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Inspection carried out on 25 July 2018

During a routine inspection

We carried out a comprehensive inspection of Marlow on 25 July 2018.

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.