St Mary's 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 requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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

This service scored 58 (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 were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People did not always receive effective assessment of their health, care, wellbeing and communication needs. Care records showed assessments were completed, but some lacked essential detail or were not updated in line with changing need. For example, in several cases Mental Capacity Act assessments did not follow the two‑stage test, and best‑interest processes did not involve relevant parties, such as relatives or relevant person’s representative (RPRs), despite decisions affecting people’s daily lives and freedoms. In one instance, a person was permitted to leave unsupervised at night despite being subject to a Deprivation of Liberty Safeguards (DoLS) authorisation. Staff had not completed a corresponding robust risk assessment for this decision and community leave was not explicitly stated as an agreed condition of that person’s DoLS authorisation. Following the inspection, the provider convened a multi-disciplinary meeting and completed a more robust risk assessment for similar future decisions. Care files showed inconsistent recording in areas such as such as annual health checks, screening outcomes, and follow‑up actions.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People did not always receive evidence‑based care and treatment in line with current best practice. Although care plans for people with learning disabilities had improved guidance in place in areas such as communication and sensory needs, we also found gaps in other areas including behavioural support and consent. Further and sustained improvement was needed to ensure care and treatment was evidence-based.

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.

Professionals told us communication was clear and timely. One community professional told us, “They’re really good here… the staff monitor things closely and get in touch if any help is needed.” Another described strong joint working with staff to build a person’s independence in the community. Staff described positive internal teamwork, saying there were regular handovers, updates on people’s changing needs, and opportunities to raise concerns. Relatives also described cooperative working and improved access to professionals. For example, 1 relative said that staff supported a person to attend an appointment by talking them through it in a way that reduced anxiety.

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.

The provider supported people to live healthier lives through meaningful activities, community access, and education around wellbeing. Records showed people engaged in healthy‑eating projects, personalised 1:1 activities, and community programmes, including college courses, budgeting skills and travel training. Relatives told us people were supported to maintain health routines. One relative said, “[Named person] just had a health check… they take her every year”, and described staff reassuring and supporting the person with this. Staff also encouraged physical activity and social participation. A relative described how a person was supported to go for walks and be active when they chose to. People were encouraged to develop independent living skills such as cooking, laundry, and budgeting, with enabling areas used throughout the home. Staff told us they promoted independence and healthy choices daily.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

Outcomes were not consistently monitored or used to drive improvement. While some monitoring tools, such as nutritional risk scores, falls diaries and monthly clinical risk meetings were in place, evidence from records showed gaps in follow‑up and assurance. For example, 1 person’s health check outcome was not followed up despite an identified issue. Staff did not review trends or evaluate the effectiveness of positive behavioural support (PBS).

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

People were not always supported to consent to care and treatment in line with the Mental Capacity Act (MCA). Several MCA assessments did not follow the two‑stage test or lacked clear records of who was involved. Best‑interest decisions in relation to photographs, record‑sharing and lap‑belt use, were often only completed by staff without documented involvement of relatives or Relevant Person’s Representatives. In one instance, a person was permitted to leave unsupervised at night despite being subject to a Deprivation of Liberty Safeguards (DoLS) authorisation. Staff had not completed a corresponding robust risk assessment for this decision and community leave was not explicitly stated as an agreed condition of that person’s DoLS authorisation. Following the inspection, the provider convened a multi-disciplinary meeting and completed a more robust risk assessment for similar future decisions.Although some well‑completed MCA documents existed, and staff reported improved training and awareness, the provider did not ensure consistent, lawful decision‑making or clear records of how people’s rights were protected.