Marian 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.

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.

Care plans and risk assessments did not always contain enough detail to ensure people received effective care and treatment. Important information was missing, meaning staff did not always have clear guidance on how to meet people’s needs safely and consistently. For example, one person’s care plan identified potential signs of distress. However, there were no proactive or reactive strategies documented in their care plan to guide staff on how to effectively prevent or respond to the relevant person’s distress. Where a person had difficulty accessing the community due to their mobility needs and restrictions with their mobility aids, action had not been taken to escalate referrals to external professionals in a timely way.

Referrals were made to speech and language therapy for assessment and guidance. This guidance was incorporated into care plans to instruct staff in the preparation of food and drink in accordance with their assessed needs and the support people required to eat and drink.

There was a system in place for assessing people’s needs prior to admission. There had been no recent admissions to the home. Staff demonstrated a good knowledge of people’s needs and told us they were kept up to date about any changes. The registered manager told us they had recently implemented a more structured approach to reviewing people’s care, and review meetings were taking place with people and their relatives.

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

Care records incorporated some professional guidance for staff to follow to ensure people’s care was delivered as directed and in line with evidence-based practice. The provider used some nationally-recognised tools to assess risks to providing people’s care and support, including to assess the risk of malnutrition and to monitor discomfort or pain. People’s nutrition and hydration needs had also been considered, and staff were aware of people’s specific dietary needs. However, some needs had not been identified and planned for, including moving and handling, cerebral palsy and sensory needs. This meant there was a risk that some needs may not be adequately met.Although people did not have direct access to a kitchen, snacks and drinks were available to people.

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 provider had systems in place to support communication and information sharing among staff. Staff received a handover at the start of each shift, ensuring they were informed about any concerns, appointments, or changes in people’s care needs.

Staff told us that updates were shared promptly with them. Staff told us they worked a set shift system, and this helped ensure people received continuity with their care. Staff also told us they felt they worked well as a team. A staff member told us, “I think we work well together as a staff team. I am confident that I know people’s needs and are kept up to date with any changes.”

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

People were supported to attend medical appointments and access healthcare in the local community. However, not all health conditions had been assessed and care plans and risk assessments put in place. This meant some conditions may not be fully monitored and could lead to unmet health needs.

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.

Processes were in place to monitor the care and support people received and daily records were completed. However, because some risks and health needs were not addressed in people’s care plans and risk assessments, there was a risk that some needs were not being monitored or met. In addition, people’s care plans did not consistently evidence how they were being supported to identify or plan future goals and aspirations and there was no structured approach to improving or maintaining people’s quality of life.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

There were some inconsistencies in how the service assessed and recorded people’s capacity to consent. Where relatives had been involved in making decisions regarding people’s finances there was not always evidence, they held the relevant authority to do so. This meant we could not be assured those making decisions on the behalf of people had the appropriate and legal right to do so. The registered manager was in the process of reviewing this with people and their relatives, where required.

Staff were observed interacting kindly and respectfully with people. We saw staff explain what they were doing, seek agreement before offering support, and look for non‑verbal cues to gauge whether the person was comfortable.