St Margarets 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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to consent to care and treatment.

This service scored 29 (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 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 found significant shortfalls were present in how the provider undertook care planning and assessment processes at the care home. People’s care plans were not robust, fully informative or descriptive of people’s needs and wishes. Assessments of people’s care, and treatment needs had not considered specific issues that are common in certain groups of people which could result in poor outcomes for them if not addressed. For example, swallowing difficulties, epilepsy, skin integrity concerns, end of life wishes and dementia in older people. When we asked staff about care plans, we were told basic information was recorded, and they relied on getting to know people through their contact. This placed people at risk of harm and their needs being unmet.

We reviewed initial assessment documentation for 1 person who was recently admitted to the care home. We found this did not consider the person’s medical diagnosis and history for a condition which may require emergency support and response from staff.

The provider used templates which were not suitable for long term care planning, this meant they were not prompted to assess and record specific needs, outcomes and goals. We found limited evidence of people being involved in their care planning and records did not demonstrate the provider ensured regular involvement of people’s representatives, where this would be appropriate and wished for.

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

We found limited evidence of meaningful activities taking place at the care home, and no evidence of any activities specifically designed for people living with dementia. The provider told us 11 people were living with dementia, however, failed to consider how providing a variety of approaches and activities is known to help people feel engaged and valued. The provider employed an ‘activities co-ordinator’, but we found when they had planned leave, arrangements were not made to cover this role.

We observed people were not always engaged, and some people told us they sometimes felt isolated due to a lack of people to either chat with or play games. We found people who spent time in their bedroom, due to preference or health need, did not have regular meaningful interactions and their social and emotional needs, and preferences, were not always seen as a priority.

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.

The provider ensured referrals were made for specific specialist healthcare involvement. We saw evidence where people had been reviewed by the community falls team, community nurses for specific nursing support and the Speech and Language Therapy (SALT) team for safe swallowing assessments. However, the specific involvement, assessment outcomes and advice were not recorded in people’s care plans and risk assessments. We found health professionals left summaries of their assessments and recommendations; however, this was not used to inform a holistic care plan which was reviewed on a regular basis.

One person’s representative told us, “[Staff] are red hot when it comes to getting the doctor involved”. Another representative told us, “[Person] has developed some [health condition], this was picked up on by the staff and is being investigated by the doctor”.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible reduce their future needs for care and support.

The provider did not have robust systems in place to ensure people were supported to live healthier lives. We reviewed records for 1 person who required support with eating and drinking. We found records were not complete, reviewed and some days were not filled in at all. Staff told us the SALT team had requested these be completed; however, we found no recording of this request, nor any guidance for staff within the person’s care plan. This meant effective monitoring had not been taking place in line with the health professionals’ advice and request.

Care plans lacked important information on how to promote health. For example, 1 person’s care plan did not clearly identify the support they required to manage their diabetes, and we found further concerns relating to their skin integrity and how this was being appropriately monitored and supported. Care plans did not guide staff on the needs of people, and how to support them to achieve positive outcomes.

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

The provider did not have thorough systems in place to ensure they captured ongoing assessment information. This included health professional advice and reviews. Staff were unable to confirm 2 people’s skin integrity status and needs as staff had not effectively recorded updates from the community nurses. This meant the wider staff team were unaware of the specific needs of the person and how a holistic approach to their care could assist with skin healing, such as regular movement and other approaches to health promotion.

We found the providers monitoring documents were not sufficient. For example, where people required support with positional changes to reduce the risk of pressure sores, we found the charts had times pre-populated. This was also the case for observational monitoring charts. This meant staff did not record the actual time the support was provided. It was therefore not possible to confidently view these records to determine if people were supported safely and effectively.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. We were not assured staff training in the Mental Capacity Act 2005 was effective as staff and the provider had limited skills and knowledge in this area.

Consent to care and treatment was not sought in line with law and guidance. The provider and their staff did not demonstrate a clear understanding of their responsibilities under the Mental Capacity Act 2005. This meant people were at risk of receiving care and treatment which was not in their best interest, and furthermore, were at risk of being unlawfully deprived of their liberty.

The provider did not have effective systems which sought the views and consent of people, or their representatives, where appropriate. People were not central in decision making when care and treatment was delivered to them. For example, we found the provider failed to ensure best interest assessments were completed appropriately, and thoroughly, when specific decisions were made. This included when people shared a bedroom, when bedroom moves took place, and when specific technology was used to monitor people’s movement.