Marlow

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing, and communication needs with them.

Assessment processes for the most recent people who moved into the service, failed to fully identify people’s needs. There was a failure to recognise the complexity of people’s need, and this was not reflected in the skills and competencies of the staff team.

This resulted in a number of safeguarding alerts being raised with the local authority and considerable support needed from a range of health professionals.

Families told us they participated in the pre-admission assessments conducted by the service but felt expectation of the service being offered did not match the experience.

The provider has developed more robust pre-admission assessments documents and guidance, which have been used in other of the providers services but are not yet evaluated at Marlow.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

For example, a person with a stated diagnosis of autistic spectrum condition did not have guidance in their support plans to guide staff how best to support them. Staff were not aware of their specific needs around sensory sensitivities or difficulty understanding what was happening next or concepts such as waiting for something. Relatives told us this had resulted in the person becoming distressed on a number of occasions

The service did not always work well across teams and services to support people. They did not always commincate effectivly with external professionals. Feedback from professionals sought following the assessment reported "People's needs have changed since starting their placement (at Marlow) and these have not been met effectively or in a timely manner which has led to harm. We believe that professional guidance is not always followed (SALT, physio, OT)."

Feedback we received from health professionals identified communication between the service and themselves had been difficult to establish in order to work effectively. They told us this had started to improve recently. There has been positive feedback about the interim manager's approach to working with external proffesionals.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice, and control. people were not always supported to live healthier lives, or where possible, reduce their future needs for care and support.

For example, changes in people’s presentation, emotional state, or distress, which may show a deterioration in their health or wellbeing, had not always been recognised in a timely manner. A health professional told us they had experienced a, “Lack of urgency in implementing or escalating client’s specific needs. i.e. if a pressure area has been noted, there has been occasions whereby Marlow staff have not acted on this quickly, and it has been through parents’ due diligence that District nurses or tissue viability nurses have become involved.”

There had been improvements in this area recently with improved staff knowledge and management oversight, however changes need to be fully embedded into practice, so this continues to be an area requiring improvement.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There were mixed outcomes for people. Some people and their families told us they were not always engaged in developing skills and having life experience and strengths discussed with them. There was a lack of understanding how people’s short-, mid- and long-term life choices, goals, ambitions, and outcomes could be planned and achieved. For example, not everyone had their ambitions or preferred outcomes recorded. Where they were recorded, they were generic for example: statements such as “improve my quality of life.” There was no specific detail and no guidance for staff to follow to support the person to achieve outcomes they may want. For some people they were able to talk to staff about their preferred outcomes and actions were taken to support them, for example a person said they wanted to try a voluntary job, and staff had supported them to achieve this.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were supported to exercise choice where they were able and best interest decisions were in place where people found it difficult. People who needed it were referred for a deprivation of liberty assessment.

Staff were able to talk about their role in supporting people to meaningfully consent or not to care. One staff member explained when asking if ok to support a particular person with their care. The person will, “Stick out their bottom lip if they don’t want to do it now, so we leave it for a little while and try again later when they are ready.”