Archived: St. Catherines Residential Care 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 our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

Requires Improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation people’s consent to care.

This service scored 42 (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 was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

We identified some concerns in relation to the provider’s processes for assessing, documenting and reviewing people’s care needs. People’s needs were assessed before they moved into the service. However, people’s care records did not always provide clear, up-to-date and accurate information about their current needs, to ensure staff fully understood these. For example, where people required to be repositioned every 2 hours, this information had not been updated in their care plans. One person had been issued an air flow mattress by the district nurses. This is a medical device used to prevent and treat pressure ulcers. Their care plans did not provide staff with clear information or guidance on confirming the correct mattress settings or repositioning guidance to support skin integrity. We raised this with the provider, who told us repositioning was unnecessary due to the presence of the pressure-relieving mattress. This raised concerns about clinical oversight, and staff’s understanding of effective skin monitoring and repositioning practices, leaving staff without clear direction on essential skin integrity checks. NICE guidelines recommend repositioning every 4 to 6 hours, depending on risk, in conjunction with the use of air flow mattresses.

Care plan reviews were completed; however, these had not identified the shortfalls we found at this inspection.

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

The provider’s processes for ensuring people were consistently involved in their care planning and that the information recorded in support plans was accurate, were not effective. Important information about people’s care and support needs had been missed from some support plans and monitoring charts. Some people’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs.

We identified concerns regarding the monitoring of nutrition and hydration for 1 person. Although the care plan clearly stated that support was required in this area, staff were not consistently recording relevant information in their daily care notes. Staff reported that the handheld device used to log care interactions and tasks had not been updated, resulting in a lack of prompts and guidance. This oversight placed the person at risk of not receiving appropriate support. The registered manager confirmed that updates to the handheld devices were underway.

The provider was using nationally recognised tools, for example the Waterlow score, for assessing people’s risk of pressure damage and the Malnutrition Universal Screening Tool (MUST) for monitoring people’s weight. However, the use of these tools was not consistently documented within people’s care records.

We observed a poor lunchtime experience that did not reflect evidence-based principles of person-centred care and nutritional support. People were not offered a choice of meals or drinks during the meal and there was limited availability of condiments. Second portions were not provided, even when initial servings were noticeably small and quickly eaten. There was a lack of meaningful choice in mealtime arrangements, falling short of expected standards for promoting dignity and nutrition. We received mixed results from people about the meal options. Whilst some people spoke positively, others told us they did not receive a choice. We shared this feedback and observations with the registered manager who agreed to follow this up.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Staff did not always know how to access information they needed to appropriately assess, plan and deliver people’s care and support. For example, staff were not able to access or retrieve information on people’s care and support needs which included mental capacity assessments, best interest decisions, falls incidents and professional appointments. A staff member told us “The information is buried in the daily notes and difficult to find.” We shared these concerns with the provider who has arranged additional training for staff and the systems issues to be addressed.

We observed a staff handover meeting used to share information about people at the end of each shift. There was no formalised record of this handover to evidence what had been discussed and agreed. A staff member told us, “At handover the senior tells us about people and asks us to monitor and document things.” Communication and coordination within the staff team was not always effective. For example, staff told us when they worked different shifts, there was no system or process in place to share information on their return to work.

We observed staff supporting a person to access other areas of the service via key-coded entry pad. This happened several times during the day and staff were observed engaging with the person each time a request was made. We found that generally staff worked well together but were not always proactive at engaging with people and promoting independence and choice.

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.

We were not assured that people’s risks were always managed appropriately to ensure their health and wellbeing. People were not always supported to live healthier lives as systems and processes were not robust to ensure staff identified and escalated concerns about people’s health needs.

Monitoring charts were not always fully or accurately completed meaning there was a risk that any deterioration in people’s conditions would not be noted and acted upon. For example, records indicated people were not repositioned in line with their care plan to mitigate the risk of skin breakdown. One person required hourly checks as they were unable to use the call bell; however, we found records were not completed in line with their assessed need.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not ensure outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider’s systems and processes that monitored quality and safety were not effective in supporting people to experience positive outcomes. For example, outcomes of audits and monitoring checks, including feedback from health professionals, relatives and staff, were not analysed to identify issues and learn lessons to make improvements.

People’s individual care plans, risk assessments and monitoring care records were not regularly reviewed and amended as people’s care and treatment needs changed. This showed ineffective monitoring systems used to improve outcomes.

People’s health needs were not always reflected in people’s care plans and there was sometimes conflicting information. This conflicting information increased the risk of staff error, and this placed service users at risk of harm.

Where people’s fluid intake required monitoring there were no guidelines for staff to follow which meant this monitoring was not effective. Where people’s fluid consumption was insufficient, this was not followed up and advice sought, as needed, from health professionals. Where people required repositioning, this was not monitored, and there was no evidence that people were being supported to reposition on consistent basis. Where care plans detailed health tasks which required monitoring, staff were not consistently completing these tasks explaining they were not prompted to do so on their handheld devices.

We found that the provider had failed to continuously monitor people’s care and treatment to improve outcomes.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

CCTV had been installed at the service without proper consultation or consent in line with the Mental Capacity Act (MCA) 2005. People were not consulted, and communication to families via a newsletter did not amount to meaningful engagement. No related impact assessment was carried out, and signage to alert people and visitors to the presence of CCTV surveillance was missing at the time of inspection. The CCTV monitoring system was visible from the hallway and not solely used for safeguarding purposes, raising privacy concerns.

Consent from people and families to the introduction and continued use of CCTV had not been obtained. For those people lacking capacity, there was no evidence of best interest decisions being made in line with MCA requirements.

The service also lacked a formal policy detailing the provider’s arrangements for the storage, retention, disposal, or sharing of CCTV footage.

Following our inspection, the provider installed CCTV signage, implemented a CCTV policy, and initial steps were taken to obtain consent to the use of CCTV at the service. However, these processes lacked coordination and clear procedures for withdrawing consent or raising objections had not yet been addressed. We found the provider had started to address some key actions, such as formal MCA assessments and best interest decisions for people living at the service.

Staff were observed seeking consent before providing care and respecting people’s choices, such as when offering medicines. However, the provider did not consistently ensure that systems for recording best interest decisions were effectively used.