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 the last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We found the provider was in breach of the legal regulation relating to person-centred care, and the skills of the registered manager.

This service scored 46 (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 and registered manager did not always make sure people’s care and treatment was effective. Care records had been solely based on providing support for people with physical health needs. They did not provide any relevant information about how to support people when their needs related to their dementia, mental health, learning disability or autism. Staff told us the care record templates in place had not been changed or reviewed for over 10 years. This led to staff not having the tools to assist them to identify how people’s learning disability or autism impacted them, how to support people with dementia, any relapse triggers, or how people with mental health needs presented when they were well and unwell. The provider immediately employed an external consultant to assist the registered manager develop care records.

The registered manager and staff were unaware of best guidance for people working with individuals who have a learning disability or autism. All the documents the registered manager supplied showed a lack of understanding and knowledge about delivering a specialist service. Staff followed practices which did not provide individualised support, for example, drinks trolleys and meals were provided at set times. Activities were organised in groups and staff would only spend 1:1 time with people when routine tasks had been completed such as serving drinks and attending to personal care needs. The service had not been designed to provide individualised support or enable people to lead meaningful goal-orientated lives. We found staff were not following best practice guidance around supporting younger people to lead ordinary lives.

Staff worked well with other professionals and services to support people. Staff worked closely with other agencies and professionals such as community nurses and GPs to ensure people received appropriate support. A professional said, “We have a very good working relationship with the staff and they always let us know if there are any changes.” The registered manager facilitated a weekly ward round and invited all relevant professionals. During the inspection they included staff from the community learning disability team. The registered manager had not considered if the model being used remained appropriate now the service predominantly support working age adults and people with a learning disability or autism.

Staff did not always support people to maximise their independence, choice and control. Staff had a lack of awareness of how to work with people’s whose main presenting need was a learning disability or autism. For example, an autistic person spent most of their time in the upstairs lounge/diner moving from chair to chair with no respite from the high levels of noise and activity. They demonstrated stimming behaviours which are associated with feeling overwhelmed and attempts to reduce sensory input. The care records made no mention of any of these behaviours and therefore provided no information on how to support the person to manage them or what they meant.Following the inspection the provider sent us information to show what action they were taking to improve the care records and staff practices.

People who had mental health conditions and physical health needs reported they had found the service met their needs. During the inspection the provider installed a domestic kitchen and laundry, which people were looking forward to using and felt would help them learn skills. A person said, “Have you seen the new kitchen they are putting in. It’s great and I can’t wait to use it.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Staff were not providing individualised, tailored support, which enabled people to go about their life like any other member of the community. We observed people whose presenting need related to their learning disability or autism spent most of their day in their bedrooms, walking the corridors and sitting in the communal lounges watching programmes 1 person or staff had picked. Albeit activities such as making overnight oats were run; this was on a group basis and during the day. The activities were treated as something to break the day up rather than a meaningful exercise to assist an individual develop skills needed to enable them to live more independently. People who could not go out independently told us they had become accustomed to spending time in their rooms or sitting in communal areas with little purpose to their day. We found the model of care in place did not provide specialised support for people with a learning disability or autism. Following the inspection the provider sent information to show the range of individualised activities being undertaken and improvements being made to the service.

Staff did not always tell people about their rights around consent or respect these when delivering care and treatment. Capacity assessments and ‘best interests’ decisions were in place, which were completed with external professionals, relatives and advocates. But these had only covered the need for a DoLS and not wider range of decisions such as only going out with staff, management of monies, access to cigarettes and healthcare decisions. People were unclear why restrictions had been imposed upon them such as having limited access to monies and the reason for this had not been recorded. When people appealed their DoLS staff had not taken steps to determine whether they were able to live more independently so could provide no evidence to the Court of Protection to assist them decide whether the DoLS should be upheld or not. The provider and registered manager immediately started to address these shortfalls.