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. There were 43 people in residence during our inspection visits.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.