Mariantonia House Residential Care Home

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• 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

Risk assessments and care plans lacked detail and did not demonstrate that service users needs had been comprehensively assessed. Language and terminology used to describe service users needs and communication was depersonalising, dis-empowering and not respectful of service user's needs. Decisions were made without consideration best interests or people's capacity to make choice for themselves.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some relatives told us they felt involved when their loved ones needs changed, however some relatives told us they did not feel involved. There was no documentation to show when or how people had been involved in making decisions in relation to their needs and how these needs were to be met.

Staff were able to tell us about people’s needs. However, care plans and risk assessments lacked the detail to ensure staff understood how to manage people’s risks. One risk assessment had identified a person as being a high falls risk, however there were no measures detailed in either the risk assessment or care plans on how to reduce the risk of falls. Another risk assessment detailed catheter care for a person and identified potential signs of concern, but did not detail actions the staff needed to take. Staff were unaware of the side effects and risks associated with some people’s medicines, and these were not detailed in people’s care records.

When we visited in July 2024 there was no clear system to ensure peoples care plans and risk assessments were accurate, relevant and up to date. When we visited on 17 September 2024 we could see some improvements had already started to be made with the support of the local authority. However, there continued to be gaps and missing information in peoples care records and serious concerns remained.

People and relatives did not feel actively involved in the assessing and reviewing of their needs. However, no concerns were raised by the people we spoke with about needs being met. However, the registered manager had not shared the levels of concerns or the lack of consideration of legislation and evidence based care.

The registered manager did not have a good oversight or acknowledgement of the risks linked to people's care and during this assessment. We identified serious concerns about people’s safety. The registered manager did not keep up to date with legislation and current evidence based care.

People's care records, risk assessments and care plans lacked detail . We found concerns over the scope and objectivity in what was written in care plans and professional assessments, with decisions about care provision being made by the registered manager without application of processes to ensure an approach based on best practice and evidence based care.

Feedback from people and relatives did not raise concerns about how people were supported to live as independently as possible . People gave examples of how they made choices about activities for example one person told us how they liked going to a local food chain restaurant for breakfast. However, we found people were overcharged for some of these activities with no clear list of charges. This meant some people may not have been able to afford to go out into the community or to undertake certain activities of their choosing.

The registered manager felt that people's health and well being were promoted through the care provided, however decisions made did not always account for what is always best for people's health and well being. For example, people's personal care, nutrition & hydration care plan had not considered actions needed to monitor weight loss and dietary intake even though the assessment indicated this was needed. Also where some people needed to see health professionals to have their medicines monitored, some of these appointments had been missed and not rearranged in a timely way. The registered manager and staff did not always consider or understand people's views or the views of other professionals in ensuring effective care and treatment.

Systems and processes were not in place to effectively monitor people’s health outcomes. There were no comprehensive systems to ensure assessment, monitoring or evaluation of peoples outcomes.

People and relatives did not raise concerns over how care was monitored. However, people were not aware of the potential impact of missed appointments or poorly managed medicines.

The registered manager and staff told us they maintained a good oversight of people's health and would take action if concerns were identified. However, where the effects of some people's medicines needed regular monitoring this was not always carried out, and where appointments with health professionals had been missed these were not always rearranged in a timely manner. The registered manager had not considered the impact of missed appointments until it was identified by other professionals and only then were steps taken by the registered manager to ensure more regularity with appointments.

Systems and processes were not effective in ensuring care and treatment was monitored or improved.

People were given choice over what to do on a day to basis, this related to food choices, outings and family contact.

Managers and staff did not have a clear understanding how to apply the principles of the Mental Capacity Act 2005 (MCA) and did not always consider or support people’s capacity to understand or make choices relating to their care and treatment. Decisions about how their personal money was spent was made without the involvement of the person. Where capacity assessments were required to support decision making, these had not been made and care records contained terminology which was not supportive of the person’s right of expression or choices. One Deprivation of Liberty Safeguards (DoLS) application described a person as “displaying anger, arrogance, rude, an air of entitlement….and screams and demands immediate attention.” It did not describe or give any indication of the persons capacity to make choices related to their care and these statements appear judgemental in nature without acknowledging the person needs or abilities. Another person was referred to as having ‘a mental age of a nine year old” whilst another person was referred to as “having the mind of a child.” This terminology does not reflect an approach that respects people and their rights to make choices in their care and treatment. This was a breach of Health and Social Care Act (Regulated Activities) Regulations 2014 Regulation 11 (Need for consent).

There were no consistent systems to ensure people's rights around consent were respected. Decisions were often made in isolation of the person and application of legislation and regulations to ensure people's rights were protected were either missing or inadequate and did not recognise people's protected rights and characteristics.