Margaret's Rest Home

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• 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 previous 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.

The service was in breach of legal regulation in relation to restrictive practices.

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.

The provider was in the process of developing person-centred care plans and not all people had these in place at the time of our assessment. We saw some that had gone through the process of being developed but there was little evidence of the person and their relatives being involved. Desired achievements and outcomes were not reflective of personal goals and were generic and vague. There was mixed feedback from people on their involvement in care planning. Some felt they were involved and happy with their or their relatives care, some were involved but the information they shared was not used, others felt they were not involved with their care plans and day to day care was not reflective of their likes and dislikes. For example, one person shared that their relative was being offered and provided food that they have made the service aware they do not like. This did not support their right to choose and could impact on their nutrition.

There were some shortfalls in how the provider understood the diverse health and care needs of people, so care was not always joined-up, flexible or supportive of choice and continuity. The provider told us that there was a process in place as part of the assessment to identify which available rooms were best suited to the person and their needs, however, we were not assured that this was always the case. For example, people who required more supervision from staff due to higher needs were found to be on the 1st floor where there is little, and sometimes no staff presence.

The provider did not have reliable systems in place to ensure people who spent time in their rooms always had access to drinks, or their call bells. This meant people were at risk of dehydration and not receiving care in a timely way.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

During our assessment we saw evidence of the service having tools to adapt information into a way that suited some people’s needs. For example, some people made day to day decisions, like meal choices, using pictures, or in writing due to hearing difficulties. However, we were not assured this was being done consistently as care notes did not always reflect these tools were being utilised, nor did we observe them being used during our inspection.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. During our assessment we observed that most of the time, people were supported to access care. We saw a close working relationship with the GP who attended the service once a week, as well as evidence of requesting referrals to other health professionals, such as, SALT. Staff had good knowledge of who to contact out of hours to access care and treatment, as well as how to do so, for example, 111. However, we were not assured that there was consideration to eliminating barriers to accessing care and treatment all of the time. For example, if people living on the first and second floor, needed to get out of the building on a stretcher, this would not be possible as the lift cannot accommodate something of that size. This leaves them at risk of not being able to access emergency medical treatment in a timely manner. There were other areas of the home that required mobility aids for people with physical disabilities to get around and had them in place. For example, there was a stair lift in place in the extension.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. During our assessment we observed that most of the time, people were supported to access care. We saw a close working relationship with the GP who attended the service once a week, as well as evidence of requesting referrals to other health professionals, such as, SALT. Staff had good knowledge of who to contact out of hours to access care and treatment, as well as how to do so, for example, 111. However, we were not assured that there was consideration to eliminating barriers to accessing care and treatment all of the time. For example, if people living on the first and second floor, needed to get out of the building on a stretcher, this would not be possible as the lift cannot accommodate something of that size. This leaves them at risk of not being able to access emergency medical treatment in a timely manner. There were other areas of the home that required mobility aids for people with physical disabilities to get around and had them in place. For example, there was a stair lift in place in the extension.

People were 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. We saw evidence of Advanced Care Plans formulated around end-of-life care, created with the involvement of people and their relatives. This included relevant details, including their choices around health care if their health deteriorated such as if they would or wouldn’t want to be admitted to hospital. Do Not Attempt Resuscitation (DNAR) forms were in place, and they were in the process of changing to Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms which incorporates other end-of-life choices in addition to whether someone would or would not want CPR.

Some staff told us that they hadn’t received end of life training, however we did not find this during our assessment and saw evidence that all staff were assigned end of life training on their E-Learning system.

People were 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. We saw evidence of Advanced Care Plans formulated around end-of-life care, created with the involvement of people and their relatives. This included relevant details, including their choices around health care if their health deteriorated such as if they would or wouldn’t want to be admitted to hospital. Do Not Attempt Resuscitation (DNAR) forms were in place, and they were in the process of changing to Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms which incorporates other end-of-life choices in addition to whether someone would or would not want CPR.

Some staff told us that they hadn’t received end of life training, however we did not find this during our assessment and saw evidence that all staff were assigned end of life training on their E-Learning system.