Marian House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s care plans were not always detailed to demonstrate how person-centred care was being delivered in line with people’s personalised preferences and needs. Staff met people’s individual needs relating to their direct, day-to-day support such as support with personal care, eating and drinking and some activities. However, staff did not always support people to develop their individual skills, to identify goals and aspirations and to work towards them.

We received mixed feedback from some relatives about how much people were supported to go out and how well the provider promoted people’s choice and engagement in activities.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The registered manager had taken steps where a person’s needs were not currently met, and work was underway including a re-assessment of their needs by the relevant professionals. Although staff had advocated on people’s behalf, this was not always consistent and timely. There had been a delay with escalating a referral to the relevant healthcare professionals regarding mobility needs and barriers to accessing the local community. The registered manager told us this was now being addressed.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s communication needs were recorded in their care plans including if the person was reliant on facial expressions, body language and visual prompts to aid their understanding. During our visit we observed staff communicating with people. There was some pictorial and written information for people around the home. This included information about staff on duty, activities and how to complain. Staff offered people choices using a range of words, visual cues, prompts and objects of reference.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Relatives were invited to complete feedback questionnaires, and the most recent ones were shared with us and were generally positive. However, no action plan or follow up plan was in place on the few suggestions that had been made. One relative shared feedback with us where they felt improvements could be made, and we asked the registered manager to follow up on these points, and they confirmed to us they had done this. A formal complaints procedure was in place including a recording system to log complaints. The registered manager could tell us in detail about the action they had taken regarding these. However, there was no process, or written analysis in place for monitoring themes or to demonstrate what learning had taken place from these.

People had opportunities to offer suggestions and give feedback about the service during ‘house’ meetings and key worker meetings. Staff we spoke with understood the importance of communicating with people in a way that met their needs. This ensured people received the support they needed to share their views, including any complaints they may have.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Discussions with the registered manager demonstrated an understanding of how to access specialist health and social care services, including referrals to external professionals such as speech and language therapists. However, during our visit we identified there had been delays in referrals for 1 person regarding their mobility and overcoming the barriers regarding accessing the community. This did not promote their equality. During our visit the registered manager confirmed this was now being addressed.

People had hospital passports and health action plans in place. (A health action plan helps identify any health concerns at an early stage to improve the person’s health outcomes). One staff member told us, “If someone needed to go to hospital, I would make sure I took their hospital passport, and the information is up to date.”

Out of hours support was in place, covered by the management team to ensure staff always had access to advice and support.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The registered manager had not always been proactive in removing barriers for people, so they experienced positive outcomes. The physical layout of the care home had not always been planned and developed in people’s best interest. The layout of the building with large communal areas did not always reflect the needs of autistic people or people who preferred quiet areas, due to their sensory needs. The staff office, where the managers were based, was not accessible to people who used a wheelchair. There had also been delays by the provider in tackling and actively working to remove the barriers and challenges in place for a person not able to access their local community.

During our visit we observed positive interactions between staff and the people they supported. People appeared comfortable and relaxed when engaging with staff. Staff had received training in equality and diversity.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People were not always supported to identify their aspirations and work towards goals; this had not been included in people’s care records. The registered manager had started conversations with people and relatives around their end-of-life arrangements.