We carried out a review of the data available to us about Marlow on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Marlow, you can give feedback on this service.
Marlow is a care home providing accommodation and personal care for up to 15 adults with learning disabilities and/or a variety of associated health and support needs.
People lived in separate parts of the building comprising the ground and first floor. Upstairs there were two self-contained flats for people who were supported to live more independently. At the time of the inspection there were 15 people living at the service.
People’s experience of using this service and what we found
People’s care and support was provided in a safe environment which met their individual needs. People were protected from abuse and poor care. People and relatives told us they had confidence in how staff kept people safe. Systems were in place and safeguarded people from the risk of abuse. Staff could recognise signs of abuse and knew actions to take. The provider ensured staff received safeguarding training and received opportunities for continual learning.
People were supported to be independent and had control over their own lives. Staff demonstrated person-centred support which included supporting people to manage risks. The service worked closely with medical professionals to review and manage specific health risks. People received medicine safely and staff proactively worked with health professionals which ensured medicines were reviewed appropriately. The service had enough skilled staff to meet people’s needs and keep them safe.
People were supported by staff who understood best practice in relation to learning disability and/or autism. Caring values were embedded in the service. A relative told us, “They are proactive, really good couldn’t fault them, [person] has a completely different life now.” Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. The interim manager was visible, approachable, knowledgeable and had ensured team morale remained positive. The provider had maintained effective oversight of the service which ensured the service continued to be well- led.
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.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of safe and well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
• Model of care and setting maximises people’s choice, control and
Independence.
People were supported to make choices. We observed staff supporting people to arrange equipment repairs and contact relatives at times of their choosing.
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human
rights.
Care and risk plans were person centred. Staff demonstrated an awareness of people’s individual needs.
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
The needs and quality of life of people formed the basis of the culture at the service. Feedback from people, relatives, health professionals and staff confirmed people received genuine person-centred care supporting empowered lives.
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 (published18 September 2018).
Why we inspected
The inspection was prompted in part to follow up on the management of safeguarding processes, incidents and how lessons had been learnt. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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 looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We found no evidence during this inspection that people were at risk of harm from this concern. The service was able to demonstrate how incidents were managed safely; this included clear safeguarding processes, actions taken as a result and evidence of learning from incidents.
Please see the safe sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Marlow 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.
Marlow is a care home providing accommodation and personal care for up to 15 adults with learning disabilities and/or a variety of associated health and support needs.
People lived in separate parts of the building comprising the ground and first floor. Upstairs there were two self-contained flats for people who were supported to live more independently. At the time of the inspection there were 11 people living on the ground floor and three people in the first floor flats.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Staff were knowledgeable about people’s individual needs and preferences. They described how they offered choice to people that reflected their different communication needs. The service was welcoming and accessible in its layout and décor. Staff talked with pride and affection about the people they supported. Relatives told us that staff offered choice and promoted people’s independence.
We saw that there were enough staff to support people safely and consideration had been given to the arrangements for staff to take breaks during the rise in covid-19 cases in the service. We were assured that the service was following guidelines for preventing and controlling infection.
Right support:
• Model of care and setting maximises people’s choice, control and Independence
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human rights
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives
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 Good (published 13 September 2018).
Why we inspected
We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels and safe working practices. We found there were enough staff to support people and people were safe.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
CQC have introduced targeted inspections to check specific concerns. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. Please see the safe section of this report.
You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Marlow 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.
Marlow 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.
Marlow is registered to provide accommodation for people requiring personal care for up to 15 people, older people and younger adults with learning disabilities or autistic spectrum disorder, physical disabilities, sensory impairments and mental health support needs.
People lived in separate parts of the premises of the service; the downstairs of the building was called Marlow and upstairs there were two smaller self-contained flats. At the time of the inspection there were 15 people in total living at Marlow. 11 people lived in Marlow and four people lived in Marlow flats.
Marlow 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 this service can live as ordinary a life as any citizen.
The service had 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.
This was the first inspection of the service since it was registered with the Care Quality Commission (CQC) in June 2017.
People told us they felt safe. One person said, “I feel very safe and comfortable”. There were systems and processes in place to keep people safe from abuse. Staff had received safeguarding training and understood how to recognise signs of abuse and their responsibilities to report this internally and externally if concerned.
People had risk assessments in place that identified any potential hazards to their well-being, the risks this presented and the control measures needed to keep them safe. Where ever possible, people were involved in this process and restrictions on their independence were minimised.
Systems for ordering, storing, returning and disposing of medicines were overseen by the registered manager and were operating safely. The service had enough staff to meet people’s needs and there were safe recruitment processes.
The premises and equipment within it were well maintained and clean and hygienic. Staff received infection control training and used plastic gloves and aprons when supporting people with personal care tasks.
People and their relatives told us that the service was effective. People’s physical, psychological and social needs had been comprehensively assessed to ensure they were able to meet their preferred support outcomes.
Processes were in place to ensure there was no discrimination for people when they made their support decisions. Staff received Equality and Diversity training and there was an 'Equal Opportunities, Diversity and Anti-Oppressive Practice' policy.
All new staff received a comprehensive induction that met the Care Certificate standards. The Care Certificate was introduced in April 2015 and is a standardised approach to training for new staff working in health and social care. It sets out learning outcomes, competencies and standards of care that care workers are nationally expected to achieve.
There were comprehensive induction, probation and on-going training and supervision processes to help staff to deliver effective support. Staff worked well with external agencies, such as local authority social and healthcare services and other providers to help co-ordinate people’s support so their needs could be effectively met.
People were involved with planning their meals and had been assessed with any necessary specialist input to help manage any specific or complex eating and drinking needs. People had support to monitor their healthcare needs and access healthcare services if necessary. The physical environment of the service was personalised and had been adapted to meet people’s needs.
People had the consented to their care and the service was operating within the principles of the Mental Capacity Act. Any conditions on authorisations to deprive a person of their liberty were being met and considered how to support people in the least restrictive way.
Staff were caring and people’s privacy, dignity and confidentiality were respected. Staff listened to people and communicated with them in the most accessible way. Where necessary, staff supported people to contact and use other services to help them express their views and ask and answer questions about their support.
People were encouraged to be as independent as possible. Staff told us that it was important to encourage people to do all that they could themselves. One member of staff said, “We are always trying to upgrade people’s independence and look to see how we can make this happen.”
People and their relatives told us they received personalised care. A relative told us, their family member, “Is always doing something they enjoy”. People and their relatives were involved in planning people’s care and information about their support was provided accessible ways to help them be in control of their support as much as possible.
People had care plans that contained details about their life histories, relationships, interests and aspirations and how this related to and informed how they wanted and needed to be supported. People’s care was regularly reviewed to ensure they maintained a good quality of life and received consistent person-centred support.
People were encouraged and supported to develop and maintain relationships with important people in their lives both inside and outside of the service. Visitors were encouraged and people had regular visits from family members and friends and were supported to meet up with them outside of the service.
People had support to plan and access individual activities, to allow them to follow their interests and aspirations. People enjoyed support to access a range of activities at the service and in the wider community, including attending music festivals, social groups and local colleges.
There was a complaints policy and this was available and on display in ‘Easy Read’ format so people could access this easily. Complaints were responded to in line with the organisations policy and used as an opportunity to review if any improvements could be made.
There was a positive, inclusive and open culture that promoted empowering people through providing person-centred care. Management supported staff to deliver high quality care based on values that people using the service had been involved with developing.
Staff well-being and equality and diversity rights were respected. Staff had support with development and learning opportunities and individual staff and team achievements were celebrated.
There were effective quality assurance systems in place which management monitored to identify any risks or areas of practice in order to improve or build upon. Actions were prioritised and timeframes for completion were set to help make sure the service was addressing any issues in a timely manner.
People and relatives were consulted with to help understand how the service was performing and be involved with its development. Staff and management worked with external agencies such as the local authority care management and safeguarding team to promote consistency in the expectations and quality people’s support.