Maristow 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 our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed before they moved to the service. This was usually a face-to-face assessment, unless the person was moving to the service from hospital. In these instances, the service liaised with the hospital team prior to discharge.

During the assessment, leaders told us they considered other factors such as the compatibility with other people and the layout of the building. This was because the service was not purpose built, and not always suitable for people who needed more complex equipment.

Staff told us they were informed of a person’s needs before their admission. One staff member said, “We get told about a new resident during handover. If there's a lot of information, we get told the basics, and we then introduce ourselves and find out more. We can also read the care plans.”

Relatives told us they were encouraged to visit the home and talk to leaders, before deciding on whether the service would be suitable for their family member. They confirmed they were fully involved in the assessment process. One person told us leaders had devised a booklet about their health condition before they started using the service. This had enabled staff to be fully informed of their needs.

There were regular reviews of people’s care to ensure it remained effective and met the individual’s needs. Relatives told us they were involved in these reviews and were informed of any changes such as ill health or events such a fall.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider used nationally recognised tools to assess and monitor people’s needs and any risks they faced. This included the risk of malnutrition and skin damage. Staff understood the measures needed to minimise these risks including the importance of good nutrition and fluid intake. They appropriately supported people with this where required. This included identifying any low intake during the day so there was time to encourage additional fluid or snacks as required.

However, whilst there were clinical meetings with the registered nurses, people’s care and support needs were not consistently discussed. For example, one meeting record showed the first agenda item was a new vacuum cleaner. There was no evidence clinical concerns had been discussed. This did not ensure effective monitoring or oversight of people’s needs.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Established relationships had been built with a range of health and social care professionals. Staff told us the GP visited weekly and could be called upon as required. This ensured consistency and enabled people’s needs and their medicines to be regularly reviewed. Referrals to other professionals for advice or a visit, were made when needed.

Records demonstrated people were seen by a dentist, podiatrist and other health professionals related to their needs. This included the tissue viability nurse, diabetic nurse and hospital teams.

People told us they were able to see various health care professionals in response to their needs. One person told us the GP and chiropodist visited regularly, and they had recently spoke to the GP on the telephone.

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 care and support.

Leaders and staff told us a healthy, well-balanced diet based on fresh fruit and vegetables and regular fluids was promoted although unhealthy options were respected. They said additional milk and cream were added to some foods to enhance weight gain, although weight loss was supported as needed.

People gave us positive feedback about the food. Specific comments included “The food is very good,” and “Sunday roast is the best.” We asked 1 person what they thought was the best thing about the service and they replied, “The food is the best.”

People were encouraged to maximise their mobility and use equipment to aid safety as necessary. Leaders told us some people liked to walk around the home to keep active, whilst others went out with family and friends.

Staff used a ‘national early warning score tool’ to appropriately escalate any concerns about a person’s health. This enabled the urgency and scale of a clinical response to be determined based on a person’s observations. Care staff told us they immediately informed the nurse on duty if they identified any concerns about a person’s health.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Records demonstrated appropriate referrals had been made for people who required additional clinical support. This included referrals to the tissue viability nurse, speech and language therapy (SALT) and the older people’s mental health team.

Staff told us the GP visited weekly to monitor people’s health care needs. In preparation for this, the nurse on duty had complied a list of concerns with people’s health they wanted to discuss. Records demonstrated the outcome of the consultations were appropriately documented.

Leaders told us they regularly spoke with people and their relatives to ensure they were happy with the service they received. This was informally or more formally within care reviews.

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

Assessments regarding a person’s capacity had not consistently been carried out in line with legislation. This was because assessments were not decision specific, and best interest decision making records had not always been completed when a person had been assessed as not having capacity. In addition, these records did not show what had been discussed with the person, and if any, less restrictive options had been considered.

In one person’s records, it was documented they had repeatedly used the call bell although had not wanted staff support. In response, a mental capacity assessment and best interest meeting, had determined the call bell could be removed. However, there was no evidence to show this decision was in the person’s best interest.

Some of the records associated with decision making were not up to date. This did not ensure the decisions remained appropriate or reflective of people’s needs or wishes.

Staff understood the need to seek people’s consent. For example, one member of staff said, “I always ask people first. One resident said to me the other day ‘You always ask me if you can change my pad.’ If someone refused, I would maybe come back in 10 minutes to see if they’d changed their mind.” We saw and heard staff consistently ask people for their consent. This included asking a person if they would like an apron to keep their clothes clean whilst eating. The staff member then proceeded to ask the person if they would like help cutting their food up or placing food on their fork.