Staff had received a thorough induction and training in a range of topics relevant to their role. However, they had not undertaken sufficient training to develop the skills to work with people with a wide range of conditions, such as dementia and the effects of a stroke.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. Staff had a good understanding of the principles of the MCA. Appropriate applications had been made to the relevant authorities to ensure that people’s rights were protected if they lacked mental capacity to make decisions for themselves.

People’s healthcare needs were monitored and staff involved a range of healthcare professionals to make sure that people were supported to maintain good health and well-being. People were given sufficient amounts of food and drink and the nutritional needs of people who required special diets were met.

People’s personal information was kept securely so that their confidentiality and privacy were maintained. An independent advocate visited the home regularly to offer support to people who needed someone to support them with their affairs.

A full assessment of each person’s needs was undertaken before the person was admitted to the home. People and their relatives/friends were involved in the planning of their family member’s care and support. For people admitted for rehabilitation, plans were put in place for each person to work towards their discharge. Staff gathered as much information as possible about each person so that their support plans were personalised. Staff did not always follow the instructions in the care plans, which meant people did not always receive the care they needed.

On Mayfield, staff worked tirelessly to make sure that each person was kept occupied, with whatever they wanted to do, for as much of the day as possible. People were encouraged to pursue their interests and hobbies, assist with household tasks if they wanted to and develop new skills. People on Eden received therapy sessions but there was very little else for people to do other than watch television. People and their relatives/friends knew how to complain and complaints were responded to in a timely manner.

The management team were visible and approachable. People, their relatives/friends and other stakeholders had made numerous positive comments about the service provided at The Marbrook Centre. The service was still in its first year of operation and the managers recognised that the home was still developing. Everyone involved with the home was encouraged to put forward ideas for improvement. Notifications were sent to CQC as required by the regulations.