St Margarets Care Home

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• 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 good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to person-centred care at the service.

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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Our observations showed a person-centred approach was not always followed by staff. People’s care plans were not accurate or fully reflective of their needs.

The provider did not ensure people were central to the decisions made about their care and treatment. Care plans did not fully explore the needs and wishes of people and risks to people were not appropriately assessed.

The provider failed to ensure staff were appropriately skilled and trained to undertake care planning tasks. The provider told us they completed care plans and risk assessments at the care home. We found care plan reviews with people or their relatives if more appropriate, were not planned, and did not demonstrate their involvement and choice.

There were 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.

The service mainly supported older people with dementia, yet we found the needs of those people were not always fully understood or met. There were significant shortfalls in provisions for people in relation to care, activities and the environment of the care home. We observed staff practice did not meet the diverse communication and health needs of people.

We found limited information was known about people and their health needs. This included background history of health conditions, and the provider did not recognise how specific conditions affected people differently. For example, the provider told us 11 people had a diagnosis of dementia, however, their care plans did not specifically guide staff to the type of dementia, how the person experiences it or how staff can best support them. Furthermore, individualised information regarding what treatment or medical reviews they may be receiving was also not documented.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information about activities and menus in the service were handwritten on a whiteboard in the lounge. However, this information was not easy to read and pictorial alternatives were not available. Staff showed us they wanted to improve this with some photocards, however, these had not been fully developed and implemented.

Some people, and their representatives, had been asked by the provider to complete surveys relating to the care provided at St Margarets Care Home. We found the surveys did not offer an opportunity for specific responses, and this meant people were not encouraged to freely feedback on their individual experiences. Pictorial formats of surveys were not available. The provider was unable to demonstrate how a formal review of this feedback took place and feedback to people and their relatives had not occurred.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

Staff did not always communicate well with people. We observed staff did not always verbally communicate with people prior to assisting them. For example, we observed staff put clothing protectors on people without first communicating. Another person told us they were not aware if an important referral had been completed by staff which they had been waiting for.

Although some people had been asked to complete feedback on care surveys, due to the format, not everyone was able to do this. Resident meetings did take place, and we saw items such as activities and menus were discussed.

There was a complaints policy in place. The provider demonstrated how they acted upon concerns and complaints that were received; however, they had been unable to initially evidence this to us as they were unable to locate their complaints file.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We found people had access to health professionals, such as their GP or community nurses when they needed to see them. Staff told us healthcare professionals were supportive and approachable, and we observed staff requested reviews and took specific actions when a person appeared unwell.

However, care plans were not routinely updated to ensure they reflected the most recent information about the person, their needs and their wishes. This meant there was a risk it could lead to inappropriate care being provided to people.

Leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

There was a lack of evidence to show how people, and their representatives where appropriate, were included in the development and review of their care plans. There was no evidence to show they were consulted and listened to about their experiences to ensure their care plans were tailored and suited to their individual needs and preferences. People told us there was little to do, and we saw there were limited activities which interested them.

People were not 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. The provider did not ensure prompt care and treatment reviews took place for people, and this meant important opportunities to discuss the future and what is important to the person, did not take place.

Staff did not recognise the importance of forward planning, nor the involvement of people and their representatives, where appropriate. At the time of our assessment, the provider told us 2 people were medically assessed as requiring end of life care. However, neither person had a care plan which identified this, and their specific wishes and care needs were not appropriately recorded or sought.

We asked staff why there was not a care plan in place for 1 person, and they said, “[Person] has only been end of life for 1 month”. We were not assured the provider had systems in place which appropriately supported people at the end of their life. And we also were not assured the provider understood the importance of supporting people to consider what they would like to happen at the end of their lives, if their health were to decline rapidly.