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Archived: St Martins Residential Care Limited

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Inspection report

Date of Inspection: 14 September 2011
Date of Publication: 4 November 2011
Inspection Report published 4 November 2011 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

Overall we found St Martins was meeting this essential standard but improvements are required.

People using the service may not have a plan of care that accurately reflects their care and support needs. Therefore staff may not have clear information on how to deliver apropriate care in a consistent and effective way to meet peoples needs and improve outcomes for people.

User experience

Most people living at St Martins have varying levels of dementia and different communication needs. We were therefore unable to fully understand people’s specific issues.

We met with people who were confused as to time, person and place. They were relaxed and smiling and happy to converse with us about where they felt they were and who they were with.

Other evidence

During our visit we saw a positive relationship between staff and people who live in the home.

Staff with whom we spoke had a good understanding of people’s care and support needs. Staff were kind and caring in their approach and gave people choices.

Care records we looked at showed that the management were aware of their duties and responsibilities under the Mental Capacity Act; to protect people who lack the ability to make decisions for themselves due to mental capacity difficulties and respect people’s human rights. Assessments of capacity were in place and in cases of advanced dementia requiring care intervention, best interest assessments and decisions had been undertaken through appropriate channels with appropriate healthcare professionals.

The records showed us that a detailed assessment of people’s needs was undertaken prior to admission. This enabled the manager to be sure that people’s needs could be met before agreeing their move to St Martins.

Records also showed us that each person had a plan of care in place that recorded people’s assessed needs in relation to activities of daily living and how these were to be met by staff. We found overall that these reflected peoples choice such as their preferred times for going to bed and getting up, wet or dry shave and their food preferences and dislikes. The care plans also reflected dignity such as gender preference of care staff supporting people with their personal care.

We found that although care plans were regularly reviewed they did not always take into consideration people’s changing needs. For example the sleep and rest care plan for one person did not consider a change in sleep pattern or behaviour during the night when there was a period of falls during the night and the person was ‘found on the floor’.

A care plan for another person in relation to communication stated that they had no problems with understanding speech and yet a mental capacity assessment undertaken for this person stated that they did not recognise words and meaning.

Risk assessments were undertaken in regard to nutrition, mobilising and pressure sores. Not all the care plans we looked at incorporated risk management strategies for staff to follow to ensure any risks to people’s health, safety or well being were reduced. For example the care plan for one person in relation to skin care did not provide any steps to be taken to monitor, prevent or manage an assessed high risk for the possibility of sustaining a pressure ulcer.

We found the care plans mainly focused on people’s main presenting needs rather than adopting a person centred approach. For example they did not reflect people’s strengths and specific dementia related needs and how staff can deliver support tailored to the individual.

Individual activity records were kept separately by the activity lead person. The records contained good information about an activity undertaken, level of participation, the person’s reaction to the activity and their ability. The records also showed when someone found an activity challenging and why. The records were person focused and identified people’s physical and cognitive strengths and weaknesses in regard to, for example fine movements (holding a pencil) recognition of colour, tolerance of noise, understanding instructions and length of attention span. People’s outcomes could be improved if this information was included in the overall care plan and was accessible to all staff. This would help staff to have a fuller understanding of people’s needs and the type and level of support each person required in their everyday life.

Care plans in relation to death and dying did not include an end of life plan that reflected decisions and preferred options, particularly related to pain management, place of dying and dignified death. The care plans only incorporated information about care after death.

Care records showed that a monthly sensory check was undert