St Margarets Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

The service did not consistently provide person centred care. Care plans lacked sufficient guidance to enable staff to meet people’s needs and people experienced delays when support was requested. The provider had recognised people’s care plans were inaccurate prior to the assessment and work was underway to address these issues.

Information was shared appropriately with relatives when needs changed and with other services during transitions. The service worked collaboratively with health partners to meet people’s needs.

The service was in breach of the legal regulation in relation to person centred care.

This service scored 61 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care plans lacked sufficient guidance to enable staff, who did not know people well, to safely meet their needs. The provider had recently introduced a digital care planning system and the care plans in use at the time of the inspection, lacked information on people’s current needs and health conditions. With support from the local authority, the provider had identified these issues prior to the inspection and senior staff commented, “Care planning is very poor at present.”

With support from the newly appointed clinical lead, nursing staff were reviewing and updating people’s care plans during the second day of our inspection.

Staff used digital devices to record details of the care people received. However, signal coverage was poor in some areas of the service and staff told us, “The handsets are a bit hit and miss in places. Quite a few of us just sit by the office to do the notes.” Records detailing the support people had received were brief and did not demonstrate that planned care had been consistently provided.

People told us they did not always receive person centred care and that their continence care needs were not always promptly met. People’s comments included, “I don’t think it’s right to be left in soiled clothes”, “I do have to wait for them to assist me, and it can vary as to how long it takes, but they do their best to get around” and “I feel lost here, I don’t see staff for hours”. A person told us they limited their fluid intake during certain times of day because of concerns about the level of support available from staff. They told us, “I have stopped drinking after lunch and early afternoon so that between 4-6pm, when staff are really busy, I don’t have to wait to be assisted in distress”. Another person had not received necessary support with their catheter, which was over full, and records indicated had not been changed for 24 hours.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The provider ensured information was shared when people moved between services. This helped ensure people received consistent support.

At each staff shift change there was a handover meeting between outgoing and incoming staff to ensure staff coming onto shift had a full understanding of people’s current support needs.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider shared information accurately and promptly with people, their relatives and involved health professionals. Relatives told us they were promptly updated with details of any changes in people’s condition or support needs.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People and relatives were confident the service listened to feedback and took action in response to issues they reported. Some individuals regularly raised concerns with staff and managers, these were addressed appropriately but not always documented.

The service completed surveys regularly and recently received feedback was generally positive and complementary. However, some feedback reported that staff were at times rushed.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The provider ensured people could access support from health and social care professionals whenever required. Care records demonstrated appropriate referrals had been made for support from, GPs, dentists and specialist nursing services as required.

The provider had recently purchased a selection of sunglasses and hats to enable everyone, to safely access the service’s outdoor spaces during the fine weather.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

People who spent most of their time in their rooms said they experienced delays when requesting support and staff accepted these delays did occur. One person told us they had recently intervened as staff had not responded promptly to another person calling out for help. They told us, “At weekends the home can be very quiet. I heard a resident crying out for help from my room so I went to see what was happening…. I saw several members of staff sitting in the dining room chatting whilst the crying continued, I told them off”. During the inspection, managers and staff ate together after having supported people with their lunch. This meant there were only 2 staff available to respond to people’s care needs during this communal staff break.

People’s feedback in relation to activities was mixed, some people enjoyed communal activities and animal visits that had occurred. However, where people had individual interests, they did not feel supported to engage with them. One person had art materials in their room but reported staff did not have time to support them to access these. During the first day of the inspection there were limited activities on offer and care records demonstrated people had not been regularly supported to engage with a range of activities.

By the second day of the inspection an activities schedule had been re-introduced, and people were being encouraged to participate in games and singing in the lounge. Staff told us, “I think there is enough for people to do” and “We do have entertainment and stuff, had a pony in the other week”.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Information about people’s wishes and preferences for care at the end of their lives had been documented within care records and respected where possible. This included information about people’s wishes in relation to resuscitation, hospital admission and any future arrangements planned.

Staff told us they made sure people were pain free at the end of their lives and one staff member commented, “[Person’s name] came in [to receive] palliative care 9 months ago with a 3-month life expectancy but [They] are hale and hearty”.