St Mary's Court

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

We identified 1 breach of the legal regulations. The provider had not always considered or documented people’s capacity to consent in line with the Mental Capacity Act 2005. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. People were not always involved in planning and reviewing their care. The provider’s processes for monitoring people’s nutrition and hydration were not robust and people’s preferences for their meals and drinks were not always met. The service had not always communicated effectively with others to promote people’s wellbeing and ensure people achieved good outcomes. However, people's health needs were reviewed and appropriate input was sought from other health professionals when required.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's needs were assessed; however, these assessments were not always detailed or up to date. It was not always clear how much people or those important to them had been involved in assessing and reviewing care. People's environment had not always been adequately assessed by the provider. For example, where people were living with dementia, the provider had not considered how to make the environment more easy to navigate or interesting to interact with.

Staff completed a review of people's care needs on a monthly basis as part of their 'Resident of the day' programme. However, we found inconsistencies in people's care plans which had not been identified during these reviews. The provider told us they were making changes to this process to ensure a more in depth review was completed with greater involvement from people and relatives. The provider told us they completed an initial assessment of people’s needs before they came to live in the service. Staff confirmed they knew how to access information about people's care and support needs.

The provider's processes for assessing and reviewing people's care and support needs were not always robust. People's care plans contained an initial assessment of their needs which considered their protected characteristics and an overview of their support needs. However, this information lacked detail and was not always consistent or up to date. People's assessments did not provide enough personalised information about what was important to them or how their support should be delivered in line with their individual preferences.

People's involvement in planning their care and treatment was not always clear from their care plans. This meant it was not always apparent how well their care reflected what was important to them. We received mixed feedback about the quality and variety of meals and snacks available at the service. Concerns were also raised with the presentation and temperature of the food served. Comments included, "They put the main meal on the same plate as the pudding, like roasts with apple pie on the same plate" and "Meals are hit and miss. Many meals are served cold and go to waste". During our assessment, we found people were not always offered a variety of snacks and there was a lack of fresh fruit available for people to choose from. People and relatives told us there had been issues with drinks not being readily available for people in their bedrooms. Although, this had improved in recent weeks. Comments included, "I do get thirsty here sometimes but that's got better recently" and "Sometimes there's no [water] jug in here, other times there no beaker.”

The provider told us they monitored how people's care and treatment was being delivered through their monthly care plan review and by seeking feedback from people and those important to them. However, they confirmed improvements were needed to ensure this process worked effectively. Staff told us updates were shared with them and they were able to discuss people's care during their daily and monthly staff meetings. Following our feedback around the quality and variety of meals and snacks in the service, the provider told us they would gather feedback from people in order to identify the issues and implement a plan of improvements.

The provider had processes in place to monitor people’s nutritional and hydration needs. However, we found these processes were not robust in identifying concerns. For example, food and fluid charts had not always been accurately completed and the provider had not identified the concerns we found with the quality, variety and availability of meals, drinks and snacks. The provider had systems in place to share up-to-date information about legislation, standards, and good practice guidance with staff. Examples of good practice, lessons learnt and policy updates were shared with staff via meetings and internal bulletins.

People had information about their support needs in their care plans. However, as this was not always detailed or up to date, there was a risk accurate information about their physical health needs and support preferences may not always be in place and ready to share across services to enable people to receive consistent care.

Staff and leaders understood the importance of sharing information across services when appropriate to ensure people received consistent care. The provider was able to evidence how they had shared information between health and social care professionals when required. The provider understood the importance of ensuring an accurate overview of people's current needs was documented. At the time of the assessment, they were in the process of working through an action plan which included fully updating people's care plans and risk assessments to ensure information was accurate and up to date.

We received mixed feedback about how effectively the provider worked with other health professionals to ensure people's needs were met. Concerns were raised about how the recent number of changes in management and staffing had affected the quality and consistency of communication and how promptly information relating to people's health care needs was received.

The provider had processes in place to ensure they worked together with other services to support people's needs. However, these processes were not always robust as information relating to people's needs required improvement in the level of detail, personalisation and consistency recorded. Changes within the service's management and staffing had impacted on communication across services used by people. However, this was now improving, with a more settled management structure and consistent staffing in place.

People's health needs were reviewed, and appropriate input was sought from other health professionals when required. Comments included, "The GP sees me and I do feel a lot better now", "[Person] has definitely got better since being here", "[Person] has improved dramatically and has become more motivated to care for themselves" and "I have seen consistent monitoring and a quick reaction to any concern identified. For example, they have told me today [person] has been seen by a doctor and prescribed antibiotics."

Staff supported people to attend their health appointments and reviews and understood the importance of promoting people's health and wellbeing. The provider made referrals to healthcare professionals when necessary and shared updates and feedback with staff to support people's changing healthcare needs.

The provider had processes in place to ensure referrals were made when necessary and health appointments were attended. People's care plans contained information about their healthcare needs and the health professionals involved in their care. However, the provider's processes for ensuring care plans were updated following changes in people's health needs were not always robust. We found changes were not always transferred into the relevant sections of the care plan to ensure information was up to date.

People's care was not always effectively monitored to ensure they achieved good outcomes. Daily charts and records were not always completed appropriately. This meant there was a risk concerns which may impact on people's outcomes were not identified promptly. People's changing needs were not always accurately documented and some relatives expressed concerns about how well staff understood people's needs. People's care plans did not always contain detailed information about any personalised or meaningful outcomes they wanted to achieve.

Staff were able to explain how they monitored people’s care and what they did if they had any concerns. However, we found people’s daily care records were not always fully completed or up to date. The provider told us they were continuing to pick up concerns with document completion in the daily meetings with staff to ensure improvements in people’s care monitoring. The provider confirmed they were making improvements to the care planning process to ensure outcomes were more clearly recorded and reviewed.

The provider's processes for monitoring and improving people's outcomes were not always robust. People’s care documentation did not always evidence how people’s care was being reviewed and improved. The provider was in the process of implementing changes to their processes at the time of the assessment and told us the planned improvements to care records would ensure more accurate information was recorded and enable more in depth reviews with the person and those important to them to promote good outcomes.

People’s consent to care and treatment had not always been documented in their care plans. This meant it was not clear how they had been involved in making decisions about how they wanted their care to be provided. People did not have mental capacity assessments in place for every relevant decision and this meant staff may not have accurate information about what decisions people were able to make for themselves and where they required support. The provider had not submitted updated Deprivation of Liberty Safeguards (DoLS) applications when required. This meant information relating to how and why people were being deprived of their liberty may not be accurate or appropriate.

Staff told us they had received training in understanding the Mental Capacity Act [MCA] and understood people's right to make their own choices and how to escalate any concerns. One member of staff told us, "Every adult, whatever their disability, has the right to make their own decisions wherever possible. I should always assume that they have capacity all the time and I should support them to make their own decisions and keep encouraging them to do as much as possible." At the time of the assessment, the new interim manager had only recently come into the service. They told us they were in the process of reviewing and updating people's mental capacity assessments and were resubmitting all DoLS applications as a priority.

The provider's processes for assessing and documenting people's consent to care were not effective. Information was out of date or incomplete. The new management team were aware of these concerns and were in the process of addressing these at the time of the assessment. The provider had policies in place to support staff in understanding MCA and DoLS legislation and staff were supported to attend relevant training to underpin their knowledge and working practices.