Maidstone Care Centre

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 found that the service continued to Require Improvement in relation to the Effective domain. We identified a breach of the legal regulation in relation to consent. People’s rights had not always been protected in line with the principles of the Mental Capacity Act 2005 and best practice guidance which impacted on the services ability to demonstrate they delivered evidence-based care to all people at all times. People’s needs had not always been fully assessed and there continued not to be enough guidance in place to support staff to meet people’s needs in a personalised way. This impacted on the service’s ability to demonstrate they supported people to live healthier lives. We received mixed feedback from people, relatives, and professionals about the effectiveness of the service delivered to meet people’s needs. Staff worked well together across the service.

This service scored 58 (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 they did not know whether they had care plans in place for their needs. We received mixed feedback from relatives, some told us they were aware of care plans and had been involved in updates, others did not feel involved in assessing and discussing their loved ones needs.

Staff told us that people's needs were assessed and recorded in their care plans. Staff told us they asked the nurse to assess people when they felt there had been changes in a person’s presentation. Staff told us they continually assessed people’s needs. For example, certain needs such as nutrition and hydration had prompts in their handheld devices to ensure staff continually assessed and recorded whether people's needs had been met.

Care records for people showed there were systems and processes in place to continually assess people's needs. However, people’s care records contained varying levels of detail to help guide and support staff in how to meet people’s assessed needs. Reviews of people's care records were not always completed effectively to ensure care plans contained consistent and up to date information for staff to follow. Some staff had been at the service for only a few months and the service used agency staff who may not know people well without guidance in place.

People gave mixed feedback about their experience of how their nutrition and hydration needs were met. A person said, “I am warm, well fed, I'm not fussy. I can have drinks when I want. I can do things for myself. The food is homemade, especially the cakes. There is a choice of main course.” Whereas another person said, “There is a limited choice of food here.” Where people required additional or specific support to meet their nutrition and hydration needs, we saw this was supported. A person told us they received a pureed diet in line with their needs and The International Dysphagia Diet Standardisation Initiative (IDDSI) framework which gives guidance on modifying food and fluid to support people with swallowing difficulties.

Staff told us they delivered care in line with people's care plans to ensure people received evidence-based care and treatment. For example, staff told us they followed the IDDSI framework to ensure people with particular swallowing needs received their nutritional intake in a safe manner. A staff member said, “I would say we need to encourage residents to drink enough fluids. Sometimes we are busy that we don’t do this often enough to ensure residents are having plenty of fluids. There are people who don’t have the capacity, so we need to encourage them or assist them to drink.”

Although the service followed some national guidance such as IDDSI, other evidence-based care and treatment required improvement such as following guidance on medicines management of people’s health conditions and application of the principles of the Mental Capacity Act. Care records demonstrated the service worked in partnership with other services to ensure people received evidence-based care and treatment. For example, the serviced worked with the incontinence team to ensure a person’s needs were being met in the most appropriate and effective manner.

Feedback from people and their relatives was positive. A person commented that staff seemed to like their jobs. A relative told us the service worked with relevant other services to meet the needs of their loved one.

Staff told us they worked well together. A staff member said, “I find it good working as part of a team because whenever you have too much on, your colleagues can step in to offer support.”

We received mixed feedback from professionals who worked with the service. A professional said, ‘We find due to pressures upon the care staff that when we attend to assess a patient this assessment is primarily conducted by ourselves on our own. At times staff have been completely overloaded such that we have not being able to feedback to trained staff within a reasonable timeframe… there can be delays in obtaining information from nursing staff (bowel, fluid, medication) charts.’

There were systems and processes in place to support staff teams and services to work together. There were daily handover and ‘flash’ meetings held with the staff working on shift. Each floor also had a diary. These processes allowed staff to communicate to support them to deliver joined up, co-ordinated care. However, we found that these processes were not always used effectively as not all required information was recorded and required actions were not always completed.

People told us the service supported them to maintain a healthy life. A person gave an example about when they had a chest infection and staff contacted the GP who prescribed them antibiotics. Another person said, “If I have a toothache, they give me a Paracetamol.” Some people's relatives gave mixed feedback about the staff delivering evidence-based care. A relative said, “I think they 100% know [loved ones] basic needs but the important things like [their] diagnosis of vascular dementia they don't seem to know, I think that's something they should know by now.” Another relative gave feedback that the staff did not have a good understanding of their loved ones specific condition and how this impacted their care. However, a relative said, “I think they are aware of [loved ones] needs; they know what [their] health needs are and look after [them] And I am quite confident that they manage it well.”

Staff felt they took appropriate action to maintain people's health such as ensuring people had enough food to eat and enough to drink. A staff member commented that the service used to have daily exercise classes to help people stay active and healthy however they told us the service did not do this anymore.

There were systems and processes in place to guide staff on how to support people to live healthier lives. For example, people's care plans contained medical needs that they had with a description of the conditions. However, systems and processes were not always effectively operated to ensure all relevant details about how to care for people’s individual symptoms and conditions were recorded.

Relatives gave examples of times when their loved ones had been unwell or their abilities had deteriorated, they told us staff had supported their loved ones to improve. For example, a relative told us their loved one had been so poorly they could not stand but now they were walking, and staff had encouraged them to do that.

Staff told us they monitored people to ensure their needs were met. Staff gave examples of monitoring people's skin integrity and the care they provided to ensure people’s skin remained intact such as repositioning people, using pressure relieving equipment and applying cream.

Although there were systems and processes in place to monitor whether people's needs were being met these were not consistently followed by staff. For example, processes in place to ensure people received their required fluid intake continued not to be operated effectively and oversight of people’s fluid intake was not consistently maintained. Some other monitoring records were sporadically recorded as completed such as daily checks of people’s equipment and their schedules welfare checks. This meant the provider could not maintain effective oversight of whether people’s needs were consistently being met and they were achieving good outcomes.

The last survey results for Maidstone Care Centre showed the majority of people felt they were given some choice and staff sought their consent about their care and treatment. However, a quarter of people who responded disagreed that they were given choice and asked for consent. During our assessment, most people told us staff sought their consent before entering their rooms to deliver care. A person told us staff just walked into their room.

Staff were aware of the importance of speaking with people before providing care. A staff member said, “You're not supposed to impose things, you are meant to listen to their preference.”

People’s rights were not always advocated for and upheld in line with the Mental Capacity Act 2005. Some people whose care plans recorded they lacked capacity to make decisions did not have capacity assessments completed to determine if they did lack capacity to make specific decisions. Other people did have some mental capacity assessments in place; however, these lacked the detail to evidence how the decision was made in relation to mental capacity or how decisions were made in their best interests where they were determined to lack capacity. For example, a person’s best interest decision only had 1 staff member recorded as being involved in making the decisions. There was no evidence others had been involved, such as relatives who knew the person well. Some people had a gate attached to the doorway of their room and some of those people were recorded as lacking capacity in other areas of their care records. Not all people who had a gate across their doorway had a mental capacity assessment in relation to this gate and it was not recorded for all people whether they were able to open their gate independently. This placed people at risk of having their freedom of movement restricted. We were not assured people were given the time and the opportunity to fully take part in their mental capacity assessments. For example, 4 separate mental capacity assessments for different decisions for 1 person had been completed at exactly the same time on the same date.