St Mary's 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 the last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant people’s needs were not always met.

We found the provider was in breach of the legal regulation relating to person-centred care and good governance.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not make sure everyone was at the centre of their care and treatment. They did not work in partnership with people, to decide how to respond to any relevant changes in their needs. Despite the increase in staffing levels and a shift to providing people with more opportunities for learning new skills, people were predominantly expected to join group activities. There is little appreciation that people should be supported in an individualised manner to develop daily living skills, engage in meaningful activity that are relevant to them and feel a part of the community. Following this being raised the registered manager took action and the more independent adults started to be encouraged to look at more outcome-focused goals but not the people whose needs were related to their learning disability or autism. The provider worked with an external consultant to start to alter care records so they were more appropriate for a specialist service but these still needed to become more person-centred.

Staff understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. A visiting professional said, “Staff understand people’s needs and are good at working with individuals who have complex needs. They have successfully supported people to work with us and take action to ensure their physical health needs are met.”

Staff did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Information was available in a variety of formats and way people could understand. For people who had limited verbal communication skills there was no information in care records to show how staff were to gain their views and converse. There were no communication aids in use such as Picture Exchange Communication System (PECS) or talking mats. Staff had not received any training around communicating with people who had limited verbal skills.

Staff did not always involve people in decisions about their care or tell them what had changed as a result. Some people did not have active involvement with their families, but they had not been supported to access the services of independent advocacy. We saw no information about independent advocacy support on display. Advocacy services had been used when staff applied for DoLS but they were not routinely involved in supporting people make decisions about their wishes and aspirations for the future. Anumber of people had limited or no verbal communication skills but there was no information to show how staff were to gain their views.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. No data is collected about how people are progressing/struggling with the activities they are involved in, enjoying their hobbies and interests, working towards developing their daily living skills and achieving goals. There were no support plans in place to record these areas of care, as staff had not recognised this as an area to focus on. For example, 1 person was challenging their DoLS and the restrictions imposed on them. They wanted to demonstrate they could lead an independent life and go out without staff however no risk assessments had been completed around their road safety and vulnerability in the community and no support plans were in place to guide staff on how they could work with the person to achieve these goals.Following the inspection the provider submitted information to show improvements were being made to the records. People were now being encouraged to develop their independent living skills, including enrolling in college courses.

Staff and 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. The registered manager did not appreciate that people should be supported to develop more independent living skills, engage in meaningful activity that is relevant to them and feel a part of the community. Staff were not supporting people’s autonomy, independence and involvement in the community. We found 1:1 support had not been provided for individuals who have significant needs due to their limited communication needs, physical disabilities and learning disabilities. They were not experiencing equity in the support they received.

People were always not supported to plan for important life changes, so they could have enough time to make informed decisions about their future. People had not been encouraged to consider their goals and aspirations for the future. When appropriate people were supported to plan for the end of their life. The model of care operated at the service had been based on thinking people would want to always remain there and never think about moving on. Thus, the provider and staff had not considered how to support people develop their independent living skills or develop goal-orientated plans for their stay at the service. Following the inspection the provider sent evidence of action they are now taking to design a service on the principles of enablement. For example, they had developed activity and goal plans, which covered areas such as education, employment and skills development.