St Mary's 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 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 changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 62 (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 by assessing and reviewing their health, care, wellbeing and communication needs with them. Care plans were in the form of a running log. This meant it was sometimes unclear as to which were the most recent entries. Some entries had been highlighted; however, this was not consistent. People’s assessments and care plans had been reviewed and improved. Whilst the majority of assessments identified what was important to people, and staff were aware of this information, we saw instances where plans needed to be reviewed to reflect the most up to date information.

Some people and relatives we spoke with were not aware if they had a care plan in place or how it was updated. Other relatives told us they had been involved in the assessment process and were regularly updated regarding any changes to their family member’s care and support.

Processes were in place to assess people’s needs prior to them moving in and at regular intervals. Staff told us there were sufficient details within people’s care plans to enable them to provide care for people. However, we found some records contained different levels of clarity for staff on how to meet people’s assessed needs and a small number of assessments and care plans needed review to keep pace with changes in people’s mealtime support needs. We discussed this with the care consultant, who ensured this was addressed at the time of our visit.

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

Risk assessments and care plans identified areas requiring evidence-based interventions. Nationally recognised tools, such as those for assessing malnutrition and pressure sore risk, were routinely used. Staff generally followed clinical advice and policies.

People told us staff supported and encouraged them to eat and drink. Comments included, “I am not eating. I have gone off my food. The food is OK, but I don’t fancy it. [Staff] gave me a cup-a-soup. I really liked that. They keep trying and encouraging me to eat.” and “There are drinks on tap. I haven’t been drinking much. [Staff] will ask me to drink; they do want me to drink. They do give me milkshakes and I drink them.”

Staff had an understanding of dietary frameworks, including the International Dysphagia Diet Standardising Initiative (IDDSI), ensuring safe and appropriate nutrition.

Overall, clinical guidance was followed, and care was personalised according to people’s preferences. Collaboration with healthcare professionals was evident, supporting people’s wellbeing. People’s meals were prepared in line with this guidance and staff were aware of people’s need in relation to this. Where the Speech and Language therapy (SALT) team had provided guidance in relation to people being at risk of aspiration or choking this was implemented in most cases. However, we saw 1 person who was not supported in the correct position while eating. Their care plan was not detailed enough about their ideal seating position when eating and drinking and their SALT assessment was not readily available for staff to follow.

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. Staff and members of the management team said information was shared between teams and services to ensure continuity of care for people when they used and moved between services.

People told us of various healthcare professionals and services they had access to and used. People’s comments included, “They [staff] do call Doctors if you need anyone.”, ”I see the Parkinson's nurse. She comes in. If I want to see a Doctor I think I could, I haven’t asked. I haven’t needed to.” and “They [staff] are great people, they are very good at changing my dressing.” Relatives confirmed people’s needs were met.

Overall, people were supported with their health outcomes. For example, the menu was designed to offer people healthy and nutritious options in line with their needs and preferences. People were supported to have enough snacks and drinks throughout the day.

People told us they had access to healthcare services and relatives confirmed they were informed of changes in their family member’s health. One relative said, ”[My family member] came here from hospital. They[staff] look after him well here. He is getting better.”

Most people and their relatives confirmed equipment was available to support people’s needs. One relative said, “[My family member] has a walking frame and sometimes staff use a wheelchair to take her further. They remind her to use her walking frame.”

The provider had improved the way people’s care and treatment was monitored to ensure continuous improvement, although there remained room for further improvement for some people. For instance, we noticed a person had not eaten their breakfast or their lunch. They told us they were not well, and their appetite was very poor. However, staff had not taken time to talk with them to find out what food they considered treats[HP1] and felt they would be likely to eat and enjoy. Another person’s care plan had not kept pace with their changing need for staff support with eating. We discussed these areas with the care consultant who took action to address them at the time of our visit.[

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

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 take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS)

We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

Care plans reflected people’s preferences and choices. Where people lacked the mental capacity to give consent, appropriate best interest decisions were made in line with the MCA, involving people’s family members or representatives where needed.

Staff demonstrated a good understanding of the principles of consent and the MCA). Staff took time to explain to people what they were doing and sought their consent prior to providing their care.