Mapleford Nursing 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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. People’s oral care needs were not being met and staff told us mealtimes were often rushed due to low staffing levels. Records did not always evidence when referrals to other services were made and monitoring tools were not always accurate. People’s needs were assessed prior to their admission to the service and consent was always sought before any personal care interventions. The service was in breach of legal regulation in relation to how people were not supported in a person-centred way.

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.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Care plans held a record of people’s dietary requirements. For those who had a specialised diet such as pureed meals and thickened fluids, there was a log in the kitchen to guide staff. We saw evidence of referrals being made when people were losing weight and for those who were at risk of choking. Food and fluid charts were in place for those who required this. Staff told us they were aware of people’s dietary requirements. One staff member said, “We have handovers twice a day. People’s dietary needs are included in handovers.” Relatives praised the meals on offer describing them as ‘nutritious, well-presented and a good amount of choice.’

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Care plans held a record of people’s dietary requirements. For those who had a specialised diet such as pureed meals and thickened fluids, there was a log in the kitchen to guide staff. We saw evidence of referrals being made when people were losing weight and for those who were at risk of choking. Food and fluid charts were in place for those who required this. Staff told us they were aware of people’s dietary requirements. One staff member said, “We have handovers twice a day. People’s dietary needs are included in handovers.” Relatives praised the meals on offer describing them as ‘nutritious, well-presented and a good amount of choice.’

The service mostly worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. However, some referrals that were being made required more detail. This made it difficult to know what services people had been referred to. This was rectified during the assessment process. Most staff told us they worked well together as a team and were kept informed of any changes to people using the service. However, some concerns were raised by staff about the lack of support from senior members of staff during busier periods and that the culture between team members was not always positive. Information recorded on handover records was detailed and included important information about people as well as staff allocation for the day. Partners told us the service acted promptly when concerns were found, and referrals needed to be made to their services. Relatives told us they were involved in the referral process and said staff always let them know about any healthcare appointments.

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. There was a lack of promotion of good oral care practices and many bedrooms we entered did not have a toothbrush or toothpaste. Care records did not always reflect people were being supported with oral hygiene. Therefore, we could not be assured people’s oral care needs were attended to. There was a varied menu which was displayed on communication boards. However, staff told us mealtimes were rushed due to staffing levels. One staff member said, “There is not always enough staff (at mealtimes).” We also found gaps in the recording of food and fluids. Following on from the assessment, the registered manager assigned an oral healthcare champion and created an audit to monitor this. Records relating to people’s specific health conditions were in place such as diabetes which would be used to guide staff should the persons condition deteriorate. Staff told us they knew what to do should someone become unwell and the registered manager told us they use a diary to communicate any medical appointments and outcomes. Relatives felt confident in the staffs ability to seek medical advice should this be needed and told us staff encouraged their loved ones to eat and drink well.

The service did not always accurately monitor people’s care and treatment to continuously improve it. Tools were in place for monitoring outcomes, however, some of these tools were not always accurate. One person had a skin care risk assessment in place, but it had been calculated incorrectly which meant they were at higher risk of skin breakdown then the records evidenced. Another person’s falls risk assessment was not accurate, again this meant they could have been classed as higher risk of falls and measures may have been put in place to prevent future occurrence. Behaviour charts were not always completed to show an accurate picture of when incidents occurred, events that led up to the incident and the outcome for the person. This meant trends and themes could not be identified to help monitor future risks.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. At the last assessment we had concerns in this area as not everyone had a consent form in place. This was rectified at this assessment and consent to care forms were in place and had been signed by the person or their relative. DoLS paperwork evidenced conditions were being met and we saw evidence of capacity assessments and best interest decisions which included relatives and relevant healthcare professionals. Staff told us what they would do should someone refuse care and treatment and spoke about the importance of gaining consent before personal care interventions. Relatives told us their loved ones were offered a choice.