Mapleford 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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service 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.

Care records were on an electronic systems. These generally reflected people’s individual needs and how to support them. However, some of these contained conflicting information and at times were difficult to follow. Further information was seen in paper records in the office. We discussed this with the registered manager and senior team. They told us the electronic system was in the process of being updated to include all information about people and to ensure records were detailed and person centred. Following this they provided assurance that this task had been completed and all care records had been reviewed.

There was evidence that people and others were involved in the development of care records, but not all demonstrated people had been involved in their reviews. However, most relatives we spoke with were aware of their relative’s care plan and had been asked to review it and were involved in the planning and making decisions on care. One said, “I have seen the care plan and I have reviewed it.”

Staff told us care records contained information about supporting people’s needs and these were updated as their needs changed. Comments included, “The nurses write and review care plans” and, “Information about people is on the electronic (care record) system the records are updated every month or if things change. We let the staff know of any changes.”

The service mostly planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Care records contained information about how to support people’s individual meal requirements. We saw people being offered meals in alternative consistencies but 1 person was provided with a consistency that was not in line with their record. Whilst no harm occurred the registered manager told us they would take action to ensure all staff supported people in line with their assessed needs.

We observed the mealtime experience in all of the units at the service. Staff were noted to be wearing PPE as required. Whilst some people were supported by an engaging staff presence with positive interactions, this was not the case for all. A staff member was observed supporting 2 people at the same time with their meal where one of these was at risk of choking. Whilst no harm occurred the registered manager provided assurance about the actions they would take to ensure people received appropriate and timely support with the meals.

People told us they were enjoying the food provided during our observations. No relatives raised concerns in relation to people’s diet and meals provided. One said, “They bring [person] meals into the lounge and help them to eat. They have a soft diet, because [person] has been struggling to swallow, they had a swallowing assessment.” Feedback in surveys was positive about the meals offered in the service.

Menus were on display in the entrance to the service and the kitchen and the menu of the day was on display in each unit and drinks were available to people throughout the day. The kitchen was clean and tidy with supplies of food available, staff told us people had choices of meals and if the menu of the day was not to their liking they would be able to have what they wished. Kitchen staff told us there was, “Enough supplies, the chef orders things there are no restrictions on budgets.”

The service 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. Records included information that demonstrated a range of professionals had been involved in supporting people’s care and needs.

Relatives told us that professionals were involved in people’s care and referrals were made by the service as needed. They said people were supported to attend medical appointments as required. Comments included, “Care and treatment decisions are discussed with the GP and mental health services” and, “I have met with the doctor, the social worker keeps in touch and mental health (team) come back and assess.”

Most professionals were positive about their experiences with the service. Comments included, “They proactively approach our team for support in areas where they feel it is needed” and, “[Staff member] has also kept me informed throughout.” We saw professionals visiting during our site visit. However, another professional discussed a concern in relation to the management of interaction between them in the service. The registered manager told us they would undertake an immediate investigation and take action on the findings.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Feedback from relatives was that people were able to access professional support and advice as needed and they were supported with their health needs and choices. They said, “The [health professional] are still coming to [person] once a week and the staff continue the (treatment) with them in between”, “[Person] has had (medical treatment), a carer (staff member) will go with him” and, “We were involved in planning and making decisions on care.”

Partners told us staff engaged with them for supporting people’s health care needs. One said, “I noticed they kept everything documented and up to date. If they (the staff) requested something, they are able to evidence why and are easy to communicate with.”

Handover records were completed to ensure staff had access to information and updates about people for each of the shifts. These included updates in relation to people’s health. Staff told us, “They have a handover for each shift for all staff, everyone knows what is happening and is up to date.”

The service 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 access medical and health professional’s as they required. Staff were positive about the relationships between the service and partners. There was evidence in care records that others had been consulted at some point in regards to their care planning, in particular ongoing medical support and support from other professionals.

Information and guidance was on display in the entrance in relation to support with health needs such as antibiotic guidance as well as activities to support physical improvements for people such as exercise events.

Daily records, charts and checks were completed. There was some evidence of ABC (behaviour) charts being completed that recorded where people were displaying increasing behaviours. However, we discussed with the registered manager these required more detail to demonstrate the actions taken to manage future risks safely.

People were seen to have access to toothbrushes and toothpaste to support their oral care needs. The registered manager told us they had introduced a dedicated staff member to check all people have the equipment they needed to support their oral care needs. Care records included information about managing people’s oral care needs, policy and guidance was in place and up to date to support this.

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

Not all electronic records for people contained up to date information about DoLS and how to ensure their rights were protected. However, this was included in the paper records for people, where this was relevant. The registered manager took immediate action to demonstrate how they would ensure all up to date information was included in the electronic records that ensured all staff had access to the information. Where DoLS applications had been submitted a matrix was in place that demonstrated these were being monitored. Policy and guidance was in place and up to date. This included easy read information in relation to DoLS to support people with alternative ways of communicating. There was some evidence of people or representatives signing consent forms in the records we reviewed but this was not in all of them.

The registered manager told us, “If someone has capacity, they will always get consent if they don’t have capacity we would undertake a mental capacity assessment and we would have a multidisciplinary meeting to discuss.” While staff told us about the importance of asking for and seeking consent from people before undertaking an activity or task, not all understood MCA and DoLS. The training matrix showed staff had undertaken training in this subject, but we discussed the importance of ensuring all staff had the knowledge and skills to protect people from unlawful restrictions with the registered manager.

We observed staff asking permission from people before undertaking a task or activity and knocking on doors before entering bedrooms and bathrooms. Relatives told us, “Carers always sought permission before offering assistance” and, “They give [person] choice.”