St Margarets 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.

People’s needs were assessed before they moved in and the service worked collaboratively with partners to ensure their heath needs were met. People’s choices were respected and meals were well presented.

Records in relation to people’s capacity to make specific decisions were disorganised and the service did not have accurate records of the Deprivation of Liberty Safeguards (DoLS) applications made.

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

This service scored 58 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider had processes for assessing and identifying people’s needs before they moved into the service. Staff told us, “They tell us a lot about the residents who are coming before they arrive”.

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

People’s care plans were inaccurate, and did not reflect people’s current support needs. Risks known to some staff had not been documented and mitigated. This meant staff who did not know people well were unable to fully meet people’s needs.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service worked with involved health and social care professionals to ensure people’s needs were met. People were able to access GP’s, dentists and specialist nursing teams as necessary. Where district nursing teams had missed appointments to support people in receipt of residential care the service’s clinical staff had ensured this situation did not impact on people’s wellbeing.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People’s feedback in relation to the quality of meals provided was mixed. Most people were complimentary stating, “The food selection is good; the chef comes to each room each day to discuss my choices” and “The food is lovely”. However, some people felt the menu was quite limited and their comments included, “The cooks do try hard, but there is no variation other than what’s on the menu”.

The food on both days of the inspection was well presented and people were able to choose between two available main meal options. Drinks were served regularly throughout the day.

Staff respected people’s choices and individuals controlled when they got up and where they spent their time.

People were appropriately dressed, and hats and sunglasses had been purchased to enable people to safely enjoy the spring sunshine.

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.

Systems to monitor the quality of people’s care and ensure their care plans accurately reflected current support needs were ineffective. Risk assessments had been completed in relation to 5 topics; general risks, bed rails, falls, medicines and movements. Where risks existed outside of these areas, they had not been assessed or mitigated. For example, one person was visually impaired, and risks associated with this condition had not been assessed. Staff told us these risks had previously been assessed but had not been included in the new digital care planning system. The provider had failed to identify that important information had been lost during the transition to the digital care planning system.

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

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. Where people lack the mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

The provider did not have robust systems to ensure people’s rights and liberty were protected. People’s capacity to make specific decisions had not been appropriately assessed. Where decisions had been made in their best interest accurate records had not been maintained or detailed who had been involved in these processes.

The provider had no system to record details of DoLS applications made and authorisations granted. When asked, the registered manager was unaware the service had made a DoLS application in relation to restrictive practices for one person and no details of a DoLS application were recorded in their care plan. During subsequent discussions with the local authority, it was established a DoLS application had been previously submitted in relation to this person by the service.