St Georges 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 good. At this assessment 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.

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 did not always make sure people’s care and treatment was effective because they were not always ensuring assessments and reviews were identifying all changes to people’s heath and care needs.

Clinical review meetings were held daily with nursing staff and a member of the management team. These meetings were an opportunity to discuss any changes to people’s individual needs. We found they were not always identifying where referrals were needed when people’s individual health needs were changing. For example, when people were losing weight. Two health care professionals confirmed, referrals were not always being made by the service when required. They had identified this when undertaking routine reviews of the person and when concerns had been raised.

People’s care needs were assessed by the management team. At the time of the inspection, all referrals to the service were being reviewed and agreed by the management team. The registered manager and regional director confirmed this was so they could be assured they were able to meet people’s individual needs.

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

Staff recorded people’s food and fluid intakes where required. However, people’s eating and drinking care plans did not always record if their fluid intake was being monitored, or how to encourage people with their fluid intake.

We were not assured people’s food intake was being monitored to ensure they received the type of diet they wanted or required as per their eating and drinking care plan. For example, 1 person’s eating and drinking care plan recorded they preferred a vegetarian diet. However, their care notes recorded they were regularly eating fish. We raised this with the deputy manager who told us the person liked to eat fish. They confirmed they would review this person's care plan following our feedback. Another person’s care plan had conflicting information about the level of modified diet they required. People’s care notes did not specify which snacks people had eaten or if people’s meals or snacks had been fortified where needed to promote weight gain.

The service had a list of people’s dietary preferences and allergies. However, kitchen staff were not all able to tell us people’s dietary requirements, this included where people followed a modified diet.

Staff used clinical monitoring tools for people at risk in areas such as malnutrition or pressure damage. These were reviewed regularly. Where people were assessed at risk of pressure damage they had skin integrity care plans. However, these care plans did not record the required settings for people’s air mattresses.

During mealtimes, we observed people who required support to eat were supported in line with their care plans. People mainly had access to drinks within their bedrooms. However, there was a lack of drinks and snacks available to people within some communal areas.

People and their relatives were mainly positive about the meals available. Comments included, “The food is not bad at all, there is a choice” and “There is a choice, and they will make you something different.”

The provider was not always able to demonstrate how they made referrals and liaised with certain teams and services to support people. We were not always assured all possible referrals were being made when people’s individual needs had changed.

For example, the provider worked well with the dementia service and the local GP service. They confirmed referrals were made to the dementia service when required. However, we were not always assured all GP referrals were being made as required. This included when people were losing weight.

The management of the service confirmed there was an improved working relationship with the GP surgery. We received mixed feedback from health and social care professionals. One health and social care professional confirmed the service were making new referrals and they felt the management of the service and staff were liaising with them as needed. Two other health care professionals told us they had identified through reviews where referrals had been needed sooner.

The provider did not always support people to manage their health and wellbeing to reduce the future need for care and support. However, staff promoted people’s independence, choice and control.

Referrals and appointments were being made for people to have optician and dental appointments and regular visits were also made to the service from the GP surgery. However, we were not always assured all health conditions were being considered to ensure referrals were being made quickly to support people to stay healthy. For example, 2 health and social care professionals felt there was improvements needed by the service to ensure all referrals were being made when required and with sufficient information and any interim action taken by the service before making the referral.

Staff gave examples of how they promoted people’s independence. For example, where people could complete certain personal care tasks themselves, including what to wear and what to eat and drink. One member of staff told us, “We respect people’s choice.” They said this included what the person wanted to eat.

People were encouraged to remain active through being offered physical activities by the service activities co-ordinators.

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.

People’s care plans were reviewed. However, these reviews were not identifying shortfalls to people’s individual health and social care needs. This included where there were changes to people’s mobility, cognition, care and health. More information can be found within the quality statement of ‘Involving people to manage risk’.

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

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack capacity to make specific 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. The provider’s training statistics confirmed 94% of staff had received training on the MCA.

People’s care plans confirmed if the person had capacity. However, where people lacked capacity we found mental capacity and best interest documentation was not always completed for specific decisions. More information is within the quality statement of safeguarding.

We observed staff gain consent from people before supporting them with any care and support. However, 1 person who had an MCA completed confirmed they lacked capacity. On discussing this with the person’s relative they told us they had not been part of any decisions about their care and support. The provider was therefore not ensuring best interest decisions were being made on behalf of the person and in their best interests.