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 he

The Marbrook Centre is a purpose built care home, which provides accommodation and care, with nursing, for up to 81 adults. The home is situated in Eaton Socon, close to the A1 and the Cambridgeshire/Bedfordshire border. The Marbrook Centre delivers a service to people with neurological conditions including acquired brain injury and stroke. The centre also provides a service to people who are living with dementia.

This comprehensive inspection took place on 9 and 23 November 2016 and 4 January 2017. We visited unannounced on 9 November 2016, announced on 23 November 2016 and unannounced on 4 January 2017. This was the first inspection of this care home, which opened in May 2016. There were 18 people living at the home when we visited. Nine people were living on Eden, the ground floor rehabilitation unit and nine people were living on Mayfield, the unit on the top floor for people living with dementia. Our visit on 4 January 2017 was carried out following concerns that were raised by someone who wished to remain anonymous. The concerns related to a number of issues, including staffing levels, particularly over the holiday period.

As part of its conditions of registration, this home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 home is run. There was a registered manager in place who was present on the first two days of the inspection. The registered manager told us that a new general manager had been appointed, who would be applying to be the registered manager. On 4 January 2017 the new General Manager was present during the inspection.

Whilst some people were receiving a good service, this was not the case across the home. The auditing and monitoring of the service had not been effective enough to identify and address the issues we found.

People had warm, caring relationships with the staff and staff showed that they cared about the people they were supporting. Staff treated people with respect for their privacy and dignity and encouraged people to maintain and develop their independence. Relatives/friends appreciated the care and support given by the staff team, to them as well as to their family members. Staff liked working at The Marbrook Centre and felt well supported by the management and by each other.

Staff had undertaken training and knew how to recognise incidents of harm and report any concerns to their managers. The management team worked well with local safeguarding teams and made appropriate referrals. Potential risks to people had been assessed and guidance given to staff to minimise risks so that people were kept as safe as possible.

There were not always enough staff on duty to make sure that people were kept safe and that their individual needs were met in a timely manner. Medicines were not always managed safely. Staff had received a thorough induction and training in a range of topics relevant to their role. However, they had not undertaken sufficient training to develop the skills to work with people with a wide range of conditions, such as dementia and the effects of a stroke.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. Staff had a good understanding of the principles of the MCA. Appropriate applications had been made to the relevant authorities to ensure that people’s rights were protected if they lacked mental capacity to make decisions for themselves.

People’s healthcare needs were monitored and staff involved a range of healthcare professionals to make sure that people were supported to maintain good he