Mary House

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 remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People's health and social needs were assessed before coming to live at the service; the impact of these had been fully considered and there was clear information about what was important to people and their families and how they would like their care and support to be delivered. This was monitored and adapted during the transition stage. This had also ensured the service could meet the identified needs of the person and that staff had the necessary training to keep them safe and well. There was clear evidence of family involvement within the documents.

People were assigned ‘key workers’, these were staff members with specific responsibility for the person. Staff therefore quickly got to know people well and were able to provide them with the support they needed. After moving in there was regular review with the person, their relatives or advocates and staff. Any issues were addressed, and care plans and risk assessments were updated as required. There were then monthly reviews of people’s care and support which would be more frequent in the event of an incident or illness or if a person had spent some time in hospital.

People’s communication needs were assessed regularly and different methods of communication tried and reviewed so as to ensure people were offered every opportunity to participate in their care decisions. People’s care records were reviewed regularly to ensure they remained an accurate reflection of people’s needs. The provider's processes for assessing and reviewing people's care and support needs were robust. People's assessments included sufficient detail about their individual care needs and preferences, which had ensured their needs were met consistently and effectively.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Recognised assessment and monitoring tools were used appropriately to track improvements or concerns. The management team had oversight of these and planned action appropriately with the involvement of family and the staff team. The service had links with other organisations such as tissue viability services, physiotherapy teams, learning disability community team and speech and language therapists (SaLT). People's GP visited the home weekly to check on their welfare. This meant that matters could be raised quickly, and the home had easy access to the surgery in between these visits if there were any emergencies so they could be responded to quickly.

Staff were given training which followed current good practice guidance. Staff told us how they worked alongside the GP’s, social workers and other health and social care professionals to ensure referrals were made and any recommendations were acted upon. For example, people’s ability to eat safely and maintain a healthy weight were assessed and monitored and appropriate action taken. Staff were knowledgeable regarding people’s nutritional requirements, and this was clearly recorded to ensure all changes were shared. For some people, who struggled to eat and drink sufficient amounts, there were directives regarding the use of PEG nutritional feeds to ensure they received the necessary nutrients. Where needed, advice was sought from healthcare professionals on how people’s diets should be adapted to suit them. Information was available in the kitchen to ensure people received appropriate drinks, meals and snacks. Food and fluid charts were completed to monitor people’s intake, which allowed staff to provide support and encouragement to people who were struggling to eat and drink sufficiently to maintain their health.

For people at risk of choking, and aspiration, guidance was sought and appropriate risk mitigation put in place. Some people lived with epilepsy and we saw that advice was sought from specialists and staff monitored seizures and looked for triggers such as bowel management and infections. We saw evidence of a monthly analysis of infections, seizures, blood sugars, weight loss and gain which recorded action taken and evidence of referrals to the appropriate health professionals. People’s care plans showed the service worked in conjunction with external health care professionals, to ensure people received the care they required in line with their complex and changing needs.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The registered manager had worked hard to build good relationships with other health and social professionals that have resulted in positive outcomes for people whose support was rounded and comprehensive. The service arranged appointments for people including the dentist, chiropodist, physiotherapists and occupational therapists as required. Care plans contained summary documents highlighting people’s support needs that were immediately available to visiting professionals. People received the professional support needed which was in line with the ‘right care’ element of positive care for people living with a learning disability and promoted their human rights in receiving equitable care and support. Relatives told us that they felt improvements had been made and there were good lines of communication and they were kept informed whenever their loved ones had appointments or in the event of an emergency when for example, people had to be taken to hospital.

Professionals confirmed what the registered manager had told us. One said, “I work closely with the home, I feel that they are vigilant and caring,” and “Very prompt to take action and very supportive to families.” Another added, “Information I have seen suggests they communicate with other external professionals as needed and follow up in a timely way.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

There were processes in place to guide staff about how to support people to lead healthier lives. People were supported by staff to eat healthy meals and drink regularly to maintain their physical health. The menus demonstrated a well-balanced diet, with fresh vegetables, (some grown in their own garden) and fresh fruit. Staff monitored people’s weights and if there was evidence of weight loss or weight gain, advice was sought. They were encouraged to be active within a risk assessment framework, and to take part in various activities with support from staff. People were also supported with hydrotherapy.

The organisation had their own vehicles which meant staff could take people to external health appointments such as the dentist. Care documentation showed there was evidence of regular reviews and input from the GP, Optician, Dentist and Chiropodist. There were organisational policies and protocols in place to support staff to deliver safe and effective care.

Equality and diversity were embedded in the principles of the service, and the provider had an equality and diversity policy in place to protect people against discrimination.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People’s health and care needs were monitored and records kept using recognised systems of measurement. For example, the use of Waterlow scores, a process to measure people’s susceptibility to developing pressure sores. People’s weights were regularly checked and records kept. The Bristol Stool Chart was used to closely monitor bowel movements as that was found to be a key trigger in epileptic seizures.

Care plans contained a medical history section which provided details of all medical appointments and interventions people had experienced. Relatives and health professionals told us that staff knew people well and knew their complex medical support needs. They were able to detect subtle changes in people’s presentation which allowed early interventions to make sure people received the best possible care.

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

Whilst people may not always have capacity to make decisions, staff told us that they always asked the person and assumed they had capacity. Staff also told us, “If they do not want something, we know from their body language to withdraw or wait,” and “We don’t force anything, sometimes assisting them to eat can take a long time, especially if they are not 100% but we know the time limits on the food and offer other things, to ensure they get the nutrients.” Relatives told us, “My relative can’t give consent for simple everyday things, but we have had best interest meetings, we discuss care and support and I know social services review as well.”
Staff we spoke with were able to tell us how they offered people choices in their daily care and demonstrated an understanding of people’s right to make their own decisions. Staff told us, “We treat everybody the same, with dignity, with respect, we tell them what we are doing and chat away, if they aren’t happy we know from their reaction, It can be difficult sometimes because peoples’ presentation can be so different every day, moods change.”