St Thomas' Priory

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 requires improvement. At this assessment the rating 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 54 (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 consistently ensure people’s care and treatment were effective, as care plans did not always reflect current needs. While care records showed people’s physical, health, wellbeing, and communication needs had been assessed, care plans were not routinely updated to reflect changes.

For example, one person’s care plan stated they should always wear glasses. We observed they were not wearing them, and we were informed by staff the person had recently seen a health professional and no longer required glasses. Another person’s care plan indicated they needed pressure relief on their heels while in bed. We found the equipment in the room, but it was placed on a chair. Staff told us the person’s condition had healed, though the care plan had not been updated to reflect this.

Care plans for individuals who experienced distressed behaviours lacked detail on strategies staff could use to support them during these episodes. This limited staff’s ability to respond consistently and effectively.

Staff were able to describe people’s needs and associated risks. One staff member said, “We try our best to get to know the residents, finding out what they like and don’t like and where they need support.” Relatives told us care was reviewed, and needs were assessed, although documentation did not always reflect this in practice. People told us, staff knew them well. One person said, “The staff do know my likes and dislikes.”

The provider did not consistently follow legislation or current evidence-based practice and standards. Staff did not always adhere to safe moving and handling principles or respond appropriately to incidents. However, the provider managed people’s nutritional needs safely.

On the first day of the inspection, a staff member was observed using an underarm lift to support a person to stand, this is not a recognised safe technique and poses a risk of injury. On the second day, a person was seated in a standard chair in a communal area without staff supervision and subsequently experienced a fall. This individual should not have been seated in a standard chair due to their mobility needs. A senior staff member confirmed the person required a reclining or bucket chair. The registered manager raised a safeguarding concern with the local authority and issued a memo to all staff reinforcing the importance of appropriate seating.

During a hoisting transfer, staff accidentally knocked another person’s leg twice with the equipment. The incident was not reported, no body map was completed, and no monitoring was initiated. This failure to respond placed people at risk and demonstrated a lack of safeguarding awareness and accountability.

The registered manager responded to all feedback, conducted investigations, raised safeguarding concerns, initiated disciplinary action, and reminded staff of correct procedures. We also observed instances of staff using safe moving and handling techniques and supporting people with dignity.

People told us they enjoyed their meals, and we observed staff assisting individuals with patience and attentiveness during mealtimes. One person told us, “The food is really good; I have to ask for small amounts.” One relative said, “The food is very good; [my family member] has choices, and they have fresh fruit. [My family member] always has lots of fluids.”

However, we also observed one person being supported to eat by a staff member who did not engage with them and instead watched television throughout the task. This did not promote a positive or respectful mealtime experience.

The provider did not consistently work well across teams and services to support people effectively. Referrals were made to relevant professionals when needed, but we raised concerns about several incidents on one floor that had not been referred. The provider explained these had not been reported to management in line with internal policy and procedure.

Despite this, visiting professionals shared positive feedback. One told us, “The provider is willing to work with you and take on and follow your suggestions. The service is willing to work with new ideas for new interventions, rather than using medication for people.” Another professional noted improvement in the activities offered to people.

Staff told us they worked in partnership with visiting professionals and valued their input. One staff member told us, “We do work with other professionals such as physiotherapists, GPs and SALT.” SALT is the acronym for speech and language therapists. However, inconsistent reporting and communication across teams limited the effectiveness of joint working and risk management.

The provider supported people to manage their health and wellbeing through access to nutritious meals, tailored dietary support, and opportunities for physical activity. People told us they could take part in a variety of activities that suited their interests and abilities, and relatives confirmed that individuals had access to health professionals when needed. We observed people spending time outdoors and walking around the grounds, which encouraged movement, fresh air, and interaction with others. One staff member told us, “We try our best to make sure the activities are reflective of what people want to do, and I try to encourage people to remain active and have exercise where possible.” Care plans clearly documented how people’s health needs were assessed and maintained, including strategies to promote physical and emotional wellbeing. Where modified food textures were required, staff demonstrated an understanding of people’s needs.

The provider did not routinely monitor people’s care and treatment to drive continuous improvement. Gaps in documentation and oversight placed people at risk of receiving care that did not meet assessed needs.

Where people required support with oral care, records did not consistently show what support was provided or whether it aligned with assessed needs. This lack of evidence compromised the ability to evaluate care quality and placed people at risk of poor oral health.

Staff did not consistently deliver care in line with assessed skin integrity needs. One person’s care plan indicated they required repositioning every two hours and the use of a pillow between their ankles. On the second day of our inspection, no pillow was in place, and repositioning records had not been updated since night staff had left; the last entry was at 5am. Following our feedback, the provider investigated and reported that repositioning had taken place, but staff had failed to document it. However, the times provided by the service did not align with our observations. In the absence of accurate and timely records, the provider could not be assured that care was being delivered in accordance with the person’s plan. In response, a new system was introduced to strengthen documentation of repositioning and support safer care practices.

On both inspection days, 2 people were observed sitting in wheelchairs without pressure-relieving cushions. One person remained seated for a prolonged period without appropriate support, increasing the risk of pressure damage and failing to demonstrate safe or effective care delivery.

Relatives told us staff monitored people safely and encouraged them to maintain their independence. One relative said, “They did try their best to keep [my family members’] mobility going until they finally lost their mobility.”

Staff shared examples of improvements in people’s health, and relatives told us they had seen positive changes in wellbeing since their family members moved into the home. However, inconsistent monitoring and recording limited the provider’s ability to demonstrate and sustain these outcomes.

The provider supported people to understand their rights around consent and respected these when delivering person-centred care. Staff promoted choice and encouraged people to make decisions about their care wherever possible.

Mental capacity assessments were completed in line with the Mental Capacity Act 2005. 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. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Where people lacked capacity to make specific decisions, best interest meetings were held to ensure decisions were appropriate and least restrictive. This included decisions about covert medication and where a person should live.

People told us they could make their own decisions and staff respected their choices. One person said, “I can get up when I like, I make my own choices. The staff listen to me.”

Staff demonstrated an understanding of the importance of consent and choice and worked to uphold people’s rights in daily care delivery. One staff member said, “People get up when they choose to get up. Sometimes people get tired, we [staff] won’t rush them.”