St Catherines 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

The assessment of needs of people were gathered prior to them coming to live at St Catherines which provided a framework on which to generate care plans.

People were at risk of dehydration. A sample of fluid charts indicated some people had not had sufficient fluids during a day and there had been a gap of up to 16 hours before people were offered more to drink. People who required assistance with eating did not always get immediate and appropriate support. We observed one person struggling to eat their main meal for some time until they eventually received support. Once they had finished their main meal, the person struggled to eat their dessert with no support. One relative commented meals had been offered without specialist cutlery to aid their relation. Meals had gone cold while the person attempted to eat unaided. Risk assessments for nutrition were in place. When people were at nutritional risk, referrals to dietitians were made. Weights were recorded. One person had been assessed as having normal weight but had deteriorated to being underweight. There was no evidence any action had been taken for this person. People and their families were not always involved in their care. Events that had adversely affected people such as falls, and medication omissions had partially been recognised but no effective action was taken to prevent re-occurrence and the same people experienced further accidents and incidents.

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.

We did not receive any specific views from people or their families in relation to the assessment process. However, there was no evidence people or relatives were involved in care planning or assessments. process or their regular assessments.

The manager confirmed the assessment process included a visit from themselves or the clinical lead to meet with the person and to find more information about their needs as well as other key people involved in their lives. Where people had had their care funded by a local authority, a copy of assessment was in place. This was then translated into a care plan. Care plans were reviewed monthly by the clinical lead or other registered nurse.

Pre-admission assessments were completed by the service prior to people coming to live at St Catherines. These were undertaken by the manager or the clinical lead. While key information about the person’s needs had been recorded. There were some key areas had been omitted. For example, people’s sexuality was not included and there was little reference to the leisure/interests or social history of individuals. Assessments exclusively focused on the health or nursing needs of people as well as their capacity to make decisions. One assessment included reference to a best interest meeting had been undertaken to ensure consent from the person was gained yet another did not. Two assessments had been dated as being completed after our site visits and there did not appear to be any recorded involvement of relatives.

Care plans were up to date and included details of preferred methods of communication used by each person.

People had mixed views of the meals provided. Some were happy with them, “The food is good” while others mentioned quality of food and on occasion it was cold. One said, “Meals are spoiled by [Name] shouting because [Name] needs help and does not always get it. There aren't enough staff around to support her. Poor Activity staff Name] is usually on their own at mealtimes and it is too much for them to try and help all of us by herself. The food isn't very nice, you can tell it is cheap. The staff are mostly good, but they need to be more efficient. One relative told us their relation needed more help with eating, but the staff were providing this. Our observations at lunchtime found the person was struggling to eat their meal until more staff eventually came into the dining room. The same person continued to struggle with their dessert later with no initial assistance.

One relative commented meals were left with their relation with no interaction and it was just left with them. A recent safeguarding investigation had identified the need for this person to have specialist cutlery when eating but there was no evidence this had been implemented. One relative was assisting their relation to eat lunch. The commented “there are more staff around than usual”

We observed a clinical meeting on the first day of our visit between the Clinical Lead and the Quality Director, the manager was only present on occasions. While many cases of promoting the wellbeing of people were discussed, follow up actions did not appear to be followed through.

A sample of fluid charts for some people indicated daily hydration targets for older people were not being met in line with good practice. There were long gaps between having fluids ranging from 10 to 16 hours.

Managers audits suggested staff needed to record all fluids taken. Despite this, people still did not receive sufficient fluids and were at risk of dehydration. Fluid charts did not include a daily target needed to be met to prevent dehydration. There was no reference to best practice guidance in relation to daily fluid intake for older people.

All people had been assessed using the International Dysphagia Diet Standardisation Initiative (IDDSI). This is a global standard with terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia in all care settings. Information on this was available to catering staff and had recently been made available to care staff. Evidence based practice was used in the assessment and prevention of pressure ulcers and this was effective However, the use of evidence-based practice with prevention was ineffective. Despite assessed risks people faced; repeated falls were experienced by individuals with no emphasis on prevention

Relatives had mixed views about how the staff team worked together. Some said, “Most staff work well together but this does not apply to everyone”,” Some staff are helpful and polite and others not so”, “[Staff are], very good no concerns at all”. Relatives also said key events and the progress of their relations had not always been related to them in a timely manner. For example, a medication error resulting in the non-administration of medication was not reported to their family straight away. In turn, some relatives had requested information and “nothing seems to be done”. Another commented, “They are good at letting us know if there is a problem”.

There was evidence the staff group did not work together as an effective team. Staff views on communication and teamwork varied. Staff mentioned they felt there was a need for management to have more presence within the building and communication was not always clear from management. Other staff considered teams in each accommodation worked well, however, it was unclear how teams between the two units worked in collaboration. Other staff felt there was a need for more co-operation between day and night staff.

Partners such as commissioners were concerned that the service did not work consistently with them in the reporting of safeguarding concerns. Records confirmed that safeguarding events others and care concerns had not been consistently reported. Other agencies told us that they had experienced difficulty in getting responses to emails on occasions.

A call alarm system was in use through the building enabling people, if possible, to alert staff. We observed many examples of call alarms being activated and not responded to within a reasonable timeline. We witnessed one alarm being activated in a unit and a member of staff walking straight past the room and back again without attending to the call. There were two units within the building each with its own allocated members of staff. We did not see any collaboration between the two staff team, in responding to call alarms. Managers audits were available. Where lessons needed to be learned, for example, unwitnessed falls or occasions of non- administration of medicines, general statements such as “staff need to be more vigilant in supervising people” and “registered nurses need to ensure medication is ordered in time” were recorded. There was no evidence these necessary actions had been communicated to any of the staff team. Where the risk of dehydration of people was a possibility, a general statement on ensuring people had fluids was recorded but again there was no evidence how this had been relayed to staff and how effective this had been.

Such statements in relation to unwitnessed falls, non-administration of medicines and fluid intake had not been effective as they still repeatedly occurred.

People confirmed they were able to access a doctor when needed. Relatives were concerned despite people getting access to healthcare, omissions in medication put their relation at risk of poor health. Two relatives said,” they tell us there is now only one nurse on duty at night. [Name] was in pain with a headache and crying out and was left without medication for the entire night” and “staff are excellent, but current staffing levels are unsafe” .

Staff commented the lack of appropriate staffing placed the health and wellbeing of people at risk. Staff pointed to the lack of staffing meaning some people could only receive bathing/showering and other basic personal care only when they had time, "residents are not offered or provided with assistance to have a bath or wash, sometimes for weeks at a time." Other staff were concerned about the long-term wellbeing of people and were concerned of potential neglect.

All people were registered with the same local G.P. practice. The Doctor visited the service each week and the rest of the week involved the clinical lead and manager identifying those people who may need a consultation with the Doctor. People also had named dentists, chiropodists, and other health professionals. There was evidence of appropriate referrals to other health professionals when people’s health needs changed. Where people had experienced unexplained bruising, skin tears of unwitnessed falls, systems were not in place to adequately review these or to report them effectively. Records also indicated people were at risk of dehydration. As a result, processes did not always promote people’s health.

People told us, “The staff here treat me like a lady, actually like the Queen” and “The staff are mostly good”. Relatives’ views mixed. Some relatives were happy their relations were progressing well and were being looked after. Others were not. They told us despite raising concerns over the basic care of their relatives and were of the view “nothing changes” and people’s outcomes were not improved for a variety of reasons.

Staff repeatedly told us staffing levels meant some basic care was dependent on how many staff were available. They believed the dependency needs of people were such they could not be supported effectively given current staff levels. Where events had occurred such as the non- administration of medicines or unwitnessed falls, the management view emphasised there was a need for staff to be “more vigilant” and nurses needed to ensure the timely ordering of medicines. Despite these conclusions, these events continued to occur.

Processes were either not in place or not effective which meant outcomes for people were poor. Events such as unwitnessed falls, skin tears and unexplained bruising continued to occur. There did not appear to be a joined-up process to ensure peoples’ safety and wellbeing were effective. Peoples’ care plans did not demonstrate reviews of care had involved them as they should. Care plans were accompanied by case notes which outlined every staff intervention made. There was no evidence these had been monitored or reviewed to ensure accuracy.

People were consulted by staff on day-to-day assistance such as what they wanted to do, how staff would be assisting them and the purpose of the support. Some people were not able to give direct consent because of limitations in verbal communication. Communication assessments were in place to enable staff to determine whether consent had been given.

Staff had awareness of the Mental Capacity Act 2005 and its associated elements such as Deprivation of liberty safeguards (DoLs) and best interest decision making.

Staff were aware of how people’s lack of capacity meant other ways of gaining consent was required. The manager provided evidence to suggest most people had either received been subject to a DOLS application or have received one. There was a delay in the managing authority processing some of these applications, however, these had not been significantly delayed, apart for the case of one person.

Staff and management were aware restrictions on people needed to be lawfully applied. We did not witness any restrictions on people accessing any parts of the building did not present a risk to them.

People had their capacity to make important life decisions assessed. Where possible, direct consent had also been obtained from them. do not attempt cardiopulmonary resuscitation orders (known as DNACPRs) were in place for some individuals with a process in place to reflect their best interests. Others did not want a DNACPR order in place, and this was clearly marked for staff to refer to.

Applications for standard deprivation of liberty orders (known as DOLS) had been made to the local authority. Some had recently been done, and the manager was waiting for a response to these. One person had had an application submitted in 2020. There was no evidence this had been followed up given the long time since the application had been made and as a result, this person’s human rights were at risk of being breached.