St Martins

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• 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 assessed 6 quality statements in the effective key question and found areas of good practice within assessing people’s needs, consent to care and improving outcomes. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement. The assessment of these areas indicated areas of good practice since the last inspection therefore, our rating for the key question has changed to good. People and their relatives told us they received effective care in line with their wishes. People said they were supported by staff who were experienced and competent in assessing their needs. The provider worked with professionals such as GPs and district nurses to ensure people received timely care and care plans contained detailed guidance for staff on how to support people with recommendations made by other professionals.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives were involved in care planning and their needs were reviewed on a regular basis. Everyone we spoke with confirmed they had been included in the assessment of their needs and had spoken to staff about how they wished their care to be delivered.

Staff had contributed to care plan reviews and felt confident to raise changes and concerns about care planning to the registered manager where needed. One staff member said, “The registered manager will complete a care plan review if we feedback that needs have changed, they are very responsive.” The registered manager described how this process had been made more effective since the administration support role had been recruited to. They said, “We are able to make sure that once we have assessed people’s needs they are now recorded quickly and shared with staff. This means people get the care they need safely and quickly consistently now.”

Since our last inspection improvements had been made to care plans and assessments. A range of national assessment tools were now used consistently, to understand people’s needs and how best to support them. For example, Waterlow and Must scores to assess skin condition and nutrition risks. We saw evidence of care plans being updated and modified in line with people’s changing needs. For example, where other professionals such as district nurses or GP had made recommendations, these had been updated clearly within people’s care plans and communicated to staff effectively with handover meetings.

During the assessment we observed the lunchtime dining experience which was a social and engaging activity. People told us they enjoyed the food and menu choices available. One person said, “[Staff member] is a great cook and will always make you something different if you don’t fancy what’s on the menu.” We observed staff eating their own lunch in the dining room with people, this added to the social atmosphere but also allowed staff to offer discrete help to people who required it. For example, one person who was living with dementia required prompting to eat. As a staff member was sat at the dining table with them this was done as part of a natural conversation which proved effective in ensuring the person’s nutritional needs were met.

Staff were knowledgeable about people’s needs including their fluid and nutritional requirements and preferences. Staff had good knowledge of tools that the service used, and how they impacted the care given. For example, one staff member explained that a malnutrition risk tool identified how likely a person was to be malnourished. The care plan told staff how best to support this risk. Staff understood how to work with external health and social care providers, to provide support in the most effective way.

Since our last inspection we saw improvements in how the service recorded people’s care in line with the guidance in care plans. For example, where a person’s nutritional intake needed to be monitored this was clearly recorded on daily fluid and nutritional charts which were audited to identified gaps or changes in people’s health. We observed staff providing one to one support where appropriate in line with current guidance within people’s care plans.

People and their relatives told us they had positive experiences and outcomes from the service working alongside other professional such as GPs and District Nurses. For example, one person told us, “I had a fall recently, everyone was great and looked after me really well and I was back to normal in no time.”

The registered manager told us they had a strong relationship with local professionals such as GPs and district nurses and this had led to positive outcomes for people as they were able to approach them for advice, guidance and support. Staff we spoke with supported this, one staff member said, “I work with district nurses daily as they come in to support people, I can speak to them if I have concerns or for general advice. This helps me support people effectively rather than waiting for a GP appointment.”

We spoke with a visiting professional on the day who had been visiting the home for a number of years, they told us the improvements had been handled really well and people were benefiting from the environment.

Processes were in place to ensure people’s needs were assessed and documented prior to being admitted to the home. The registered manager worked with other professionals and ensured advice and guidance was documented within care plans which ensured people received care in line with their current needs. For example, where a person was being supported by district nurses with their diabetes, there was clear guidance within the person’s care plan for care staff to follow should the person’s blood sugar levels fall out of expected ranges.

People told us they were supported to access other services as and when required such as GPs and Dentists. One person said, “I saw the optician a couple of weeks ago, they came to the home and it was a really good service.”

Staff and managers were knowledgeable about people’s needs and supported people to communicate these needs appropriately. Staff told us they were encouraged to spend social time with people to understand their needs. One staff member said, “A lot of our residents prefer to do activities in the home and that’s fine, there is always something happening such as singing and dancing.” The registered manager described improvements they were planning on implementing going forward. “It’s important to us that we offer choice and promote healthier lives but also make this relevant to people. We are hoping to start a gardening club as a lot of people enjoy this, it will promote activity and get people out into the fresh air too.”

People were included in their care planning and their choices and wishes were clearly detailed. Where people were living with conditions such as diabetes there was guidance for staff on promoting choices in line with health requirements whilst respecting people’s right to choose. We saw evidence of people being supported to attend routine health appointments such as outpatients’ appointments and recommendations were clearly recorded within care plans.

People and their relatives told us they were supported effectively by staff and their care plan was regularly reviewed. A relative told us, “Staff are very good at keeping me informed of changes, I’m always included.” One person living at the home said, “Staff are very good, I can have a shower as often as I want, it doesn’t matter what time of day I ask staff always support me.”

Staff told us they had been supported by the registered manager with training in order to update and monitor people’s outcomes and were allowed the time to spend with people to ensure they were meeting people’s needs and wishes. One staff member said, “We now get plenty of time to write our daily notes and update records, this is so important so the night shift know how someone has been in the day and if they need extra support.”

Since our last inspection the registered manager had implemented audit processes to ensure care delivered was effective and recorded accurately. For example, the manager completed reviews of call bell response times and records like turning charts and nutritional intake to ensure people’s care was consistent and in line with their wishes.

People told us staff were respectful and sought their consent prior to assisting them were their care. One person said, “They always ask before they do anything, whether that’s helping me dress or helping me get to the dining room.”

Staff we spoke with were knowledgeable about the Mental Health Act and understood the importance of seeking consent to care. Staff were able to describe how they supported people who had varying capacity. For example, one staff member said, “Sometime if someone refuses, I have to try again later or even get another staff member to try, it’s about patients and encouragement.”

Care plans contained evidence of people’s consent to care and clear guidance for staff on how to support people to gain consent prior to delivering care or where people had varying capacity. Where people did not have capacity to consent, we saw evidence of best interest decisions being completed with relatives’ input as well as regular reviews to check the best interest decision was still meeting people’s needs.