St Mary's Nursing Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Staff were kind, caring and compassionate but were not always present to meet people's needs. We observed people cared for in bed but they were not able to reach their drinks. People wanted to go outside more, both in the garden and also out on trips or out in the local community. One person told us, "Generally speaking I am happy with the care here and the food is the best thing. Areas to improve on are more staff but not just anybody."

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff were caring and that they were treated with dignity and respect. This was observed to be the case when staff were available and cared for people. There was a lack of person-centred care which meant people were not always treated as individuals. The manager recognised this and had taken action to start to review care plans and had supported staff to access additional training. A family member told us, “All the staff are good and they check on [relative]. When they get [relative] out of bed there are two of them and they come with a hoist. They are very careful with [relative]. There was some provision for activities, although this was limited and something the manager told us they wanted to improve upon and develop.

Staff knew people well and treated them with dignity and respect. Carers were kind and compassionate in their interactions with people.

Partners had identified that care and support was not always personalised to each individual and that care could be improved

We observed examples of kindness shown by staff to people. Members of staff took time to talk to service users, not just to help and leave. They called them by name, smiled and were friendly towards all of the people living in the home.

People's feedback was positive about how they were cared for and treated but observations during the inspection identified that care and support was not always personalised to each individual. One person told us, " I have done cross stitch and I have asked [member of staff] to do it but they are not interested." A relative told us, "I feel [relative] is safe because there are a lot of caring people around. Whenever we are here people are always popping in."

The manager recognised people should be treated as individuals and they were making changes and improvements to ensure care was personalised and person-centred. A member of staff told us, "People are happy and morale is good. The [nursing side of the service] can be rushed. There are lots of people who need help."

People did not always received personalised care and support and people's care needs are not always accurately reflected in their care plans. There was a standardised approach to the use of bed rails in the nursing home which was unsafe for some people. We observed limited staff engagement and involvement with some people who were cared for in bed.

Peoples care plans could be improved. Whilst they contained the necessary information, there were areas that needed improvement such as monitoring of weight and food and fluid intake. There was a standardised approach to care and support and care was not personalised to the needs of the individual. For example, people had bed rail assessments in place with the only reason given as 'Safety'. There had not been a clinical or management review of the these assessments and alternative solutions to manage people's needs had not been explored.

People told us staff were caring and that they were treated with dignity and respect. This was observed to be the case when staff were available and cared for people. There was a lack of person-centred care which meant people were not always treated as individuals. The manager recognised this and had taken action to start to review care plans and had supported staff to access additional training. One person told us, "Generally speaking I am happy with the care here and the food is the best thing. Areas to improve on are more staff but not just anybody." People told us they wanted to go outside more, both in the garden and also out on trips or out in the local community. The manager was taking steps to facilitate these requests. There was some provision for activities, although this was limited. It was an area the manager told us they wanted to improve upon and develop.

The manager understood and could demonstrate how to ensure that people had choice and control of their care and support. One person had been supported to access 1-1 support that was funded additionally. This support enabled them to go out and access the local community on a daily basis with an independent support worker.

During lunch, staff ensured everyone received their meal. People were able to feed themselves and their dignity was maintained by dignity aprons. We observed show plates being used to support and encourage people to make choices about the food they wanted to eat. Plate covers were used when food was taken to people who chose to eat in their rooms or in bed. People enjoyed the food and told us it was good quality. One person told us, "The only thing I don't like is when you have your food, they whip it away from you pretty quickly and sometimes you have not finished." Overall people treated with dignity, care and respect as individuals during lunch but it was a solitary experience for people who chose to eat in the dining room because some people were not able to eat in the dining room because of their needs.

Systems and processes in place to support people to have choice and control could be improved. Some people's care needs were not met. For example we were told that a person had refused to see the podiatrist for nailcare but there were no records that indicated whether they had been asked about or refused nailcare in their care plan and daily notes. The person informed us they wanted their toenails cutting and that they were uncomfortable and that they had raised this with staff and no action had been taken. People were involved in the discussions about what activities they wanted to do and there were some activities in place but improvement was required to further develop people's independence, choice and control. People told us they wanted to go outside more, both in the garden and also out on trips or out in the local community.

There were mixed responses to how long people had to wait for a response when using the call bell. One person told us that staff were not always responsive to their personal care needs. People and their relatives told us staff responded to them promptly when they were unwell, and records showed GPs were contacted for further advice and support. A family member told us, "Staff are approachable. They care and they understand [relative] and are good with [relative]. The staff would get a doctor [if relative needed one] and the hairdresser and chiropodist come."

Staff were aware of people's needs but did not always respond to their immediate needs in a timely manner. Staff told us that sometimes care can be rushed because lots of people need help and support.

When a person was climbing over their bedrails, members of staff had to be directed to offer support and they did not respond immediately. There were challenges to people receiving baths and bathing appropriately. There was limited access to a shower if people chose they wanted a shower rather than a bath. Hoists were used to get people into the bath. Some areas of the home operated more smoothly than others and staff had more time to spend with people. This was supported by feedback from people and their family members. People were appropriately supported during mealtimes if this was needed or requested.

Staff appeared to be happy in the workplace. The manager knew the staff team and was aware of the need for continued support and development of the staff workforce. Staff were confident to speak up if they had concerns. One member of staff told us, "If I have concerns I will talk with the management team."

There was an equality and diversity policy in place in the service. Overseas clinical staff were supported to access training to deliver care but there was a need for more effective support for staff to ensure there was an understanding of person-centred care and support.