Maryland Care 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.

This is the first assessment for this service registered on 15 December 2021. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (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 were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We could not always be assured the care and treatment being provided to people were as effective as it could be. Some people’s care plans were blank and did not contain the necessary information to help guide staff on what care and support to provide.

People’s care plans did not always demonstrate people’s needs had been discussed with them. This was important as care plans should be developed collaboratively, focusing on what matters most to the person. As care plans were incomplete and/or lacked sufficient detail, we could not be assured they were regularly reviewed to ensure they remained effective and relevant to their needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We were not always assured the provider worked in line with legislation and worked to develop evidence-based good practice and standards.

As some people’s care plans did not record peoples identified needs and risks, we could not be assured people’s care was properly assessed and planned and could not be assured care reflected evidence-based guidance and practice. For example, for 1 person who had a medical condition in which diet was influential to their well-being, there were no care plans in place to help guide staff on the appropriate action to take. Care plans belong to the person and so people’s involvement in them was important to evidence people were receiving care in a way in which was important to them.

The provider did not always involve people in planning their meals. We received mixed feedback about the choice and quality of food. People told us, “I go to the dining room, it’s very good food”, “The food could be better” and “I would like to see more options.” A relative commented, “I bring in food for [Name], the food is not good enough in quantity and quality.”

People were provided with only 1 choice on the menu at mealtimes. However, the chef told us if people didn’t like what was on the menu they could request an alternative of their choice. People had a choice of where to take their meals. The majority chose to eat in the dining room. We observed people eating lunch and found it was a social and relaxed experience.

We spoke with the cook about people’s nutritional needs. They told us they relied on staff to relay information about people’s dietary needs and preferences. Written information about special diets, food consistencies, allergies and preferences was not available and maintained by kitchen staff. This meant there was a risk people could receive a diet which was not appropriate to their needs. We spoke with the registered manager about this who confirmed written information would be provided to kitchen staff right away.

People were weighed regularly and medical advice sought if people’s dietary intake significantly reduced. However, people at risk of malnutrition/on a specialised diet did not always have their dietary intake recorded on food and drink charts. This meant it was difficult to tell whether the person’s dietary and fluid intake was accurate or sufficient. This aspect of dietary recording and monitoring required improvement.

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.

As some people’s care plans were incomplete and did not include important information about their identified care support needs and risks, we could not be assured that when people moved between services, records and any relevant information would be shared effectively.

We saw examples of where advice had been provided by external agencies to help manage people’s health care needs, however, there were no written records this had been followed through. We spoke with the registered manager who confirmed although records had not been maintained, any advice provided was acted on.

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.

Although people told us staff supported them well, we could not be assured people were supported as well as they could be to live healthier lives. For example, for 1 person who was at risk of weight loss due to having a poor appetite, a risk assessment tool had not been completed to help lessen the risk meaning the chance of leading a healthier life was compromised.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves.

Tools to help monitor people’s care and treatment such as nutritional tools, skin integrity and falls risk assessment tools were not always completed. We could not be assured people’s care was monitored as effectively as it could be. This meant opportunities may have been missed to identify areas where improvements or changes to people’s care and treatment could be made to help better their outcomes.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider did not consistently act in accordance with the principles and codes of conduct associated with the Mental Capacity Act 2005. For example, for 1 person who had restrictions in place to keep them safe, there was no evidence this had been discussed with the person, or they lacked capacity to consent to this decision as no capacity assessment had been undertaken. There was no evidence any best interest discussions or meetings had taken place. For another person who had an LPA (Lasting Power of Attorney) in place, this had not been recorded in the person’s consent care plan. This placed people at risk of being unlawfully deprived of their liberty and their legal right to consent to their care.

Not everyone who needed a DoLS in place had one. DoLS refers to the Deprivation of Liberty Safeguards, a legal framework that protects people who lack the mental capacity to consent to care and treatment. As some people lacked the capacity to make decisions for themselves, this potentially prevented people and their representatives and advocates from participating in decisions about their care. We spoke with the registered manager about this who confirmed they would start work on assessments of people’s capacity.

However, when we asked people if they had choice around their care and support, they told us they did. People told us, “I have control over how I spend my day” and “I asked for a change of my shower day, and it was changed. I have a choice of staff and can choose when I get up and what to wear.”

A staff member confirmed, “We treat people in a certain way, we let them choose. We always ask people if it’s OK before doing anything.”