Marika 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 changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to person centred care.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure people’s care and treatment were effective. They did not always ensure when people’s needs changed guidance were up to date and their changing needs were understood and supported by all staff.

We reviewed people’s care plan and daily notes. One person had recently been advised to eat an International Dysphagia Diet Standardisation Initiative (IDDSI) level 6 diet, however, we found recently reviewed documents still contained information about snacks the person would like to eat, however, these were snacks which were no longer safe for the person to eat. We also noted following this advice, this person was given food which should not be given on this diet and high-risk foods which were not modified in line with national guidance. We reported our concerns to the local authority safeguarding team and spoke with the registered manager. The registered manager told us, they would ensure staff attend additional training and they would review the person’s menu plan with the person to ensure all meals were safe and prepared to the correct consistency.

Staff told us people’s views were sought by using their preferred communication methods across various platforms including, during daily support and in meetings with their keyworker.

People were involved in their assessments and reviews and/or staff and those who knew people well were involved in people’s assessments to ensure their views and opinions were captured.

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

We reviewed a person’s care plan and noted they had been prescribed medicines and advised to have a healthy diet to help manage a medical condition. We reviewed this person’s food intake and noted the food provided was not in line with best practice guidance. The food provided was unhealthy and did not form a balanced diet. We spoke with the registered manager about this who told us they would ensure staff attended additional training and they devised and shared with us a healthy eating plan.

We observed a person had recently gone through a period of increased agitation. We noted this person’s positive behavioural support plan (PBSP) did not contain sufficient detail about when to seek medical support or when to monitor the person following an incident. Where there was a concern relating to a person’s swallowing, the registered manager had completed a referral to a Speech and Language Therapists (SaLT). However, for one person there had been some delay in implementing the SaLT guidance.

People were supported to maintain relationships with friends and family by making phone and video calls.

The service 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.

We sought feedback from professional’s who worked closely with the service. A professional told us, “The Marika House team recognised the needs of the person, and the challenges of the situation, and sought support to keep the person safe.”

People’s goals, dreams and aspirations were discussed in keyworker meetings and always communicated so a consistent approach was maintained between services. The registered manager gave us examples of how they wanted to further develop and improve this.

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

People were not always supported to eat healthy. We reviewed menus and food intake for people. The food intake for people was unhealthy, their diet contained a lot of processed foods and did not form a balanced diet. We reviewed 4 weeks’ worth of menu’s which were not in line with the requirements for a healthy diet. We spoke with the registered manager about this who devised a new 4-week menu with people which they shared with us. This new menu also did follow the correct principles for a healthy diet.

Some relatives we spoke with also raised concerns about the number of processed foods given to their relative and their weight gain which they felt was due to poor nutrition.

People were not always supported to engage in activities that supported their social and mental wellbeing. We reviewed people’s daily notes. We noted people were rarely involved in meaningful activities. We noted people went on lots of drives, but some people were not supported to leave the vehicle. For one person, they were left in the vehicle daily whilst staff went into the shops for them. We spoke with the registered manager about this, who told us they had also highlighted the lack of meaningful activities for people. They had devised a weekly activity planner for people which commenced 1 September 2025. We reviewed the activity planner and whilst it was an improvement there were still a significant number of drives for people, and the provider could not be assured they would be supported to leave the vehicle. The registered manager told us, additional information about people leaving the vehicle would be added to support plans and risk assessments. They told us the plans were an ongoing work in progress.

People were supported by a staff team who knew them well and who were able to detect signs of a person being in distress or their health deteriorating. Where needed people were supported to access emergency healthcare.

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

People were engaged to ensure they were able to make some choices about their lives. Individual meetings took place with people to understand their goals and aspirations. However, these had not been effective in improving people’s healthy eating and activities to ensure people had positive health and wellbeing outcomes.

People's capacity and ability to consent was taken into account, and they, or a person lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment.

We reviewed mental capacity assessments (MCAs) which were not completed in line with the Mental Capacity Act 2005. We could not see how the person had been involved in the assessment and how the provider had attempted to support the person to understand the decision. We did see evidence of people’s relatives being involved in the process.

When we spoke with the registered manager about our concerns with people’s food intake, the registered manager told us it was due to people’s choice, however, MCAs had not been completed to ascertain whether people had the capacity to understand the health implications of these unwise decisions.

The registered manager told us, they would commence work on the MCAs to ensure they were completed in line with Mental Capacity Act 2005 and were in place for all important decisions.

A DoLS tracker was in place to ensure the provider knew when these needed to be reapplied for. Staff described to us how they sought consent throughout the day-to-day tasks they supported people with.