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 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 67 (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.

Most people moved to St Mary’s Nursing Home from hospital following assessments completed by trusted assessors. This ‘Trusted Approach’ aims to support safe and timely discharges from hospitals and reduce delays. Staff at the home reviewed these hospital‑based assessments to understand people’s needs and to determine whether they could be met before agreeing the placement. One staff member told us, “We consider (the assessments) before we agree we can meet [people’s] needs and take the placement.”

People and relatives told us this approach had been beneficial. One person said they were able to settle quickly when moving to the home and told us, “The staff are brilliant, so I don’t want to go home.” A relative told us, “The hospital chose it for [family member]. I’m happy with their choice. [Family member] likes it, they were keen to stay.” A staff member told us, “When the new resident arrives, we offer them a drink and have a chat. It helps to make them feel relaxed. It can be a big thing, moving here. We do our best to make them feel ok.”

People’s initial assessments were used to begin developing their care summaries and care plans before they moved into the home. This information was shared with staff, so they understood each person’s needs from the outset, including communication needs, medical conditions, preferences and what helped reduce anxiety. This approach supported a safe and confident transition into the home and helped staff feel prepared to meet people’s needs. We found staff had a good understanding of the needs and preferences of people who had recently moved in, including how best to reassure them when required.

People’s risk assessments and care plans were updated as their needs changed.

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

People were supported to have enough to eat and drink to prevent malnutrition or dehydration. However, systems needed strengthening to ensure nutritional risks were fully and consistently reduced for people with more complex needs, such as those requiring specific food textures or close monitoring of hydration. For example, when people did not meet their daily fluid targets, records did not show follow‑up action had been taken. In addition, individual dietary information held in the kitchen was not up to date, which could increase the risk of people not receiving food in the required texture, in line with their assessed safety needs.

However, people told us they liked the food prepared for them, and although there were limited food options for main meals, people gave examples showing how they were supported to have alternatives they preferred. People told us they had drinks when they needed them, with 1 person commenting, “I’m supplied with lots of drinks.” Relatives provided similar feedback.

Care staff understood people’s specific dietary needs and completed records of what people had eaten. A staff member told us, “The nurse tells us if there is a change. We’re told verbally at handover and then it’s put on the computer [electronic device]. That is really important to prevent a resident from choking.”

Other elements of people’s care, treatment and support was delivered in line with relevant legislation, national standards and good practice guidance. These included a range of risk assessments and health management tools to predict people’s risk of developing pressure ulcers, and malnutrition universal screening tools. These were reviewed regularly. Staff also used recognised tools to identify, score, and respond to people’s clinical deterioration.

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.

Most relatives described effective working between staff and other health professionals. A relative said, “[Person’s name] sees a doctor every week. They watch their skin, it’s a big [concern].” A health and social care professional told us, “Staff communicate promptly and appropriately, which helps to ensure that we work effectively together.” This helped make sure people received the care they wanted at the time they wanted. Another health and social care professional said staff were regularly willing to provide care to people with complex needs, and who were often anxious. The health professional explained they, staff and families worked together and told us, “They do take them and seem to be able to provide the care. Families do tend to give positive feedback, and people in the past have opted to stay.”

Staff spoke positively about their working relationship and communication between the nurses and senior care staff. One staff member told us, “If things change, we are told at handover. There is a handover every day. Care staff don’t always attend but the seniors do and they share the information.” During the inspection we saw staff worked collaboratively as an effective team when caring for people. However, some staff told us they did not always feel communication with the management team worked as well as it could. The registered manager recognised this was an area for improvement and had started to implement processes to improve communication.

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.

A person told us they valued the gentle exercise activities provided by staff, which helped them to maintain their mobility and independence. Relatives told us they were kept informed about any events or changes in their family member’s health and felt confident staff sought professional input whenever it was needed.

Staff understood the importance of supporting people to enjoy the best health possible. Where appropriate, staff sought specialist advice from other health and social care professionals, so people would remain as well as possible. Advice from professionals was incorporated into people’s care plans.

Health and social care professionals confirmed staff took appropriate and timely action to support people’s health. A health and social care professional told us, “The staff at St Mary’s make appropriate and timely referrals to [us], knowing when to approach us for routine matters that can be discussed at planned [visits], and when a more urgent response is required.” This approach helped to ensure people’s health was promoted. A health professional said, “I regularly see care staff encouraging activities that are good for people’s mental health, and also see people being supported to eat food and encouraged to make healthier choices.”

Records demonstrated people’s health was regularly monitored and, where required, people had the access to the healthcare services they needed to maintain good health. A staff member said, “After the doctor has been if we need to do something, or keep a look out for something, the seniors will tell us. The nurses add it all to the [electronic device]. It’s there so you can see it and so you can check.”

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.

People were supported to monitor key aspects of their health. Staff assisted people by checking for any signs of deterioration, using recognised tools, such as national early warning scores. Staff gave us examples showing how they had appropriately escalated any concerns across teams and to external health and social care professionals, so people would get the help they wanted. A staff member said, “If we think a resident isn’t well, like they are not eating or we saw a rash, we would report it to the nurse. They always come and check and will get the doctor to come out.”

People’s weight and skin integrity was also regularly checked. Where people required support to manage their skin health through repositioning, staff followed care plans and records showed us people were being repositioned as assessed and planned. However, some people were set fluid targets where these did not need monitoring. The registered manager said they would review their approach to monitoring all people’s fluid intake, and the accuracy of fluid monitoring.

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

People who were unable to make specific decisions for themselves were supported through best‑interest decision‑making, carried out in partnership with family members and health and social care professionals. These included decisions relating to end‑of‑life care and the covert administration of medicines. However, best‑interest processes had not been followed in relation to the introduction of CCTV within the home. The registered manager acknowledged this and assured us this would be reviewed and addressed promptly.

However, staff understood the importance of gaining people’s consent before caring for them. One staff member told us “I always explain why I am there and what I am there to do. If the resident isn’t comfortable with me helping them, I leave and then go back and try again.” Another staff member told us if people could not communicate their agreement to care verbally, “I look for their response to me. I look for their facial expression or the way they are reacting. You learn about the residents so you can tell.”

Staff had received training in the Mental Capacity Act 2005 (MCA) and worked in the least restrictive way, acting in people’s best interests when required. They applied the principles of the MCA, which provides the legal framework for making decisions on behalf of people who may lack capacity.

Staff knew when people had representatives with legal authority to make certain decisions on their behalf, and relatives told us this was respected. Where people did not have relatives to act on their behalf, advocates had been appointed and staff worked with them to make decisions in people’s best interests.

People who were unable to make specific decisions for themselves were supported through best‑interest decision‑making, carried out in partnership with family members and health and social care professionals. These included decisions relating to end‑of‑life care and the covert administration of medicines. However, best‑interest processes had not been followed in relation to the introduction of CCTV within the home. The registered manager acknowledged this and assured us this would be reviewed and addressed promptly.