Margaret's Rest 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

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 oversight of the service.

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 was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People were not involved in the planning of their care; however, the Registered Manager was in the process of creating more person-centred care plans with people’s and their relative’s involvement. This was not fully embedded. We saw care plans that had been developed to be more person centred as well as ones that were yet to be changed. There was limited evidence of people’s involvement recorded, or how the process had been adapted for those with communication needs.

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.

Feedback we received from professionals working with the service was positive. One professional explained that the provider was asked to complete documentation as part of the referral process and this was returned promptly which enabled them to see the person in a timely manner and asses their needs without delay. Two other professionals who have been working with the service for over 5 years reported seeing significant improvements in the last few years.

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.

Feedback we received from professionals working with the service was positive. One professional explained that the provider was asked to complete documentation as part of the referral process and this was returned promptly which enabled them to see the person in a timely manner and asses their needs without delay. Two other professionals who have been working with the service for over 5 years reported seeing significant improvements in the last few years.

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 access healthcare services, including the GP on a regular basis. If people needed healthcare in between the weekly GP visits, they were supported to access relevant services.

There was limited evidence to show people were supported or offered access to make or attend dental appointments. We were not assured that everyone was being given the opportunity to receive oral care. The provider is beginning to embed the practice of documenting where someone is offered but refuses.

The provider will arrange transport to and from hospital appointments, as well as a member of staff to attend with them, however, staff reported these have been cancelled in the past due to staff shortages.

We saw evidence of referrals being made to Speech and Language Therapists (SALT) and they had a long-standing Podiatrist who visits every 10-12 weeks.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. The provider has a digital system in place for staff to record daily care. The system provides a history of daily care for the Registered Manager to monitor good care and outcomes, however some staff were not utilising the system effectively and detailing the care that had taken place making it difficult to effectively monitor the persons care and treatment, and thus, 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. This meant people were at risk of poor hydration, illnesses and other associated ailments from not being supported to tend elimination needs and malnutrition.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. We found that all persons who had money on the premises only had restricted access to their funds. As a standard practice, money was being kept in a safe in the Registered Manager’s office. There was a robust system in place safeguarding people from financial abuse, however, were not assured that people had been offered alternative options for storing their money. There were no consent forms, mental capacity assessments or best interest processes in place. This was put in place by the end of our inspection.

We found where people did not have mental capacity to consent to their living arrangements, or care and treatment, mental capacity assessments and best interest processes had been followed, including Deprivation of Liberty Safeguard (DoLS) applications to the Local Authority.