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

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 outstanding. At this assessment, the rating has changed to requires improvement. This meant people’s needs were not always met.
 

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 always make sure people were at the centre of their care and treatment choices, and they did not always work in partnership with people to decide how to respond to any relevant changes in people’s needs.
We received mixed feedback from people and relatives about their care and care planning. For example, one relative told us they did not feel their relative was supported to plan for important life changes. One relative said, “They don’t make it known and we haven’t discussed if [person’s] care may have to change if [they] deteriorate.” Relatives also felt staff could do more to create person centred care. For example, one relative told us, “They spend too much time on their hand-held devices and talking to each other. More individual care could be given i.e. short walks, conversations etc.”
We reviewed care records and found person centred information was captured. However, daily notes did not always evidence that people’s care was delivered in a person-centred way. For example, we found that at nighttime when people were repeatedly coming out of bed, they were repeatedly assisted back to bed, and staff did not evidence that they tried alternative person-centred approaches to ensure people felt empowered, and felt they had a choice in what they wanted to do.
 

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

We reviewed people’s care records and found input from external healthcare professionals, such as tissue viability nurses. Some staff told us how they contacted healthcare professionals when they recognised people’s health was deteriorating. The provider told us how they worked with external healthcare professionals to reduce the risk of pressure ulcers and upskill staff.

However, some relatives told us they did not feel the service always worked in a joined-up way with relatives. One relative told us they were ‘sometimes’ invited to review their family member’s care and support needs, however also told us, “The few times it has happened, I have requested the meeting.”Some relatives also told us that staff did not always follow the recommended guidance from other healthcare professionals, such as physiotherapists. This meant their family members’ needs were not always supported in an integrated way.Furthermore, one relative told us, “Sometimes information does get lost along the way and is not shared to everyone. They have to be told several times.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.
We found food menus were not always accessible for everyone’s needs. There was a lack of show plates and photographs to empower and support people to make independent choices. A show plate is a sample plate of a meal option used to help individuals with dementia choose what they want to eat by allowing them to see and smell the food. One person told us, “There is enough [food], but I don’t always know what it is.” The registered manager told us they had not implemented any changes as no one had requested this. However, this did not indicate people’s needs were being met and information was provided in a way in which was always accessible. We discussed the accessible information standard with the provider. The provider implemented some changes during our visit, following this.
We found that some information in people’s rooms was not up to date. For example, one folder contained information from a previous registered manager, indicating that people were not always provided with the most up-to-date information.
 

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.
The registered manager informed us about the food committee, which was established to involve people and relatives in improving the food within the home. This committee included people living in the service. The provider held meetings with people to discuss various topics and events. We noted there was a ‘You said, we did’ poster displayed in the main entrance, as well as a monthly newsletter about the service. However, we also found this information was not always displayed in a format which was tailored for people’s individual needs. The provider told us staff are able to make all documents in large print if requested or required by people.
 

The provider made sure that people could access the care, support and treatment they needed when they needed it. We received mixed feedback from people about access to external health professionals; some people told us they felt it was difficult to access the GP. The provider told us the GP visited the home on a weekly basis, and the registered manager had met with the GP to address concerns and improve the ways that both services worked together.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.
We completed a King’s Fund Assessment of the service with staff. This assessment tool is a suite of environmental assessment tools designed to make health and care settings more dementia friendly. The design principles are presented as a wheel with five sections grouped around the desired outcomes of: easing decision-making; reducing agitation and distress; encouraging independence and social interaction; promoting safety; and enabling activities of daily living. In the dementia unit, we found there was a lack of signage to the toilets, including clearly identifiable images and text, which could clearly be seen from all residential areas. Not being able to find the toilet can provoke anxiety, and using the same signs and door colours to denote all toilets will help people find them more easily. We found a large time and date display was not available in all social areas. Providing clocks and calendars will help support individuals with dementia in maintaining their orientation.
The provider informed us that they were planning refurbishments across the home and had plans to address the observations we noted. However, at the time of our visit these specific features to maximise people’s experience within the service had not been implemented.
 

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.
We found people were supported with end of life care to ensure people’s comfort and dignity at this stage of life. The registered manager told us they supported people with planning from pre-admission. They said, “We do it from the onset, and we need to know the resuscitation status. Some people aren’t ready to talk about it, so we revisit it, and as part of resident of the day or when we see signs of deterioration. We are guided by them with how open they are. Our staff have all done intermediate training around the planning of this as well.”