Marner 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 inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 79 (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 needs were thoroughly assessed by the registered manager, prior to admission, to ensure they could be met.

Following their initial assessment, people and their representatives took part in regular reviews with members of the management team and professionals involved in their care. During these reviews their support needs and progress against rehabilitation goals were discussed, to ensure they received care and support that reflected their current circumstances.

Staff demonstrated a good understanding of people's needs. One staff member said, “[Management] do all the assessments and share the information with us. We can see the support plans on the system, and we are told about any updates in handovers. We are very involved in reviewing care, so we are kept up to date that way as well. We share information all the time.”

Staff were confident new risks, or changing needs were responded to promptly. One staff member told us, “If I thought there was a new risk I would go to [Registered Manager] and they would straight away look at what needed to be done.”
 

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.

People had access to a range of specialist equipment and a variety of therapists who worked closely with people and staff to develop programmes tailored to their individual needs. This included, occupational therapists, physiotherapists, speech and language therapists, and music therapists. Therapists provided guidance and oversight to ensure support was delivered safely and consistently and helped people make progress towards achieving their goals.

Staff understood the importance of following therapeutic guidance and monitoring outcomes. One staff member told us, “We follow the way the therapists tell us to work. They will show us how to do things safely and the right way for the particular service user. It could be helping people to build up their muscle strength so they can do something independently or cutting their food in small pieces so they can eat safely. We record how things have gone so the therapist can see what is working or not and they can change things. Our role is to support the service users.”

Evidenced based tools were in place to monitor people’s clinical risks such as weight loss or risk of choking. Records confirmed staff monitored people’s progress, identified any potential risks and shared information with therapists and other professionals to ensure care and treatment was adapted when needed.

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.

Staff worked collaboratively with a range of healthcare professionals and external agencies to help ensure people received coordinated, effective and person-centred care.

The registered manager recognised the importance of effective communication across services and had taken proactive steps to improve information sharing. They had identified that although people had detailed hospital passports, these were not always used effectively when people accessed external services. In response, they developed a simplified but more accessible template to ensure key information could be easily understood and used by other professionals. Hospital passports contain important information to assist other healthcare professionals in understanding a person’s health, mental health and clinical needs and communication requirements.

Staff supported people to attend healthcare appointments and worked closely with them to ensure they understood information about their health and any decisions relating to their care and treatment. One healthcare professional told us, “The team members accompanying their service users to appointments show a good understanding of the care history and complex needs and are able to give a good account of the recent history and situation when bringing service users to outpatient appointments.”
 

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

People were supported to live healthier lives and achieve outcomes that were important to them. People told us how staff had helped them achieve outcomes they had not thought were possible, from making music to spending time in the community and with loved ones. One person told us, “Since I came it’s been about getting back home. Everything they (staff) do with me is about getting to that point. Small steps.”

People shared examples of how they had experienced improvements in their health and wellbeing. They told us staff supported them to set goals and then encouraged and supported them to, for example, stop smoking, improve their diet and increase their mobility. One person needed visual reminders, to maintain a healthy diet, and the registered manager had created a picture board to prompt them to make healthier choices when planning their own meals, encouraging independence as well as promoting health.

We saw examples of people being supported to regain independence in the community, with risks such as previous alcohol or drug misuse being considered and assessed. Safety plans were put in place, in conjunction with people, to support them safely and gradually adjust to life outside of the care home. In multiple examples, this had meant people were successfully able to return to more independent living.

Staff demonstrated a strong commitment to advocating for people and ensuring care and treatment remained appropriate and in people’s best interests. We were provided with multiple examples where staff had worked proactively with healthcare professionals to review treatment plans and challenge decisions where necessary. Staff had identified 1 person was receiving medication via a skin patch without a clear clinical rationale. Through discussions with the person's GP, consultant and hospital team, staff established the medication was no longer required and supported the person to be safely weaned from it. For another person, staff had observed their medication caused them to be fatigued at certain times of the day and had advocated for them to have this reviewed to improve their quality of life.

Staff also worked collaboratively with specialist professionals to help people achieve clinical goals. One person wished to reduce their reliance on a PEG (percutaneous endoscopic gastrostomy) tube for nutrition and hydration. Staff followed guidance from relevant specialists and consistently supported the person to work towards this goal in a safe and gradual way. They were then able to leave the care home and live more independently.

The deputy manager told us, “Maintaining good relationships with professionals is really important in helping people to maintain their health and wellbeing.” This proactive and collaborative approach helped people access the right healthcare support and achieve improved health outcomes. Conversations with staff demonstrated they knew people well and knew how they could support them to achieve healthier lives.

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.

Effective systems were in place to monitor people's progress and outcomes. Care plans and risk assessments were detailed and clearly linked to the outcomes people wanted to achieve. Staff regularly reviewed these documents and used feedback, observations and discussions with people to assess whether support remained effective. One staff member told us, “Our care plans and risk assessments are detailed and focus on outcomes. We talk to the service users about how they are feeling about things, and we observe and feedback, so we know if things are working. We have close relationships with families, and we get their feedback about how things are going. All the views help us plan next steps.”

Health professionals commissioned by the provider spoke positively about the staff's commitment to continuous improvement and achieving the best possible outcomes for people. One visiting professional told us, “They understand the importance and want to join in, they are actively seeking out ways of working to improve outcomes for people.”

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

People were supported to make decisions about their care and treatment wherever possible. Throughout the inspection, we observed staff seeking people's consent before providing support and respecting the choices people made. Staff took time to explain what they were doing and ensured people were comfortable with the support offered.

Staff demonstrated a good understanding of the principles of consent and recognised the importance of supporting people to make their own decisions. Where people required additional support to make decisions, staff used individual communication methods to help them express their views and preferences. Staff respected people's decisions and sought to understand the reasons behind their choices rather than making assumptions or imposing their own views. They understood people had the right to make decisions that others may consider unwise.