St George'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 the last inspection, we rated this key question as requires improvement. At this inspection this key question has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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.

People’s needs were assessed before moving to the service and those able to share their views with us felt the staff were able to meet their needs.

People who were able to share their experiences, and their relatives, told us they had enough information and support to ensure the move into the home and the transition went well.

Staff told us people’s needs were always reviewed and outcomes shared. A staff member said, “We do get information about service users before they come in. But sometimes not all information is given. Depends on how the preadmission assessment is carried out.”

Care plans were developed from a preadmission assessment, and through people’s involvement where possible, which included some health, support information as well as some people’s preferences and backgrounds. People and their relatives felt involved in this process.

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

There were a number of people who were losing weight, the management team told us many people were nearing the end of their lives and actions were being taken to monitor their nutritional intake. However, we discussed the need to capture action taken in a way that ensured oversight and allowed them to check staff were adhering to the needed actions. We also noted that staff were not clear on the different requirements for modified diets. This meant people did not always receive the right type of food for their needs. For example, someone who was assessed as needing a soft and bite sized diet, could be given pureed meals.

The communal dining space was small and could only accommodate 5 or 6 people. People were not asked if they wished to sit to a dining table. Most people ate in their rooms, with overbed tables at lunchtime.

People who were able to share their views, and relatives, said they had enough to eat and drink, sufficient choice and support. A person said, “The food is scrumptious.” A relative said, “My [person] cannot have solid food anymore, but all their food is carefully prepared to meet their needs.”

At lunchtime the food looked and smelt appetising. Staff were available to serve people and assist them to eat. If people were asleep, they didn’t wake them, they saved the meal until they woke up.

Staff were chatting with people, while assisting them with eating and drinking. We saw there were drinks offered throughout the day.

The provider made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People who were able to share their views, and their relatives, told us staff knew them well. They told us if they needed any health care input this was sought. A relative said, “My [family member] does have access to healthcare professionals, and I'm always informed of this.”

Staff told us they worked with health and social care professionals to ensure people had the right care and support. This included mental health teams, district nurses and GPs. Feedback from a visiting health and social care professional stated, “The nursing staff are helpful and communicate well with the residents. Staff nurse [name] is very good with the residents and always helpful when I visit.”

People’s care plans included a record of information obtained on their admission to the home. This was transferred into and informed the care plan. At times these plans needed additional information or needed further review to ensure they included consistent information throughout.

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 more complex? care and support.

Most people were unable to tell us about activities available to them. People who were able to share their views, and their relatives, told us they felt their social needs were met. They said they had things to do to fill their time. A person said, “I don’t want to do anything with my time.” A relative said, “My [person] is taken to the day room when they want to go but they like watching TV in their room and it's becoming harder for them to sit for long periods of time.” A relative told us there was a fireworks and sherry evening they were invited to, and the relatives were asked to support their family member to the Remembrance Day parade.

Most people were being cared for in their bed on the day of the visit. In the communal area a person was watching the TV, the activity organiser was going into people’s rooms having 1-1 chats. Another person was supported to go outside and told us the activity organiser was going to support them with exercises. The activity organiser told us people had opportunities to get out and about and there were visiting entertainers. They said there were events planned based on seasons or important dates.

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.

People’s care needs were reviewed regularly. However more work was needed to ensure these reviews identified inaccuracies and contradictory information. Plans were not always accurate, consistent and reflective of each other and people’s needs.

Staff were able to explain how they monitored people’s health and wellbeing. They were aware of what action to take if needed. A staff member said, “If I have any concerns with a service user's wellbeing, I will immediately carry out vital signs’ observation, escalate to the GP, out of hours services or refer to hospital via the emergency services. Signs of infection include High or very low temperature, raise heart rate, poor eating or drinking, lethargy etc.”

There were systems in place to have overview of people’s care needs, wounds and infections for example, and this included progress updates. However, we could not be assured how robust these were due to shortfalls in consistency and records we identified.

The provider could not always demonstrate how they tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Most people were unable to share their views on if their choices were listened to and records did not demonstrate how staff managed this aspect of people’s care.

Those people who were able to share their views told us they were able to make their own choices. Relatives felt people had their choices respected. A relative said, “My [person] is always involved in their care but doesn't always have the capacity to understand their needs. I'm always told of any changes in [person’s] care.”

People’s care plans included discussions relating to capacity assessments, which detailed how capacity for the decision was assessed. However, for people unable to express their wishes and views, different communication tools were not used and assessments did not always include a record of a relative, friend or advocate to help make the decision.

Plans stated where people had capacity to make day to day decisions, but more support was needed for more complex decisions. There was a record when Deprivation of Liberty Safeguards (DoLS) authorisations were requested. A DoLS authorisations tracker was in place so the progress of applications could be monitored. If anyone had conditions imposed for authorised DoLS these were recorded and staff made aware of how to comply with these. However we found in care plans, the status of the DoLS was not accurate throughout. For example, a person’s plan stated it had been applied for in 1 section, a different section stated it was in place but in actual fact it had expired and there was no record in the plan of if it had been reapplied for.

Staff were aware of the Mental Capacity Act 2005 (MCA). They were able to tell us how they incorporated the principles of the MCA in their day-to-day roles. For example, ensuring choices were offered to people and respected by staff. A staff member said, “I had e-learning MCA training. I consider every one of my service users to have capacity, therefore I ask for permission and seek consent before providing any care. Unless proven otherwise, then I would make the best interest decision for service users proven to lack capacity.”