The Marbrook Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.At our last inspection we rated this key question good. At this inspection,the rating has changed to requires improvement.This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (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, registered manager and management team had a shared vision,strategy,and culture. The management team wanted what was best for people and had a clear focus on people’s quality of care and support as a core aim and value. They encouraged staff to put people at the centre of all of their decision making. However,some staff practice led to a less positive culture and this was not always identified and addressed independently by the leadership. For example, the way in which staff described people in records or the length of time people sometimes went without interaction led to a less positive culture. It was more challenging to consistently drive direction and maintain a positive culture because staff did not always report potential safeguarding incidents appropriately, which limited opportunities for learning. The providers systems were not picking this area for improvement up leading to inconsistent outcomes in people’s experiences which don't reflect leaders aims of a positive culture. The registered manager sent us assurances they would address these points by completing supervisions with the staff team and changing the systems in place to report incidents. We were shown evidence this was effective.

However, people and their relatives were positive about their support at the service.Staff were positive and happy when supporting people and most aspects of the service had a more positive feel.One person said, ‘’I think it's brilliant here. The staff are the best, and I am helped to do what I want to do.It feels like home.’’ A relative told us, ‘‘I feel happy and welcomed whenever I visit [family member] and always have a good feeling when I am there. The staff always seem so happy doing what they do,and this reflects to [family member and people].’’

The provider had inclusive leaders at all levels who understood the context in which they delivered care and support. They did so with integrity,openness,and honesty. The management team were an active presence at the service, spending time with people and staff. They listened and took feedback seriously. As a result, people and the staff team felt included in discussions about the running of the service. Staff felt well supported by the management team. People and relatives told us the management team were kind and caring. One person said, ‘‘[Manager] is always coming around and asking how we are.’’ A relative told us, ‘‘[Registered manager and management team] are very present and are not sat in the office all the time. They know [family member and people] well.’’

The provider fostered a culture where people felt they could speak up and their voice would be heard.Staff knew how to speak up and raise concerns and told us they would feel comfortable doing this. People and relatives had not made formal complaints,however,knew what to do if they needed to make a complaint and were assured that these would be investigated and taken seriously. The registered manager kept a record of concerns and made sure people were responded to with a resolution and any changes that would be made as a result of the concern being raised. One person said, ‘‘I do speak up and let them know if I am not happy and this has never gone further than a quick chat as it is always sorted out very quickly.’’

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.Staff felt well supported and told us they could approach the management team to have discussions about any help they needed in their job roles. The provider’s recruitment process was fair and equitable.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance.The management team were completing numerous audits to monitor the quality of the service. However, these had not been effective in identifying where incidents were not being reported on one floor of the service which supported people living with dementia, nor where people may not be meaningfully engaged with for long periods of time throughout the day. Whilst the management team took action to assure us this would be dealt with, we could not be assured governance systems in place would have picked up on these issues without us finding them during our inspection.

Other audits completed by the management team were effective in areas such as health and safety, people’s care and support being monitored and overall quality monitoring of the service.The issues relating to incidents was not prevalent on the other two floors of the service which supported people living with physical disabilities and people who used the service as a rehabilitation service to regain their skills and independence.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. People saw health professionals if this was needed. Visiting professionals were positive about the staff team and how they worked with them.The registered manager worked well with partners such as the local authority. Staff supported people to places of interest in the local community such as cafes and garden centres and invited partners from the community, such as entertainers into the service. Staff supported people to celebrate holidays and days of interest. One person had been supported to use a white board to record social opportunities and appointments on. They told us this had worked well for them. A relative told us, ‘‘It would be good if staff could spend a bit more time with [family member] 1 on 1 but they always try their best and [family member] enjoys what is on offer, especially going out and about.’’

The provider and management team focused on continuous learning, innovation and improvement across the organisation and local system. However, there were several areas of the service which needed improving that had not been picked up by governance systems in place as explained throughout this report. The registered manager and management team were keen to improve at the service and took our feedback seriously. However, we could not be assured these improvements would have been identified and put in place if not for our inspection. The registered manager reacted positively to the findings from this inspection and sent evidence to show they would improve in identified areas immediately. This assured us improvements would be made and sustained.

However, staff and management team always looked for improvements and ways to help people have the best experiences of support they could have. Staff told us how they noted and shared what worked well when supporting people so improvements to the way they were cared for could be sustained. One person said, ‘‘Things get better and better here day by day.’’ A relative told us, ‘‘I am very grateful to the management and staff team for the care and support they give [family member]. They are in the best place they can be.’’