St Mark's Care Home Also known as St Mark's

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 sought evidence that people’s care, treatment, and support resulted in good outcomes and promoted a high quality of life, based on the 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. The service was in breach of legal regulation in relation to consent.

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.
Some staff told us they did not feel they always had enough time to read people’s care plans. One staff said, “I would take the time to read if it were possible, but really this is only during our breaks and to be honest, I’m usually too tired to do this.” However, the provider told us all care staff are trained and are aware that residents care plans can be accessed via the handsets.
One relative shared with us how their family member was not always supported in their communication needs. They told us, “When it comes to hearing aids, putting them in or checking the batteries, they do not seem to do this. It's all part of [their] care. If [they] cannot hear, [they] will find it difficult to join in.” This meant that people’s communication needs were not always supported, ensuring that care and treatment were effective.
Most people’s care plans provided advice and guidance to staff on how to meet people’s cognitive and emotional needs, but for one person living with dementia, they did not have a specific mental health care plan to address their needs.
 

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them.
We saw the provider completed weekly clinical risk meeting forms, which included people’s weight, medicines and skin integrity concerns. The provider told us these meetings were attended by the nurse on duty and staff told us this information was updated to them through their unit leads.
People’s health was monitored and where there were concerns, recognised tools were used, for example the Malnutrition Universal Screening Tool (MUST) for measuring people’s likelihood of developing malnutrition. Similarly, PURPOSE-T tool was used. The PURPOSE-T tool is a pressure ulcer risk assessment tool designed to help healthcare professionals identify patients at risk of developing pressure ulcers and to implement effective prevention strategies. This was a process of assessing people’s likelihood of developing pressure sores.
 

The provider did not always work well across teams to support people. We received mixed feedback from staff. Some staff told us, “The teamwork is good, it makes a major difference when we all work as a team.” However, some staff told us their workload was not manageable.
We also heard feedback from staff that they did not always work well together across the units. For example, one staff member told us, “It is a bit more difficult when staff from another unit have to cover, as they will not know the service users so well.” The provider told us all staff have access to the handset for the unit they are working on for their shift and are able to review people’s care needs. Another staff member told us that the staff in other units “Will never help anybody. The processes were not adequately covered in the induction period. They never showed me anything when I was shadowing.” Some staff also told us how the impact of this working relationship meant they would not seek support from other units. One staff member said, “I do not go and ask questions in another unit.”
 

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.
However, we were not assured from records of daily care that advice from SaLT was always being followed by staff, for example for 1 person who required level 1 thickener, sometimes the daily records recorded level 0 (un-thickened) drinks for this person.
We received mixed feedback from relatives regarding the support provided to people accessing external appointments. One relative told us, “The dentist, opticians, hospital appointments, are all made by me” and “They don't really check up on these things and I organise all of it.” The provider told us they also arranged people’s external appointments such as dentist, optician and podiatry, and supported people to attend these appointments.
One relative also told us how their [family member] was not always supported to maximise their independence, choice and control. The relative told us, “[Person] likes to ask questions if [they] [don’t] understand something and there is not always time. Also, if [person] does not have [their] hearing aids in, [they] can't always hear what they are saying, which [person] finds frustrating.”
 

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.
We also found that one person living with Parkinson’s disease did not have a detailed care plan around their condition and associated risks to ensure they were safely monitored and mitigated. For example, the person was experiencing hallucinations, yet this was not captured in the emotional wellbeing section of their care plan. This meant there was an inconsistency in the monitoring of mental health symptoms, medicine reviews, safety checks, and support for the person.
We reviewed the daily care records for one person with a catheter. We found there was a lack of evidence to demonstrate the provider always measured and monitored urine output when the catheter was emptied. The provider did not demonstrate the need for not recording output was monitored and reviewed. This meant there was a lack of assurance the person’s clinical expectations could be accurately monitored and managed.
The provider had recently implemented additional skin integrity training for staff and told us they had seen a reduction in pressure ulcers as a result.
 

The provider did not tell people about their rights regarding consent or respect these when delivering care and treatment.
People’s rights were not fully protected when they needed covert medicines. There were 4 people receiving medicines covertly; this involves giving medicines to a person without their knowledge or consent. The provider’s policy noted this process should only be considered in exceptional circumstances where this method is the only possible alternative for a [person] to receive their medicines and where treatment is necessary for the [person’s] physical, mental health and wellbeing. However, the registered manager did not ensure appropriate care plans were in place for people receiving covert administration of medicines, including how to give medicines first, any techniques to use for supporting people to take medicines and when to use covert administration as a last resort and for the shortest period. There was no evidence to show people were continuously refusing medicines to justify the use of covert administration. The staff administering medicines could not confirm to us that they were following the practice. Capacity assessments were carried out after the staff had already been using covert administration. There was a lack of evidence to show that clear and meaningful meetings were held to discuss best-interest decisions for individuals. There was a lack of evidence to demonstrate that regular reviews were taking place to ensure the covert administration was used for the shortest time. This meant people’s rights were not respected or upheld making the process unjustified.
Furthermore, external CCTV was noted around the premises and in the garden area where [people] spent time. We found the CCTV monitoring screen was viewable in the public bar/lounge room and therefore accessible to everyone, including visitors, the public and people using the service. We noted that appropriate signage warning of the use of recording equipment was displayed on the entrance door to the home. However, the recording equipment and viewing screen were not appropriately secured and safeguarded to ensure that people’s privacy was maintained. The registered manager told us that they had password-protected access to the system, and the monitor would usually be turned off. However, we informed them the monitor was on and displaying footage each time inspectors entered the room throughout both days of our inspection. Recording equipment was not kept in a private area, inaccessible to the public and people within the home. The registered manager confirmed discussions with people who use services and their families about the implementation of recording equipment being removed from new admission assessments last year. This meant that new people were not supported with informed discussions about CCTV use, ensuring that consent was always appropriately obtained.