Marcris House

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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

This assessment reviewed one quality statement in the effective key question. This was in relation to how people’s consent was obtained lawfully. We found concerns with how the service understood and applied the requirements of the Mental Capacity Act (2005). People were deprived of their liberty and had restrictions placed on them. This is a breach of regulation.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People told us that most staff were respectful and sought their consent. One person told us, “I trust the carers and that’s what makes me feel safe. They support me really well.” Another person told us, “On the whole, they are nice carers. There is one who is a ‘know all’ and if you ask for something to be done, it isn’t always carried out.” However, our observations did not support the comments made by people. We saw that improvements were needed when staff interacted with people to gain their consent. For example, one person declined support from a staff member to walk from the lounge to the dining area to have lunch. This was respected and the staff member acknowledged their decision. However, another member of staff approached the same person and, when they declined support again, they persisted in informing the person the need to go to the dining area and ignored their refusal. During the same period, we saw other staff approaching people and informing them what they needed to do, rather than seeking their consent, offering their support and waiting for a positive response. These interactions further demonstrated the task focused approach shown by many staff members. We raised these poor interactions with the director and interim manager who confirmed they would act and discuss them with the members of staff involved. We were told by the GP that they had not been involved with discussions around people’s best interest decisions, which would be expected where they were clinical based needs. The provider confirmed that MCA and BI assessments had not been completed for people for specific decisions

Staff we spoke with and those who provided written feedback were not clear about obtaining people’s consent and the actions they should take where people might lack capacity. When asked about seeking a person’s consent, one member of staff told us, “(I’ve had) no capacity training. No deprivation of liberty safeguards [DoLS] training, maybe online. [One person] locks [their] door if they are angry. We give [them] 5 to 10 mins to calm down, then go in, and offer a coffee.” Another member of staff told us, “In the first instance, I would always seek consent from the resident first simply by asking the relevant question.” However, they went on to say, “This is why it is important to get to know the residents, so that you can make an informed decision especially where welfare is concerned.” Staff were not able to demonstrate their understanding of obtaining consent, which meant people were at risk of care being delivered without their consent, and decisions being made on their behalf without a best interest’s process being followed. We identified in the process section where consent had not been obtained lawfully and people were restricted or deprived of their liberty.

Systems were not in place to support service users’ decisions where they may lack capacity to ensure their rights and freedoms were protected. Service users were restricted without proper consideration of their ability to consent or refuse those restrictions or deprivations of their liberty. People’s mental capacity had not been assessed in line with the principles of the Mental Capacity Act (2005). The oversight operated by the provider did not identify that assessments and applications had not been made.