St Anselm's 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 inadequate.This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to consent.

This service scored 33 (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 make sure people’s care and treatment was effective because they did not keep up to date with people’s health, care, wellbeing and communication needs.

Whilst people’s needs were assessed, care plans were poor and did not accurately reflect people’s needs and provide effective guidance for staff. Assessments of people’s needs were not always up to date. For example, one person had a number of falls, but their care plan stated they had only had one, and they did not have a fall risk assessment in place. However, staff were aware that the person was at risk from falls and knew how to support them.

Some areas of changing need were assessed and documented. However, there were other areas where improvement was needed. For example, one person was declining medicines. Staff had not contacted the GP to discuss this. We raised this as a concern with the provider and following the inspection the person’s medicines were reviewed.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Best practice tools were used where appropriate such as a tool to monitor weight loss when people were not able to be weighed. People’s weights were being monitored, and action was taken if people lost weight quickly or over a period of time. People were also referred for appropriate assessments when needed. For example, if staff identified concerns regarding people’s swallowing people were referred to the speech and language team who could then assess if the person needed to be on a modified diet.

However, there were gaps in people’s needs assessments. The provider’s systems did not ensure that staff were up to date with good practice and required standards, as staff training was not up to date. For example, staff were supporting people with diabetes but had not completed training in this area.

The provider did not always work well across teams and services to support people. Whilst they did share an assessment of people’s needs when people moved between different services there were gaps in care plans and they lacked crucial information. Care plans had not been updated to reflect how people should be supported once their needs had changed. For example, one person was no longer being supported 1:1 all the time but this information was not reflected in their care plan, so partners had this information.

Feedback from partners was mixed. Partners did share some positive views about how knowledgeable staff were about people’s needs. However, some concerns regarding the level of administrative organisation within the service were raised and one partner told us paperwork was poor particularly in relation to medicines.

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 provided with healthy options for meals and snacks. There were opportunities for people to participate in exercise which we saw people did.

However, staff did not keep oversight of people’s fluid intake to ensure people were keeping hydrated. During the day we saw staff did support people to access fluids and top up people’s drinks. However, records were poor and were not checked by management prior to the inspection to ensure people’s drinking was monitored where there was a risk they were not drinking enough.

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

There was a lack of monitoring to ensure people had good outcomes. For example, there was a lack of monitoring of repositioning charts to ensure people were being supported to move in bed when they needed this support. There were also gaps in records such as showing where people had been supported with continence aids. Fluids were poorly monitored to ensure people were well hydrated. This lack of monitoring increased the risks to people.

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

There was a lack of capacity assessments to ensure people needed support to make decisions and could not make these for themselves. There was also a lack of records to show that decisions had been made in people’s best interests and involved the right people. For example, there was no best interest decision recorded for the agreement to use restraint and there needed to be.

Decisions were not reviewed regularly when they needed to be. For example, there was a number of people who shared rooms. There was no recorded decision to show how this was in people’s best interests to do so. There was no review of these decisions when people’s needs changed to ensure it remained in people’s best interests. There were records to show some people disturbed each other at night and there was no review of the decision for them to continue to share a room.