Maesbrook Nursing Home

On this page

• 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 people’s safe care and treatment, safeguarding of service users and governance.

This service scored 42 (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 ensure people’s needs were fully assessed or reviewed in a timely and coordinated way. Evidence showed delays and gaps in assessment processes which impacted people’s experiences of care.

We found people did not always receive a thorough assessment of their care needs. A staff member told us they were, Some people felt staff did not proactively assess their day-to-day needs. One person told us,“I am still waiting to be washed, I’ve am sore. I like to be clean, ”which suggested staff were not consistently identifying or responding to personal care needs in a timely way.

Some relatives felt assessments were appropriate and staff understood their family member well, while others raised concerns about delayed dementia or capacity assessments, and long waits for external reviews. The provider did not ensure assessments were consistently thorough, timely, or used effectively to guide care planning, which meant people did not always receive care aligned to their current needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People did not consistently receive care and treatment which reflected best practice orevidence-basedguidance. There were gaps in care delivery which affected people’s comfort, dignity andday to day wellbeing.

People consistently described long waits forhelpwith personal care, including washing and continence needs. One person said,“In the morning carers are always busy. I ring and ring the buzzer and still Ihave towait,”and another person described being left uncomfortable while waiting to be supported out of bed.

Some relatives reported concerns with skin care and continence management, including occasions where their family member was left in soiled bedding. Relativesstatedthis had happened multiple times, causing significant distress.However, there were examples of positive,person-centredcare. Staff wereobservedsupporting someone being hoisted safely and respectfully, checkingcomfortand offering reassurance.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. There were delays in obtaining essential input from other services, particularly for people with complex needs.There were delays in obtaining essential input from other services, particularly for people with complex needs. Delays were not completely down to the home and included strains on health and social care services. One person had not received physiotherapy assessments despite staff repeatedly following this up, leaving their rehabilitation needs unmet.

Feedback from staff indicated inconsistency in handover, communication and teamwork. One relative told us, “Issues where communication is lacking and it lets down the team as a whole,” with them further explaining that poor communication had contributed to their relatives’ deterioration during a period of illness. Staff also reported challenges escalating concerns or obtaining timely decisions. For example, Staff had requested a review of a person’s seizure rescue medication in the individual’s best interest, as they felt the prescribed route was not appropriate, but the home nurses and registered manager had not responded. Some relatives described positive experiences of collaboration and told us staff involved them and kept them informed, but these experiences were not consistent across the service.

The provider supported people to maintain their health and wellbeing, although some improvements were still needed to ensure support was consistent. People generally reported good access to food, drink and day-to-day support. Relatives described the food as high quality and said people were encouraged to eat and drink. One relative said, “They are always trying to get him to eat and drink. I am very happy with the care, ”and others praised the variety of meals offered. Some individual health needs were identified and acted upon. Staff monitored pain relief effectively for some people. One relative told us, “They always ask [person] if they have any pain and bring paracetamol if they say yes. ”However, some people experienced delays or inconsistent support. However, relatives and people expressed confidence that staff promoted people’s wellbeing within the constraints of the environment and staffing challenges.

The provider did not always routinely monitor people’s care and treatment to continuously 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.

The service did not consistentlymonitorpeople’s outcomes or use information effectively to improve care.We found incomplete or outdated care plans, and staff told us some plans did not reflect people’s current needs. Relatives described occasions where observations were not completed as requested, which contributed to health concerns being missed.We found evidencewhere a lack oftimelyreview when issuesemerged. For example, concerns about wound care, eating and drinking risks, andend of lifeneeds were not always promptly assessed or acted on.

Relatives also told us of patterns of issues not being followed up, such as insufficient continence supplies, incompletemonitoringand delays in addressing concerns, which they felt affected people’s dignity and outcomes.We observed staff using encouraging interactions to support a person with limited mobility, but this was not consistently recorded or reviewed.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Practice relating to consent was inconsistent, and people were not always supported in line with the principles of the Mental Capacity Act.

Some relatives reported they were not consulted about significant decisions. One person’s family said they found out “by chance” that their family member had been started on dementia medication, with no discussion or explanation from the service. People also described care being delivered according to routines rather than individual preferences, which indicated staff were not always seeking or respecting people’s choices. For example, one person said staff insisted on completing breakfast before helping them to wash, despite their preference to shower first. Some relatives felt staff were respectful and involved them in care decisions, but feedback across the service showed this was not consistent.