St Audrey's

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 provider had not monitored the service effectively to ensure people had positive outcomes; staff had not recognised the impact of the lack of activity and social interaction on people’s quality of life. The provider’s processes for monitoring people’s nutrition and hydration were not robust. The service had not always worked well with other professionals and ensured people were supported to access other services. The provider had not ensured people’s mental capacity assessments (MCA) demonstrated if/how they were involved and supported with the decision.

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.

People’s needs were assessed when they were admitted to the service. These assessments did not all show evidence of involvement of people or those close to them. Families we spoke with told us they had not been involved with ongoing care planning. A relative said, “If I was in the care review chat, we could review some things.”

The provider acknowledged their initial assessment process required improvement. They had recently reviewed the form to include more detail and would review referrals with the new manager until they were familiar with the process.

The provider's assessment of people's care and support needs were not always robust. These assessments were used to develop care plans which included their protected characteristics and an overview of their support needs. However, these sometimes lacked detail beyond what was stated on the initial assessment and indications of potential areas of risk were not always explored. For example, it was not identified a person at risk of pressure injury may benefit from a skin integrity risk assessment.

People did not always receive support to ensure they ate and drank enough. A relative told us, “I go in and, on the table, they have 2 beakers of juice and breakfast. [Person] does not really have the strength or coordination to do it. They assessed [person] and still seemed to think [they] had capacity for drinking and eating. When they come around, they are trying but there is 2 beakers and a tea and most of the breakfast there [person] is obviously not taking enough in.” During our visit we found people were not always supported well to encourage them to eat all their meals. For example, a person’s communication care plan provided clear guidance to staff about how to engage with them effectively, but this was not followed by staff we observed. The person had unplanned weight loss of 6.8kg in 6 months. We did not see any evidence of action taken to address this. Most people we spoke with were satisfied with the quality of the food and relatives told us the food seemed okay and people were given a choice. A relative said, “Yes. I’m there when served and see the choices and it seems to be good food. The menus seem varied, I can see some people receive pureed food.” A person said, “I have no complaints - it's usually very nice.” Another person said, “The food is lovely.”

Staff working in the kitchen did not have the required knowledge to ensure people received meals and drinks which met their needs. They were unaware if anyone was diabetic or who required fortified or adapted textured meals and drinks. However, we were told only sandwiches and breakfasts were made on site with all other meals provided by a catering company. Some staff raised concerns about the hygiene in the kitchen and the lack of a qualified chef.

The provider’s food and fluid records were not effective to identify issues and ensure people were eating and drinking enough. We reviewed fluid monitoring charts and found they did not have daily targets and some people’s input was very low. Food monitoring charts showed some people were not eating all their food. We did not see evidence of action in response to this. For example, a person with unplanned weight loss frequently ate only part of their meal. There was no evidence they were offered alternatives or consideration of the cause. People’s care records did not always include up to date information about risk of weight loss. For example, 1 person’s care plan stated they had no nutrition and hydration needs but their Malnutrition Universal Screening Tool (MUST) score indicated they were at risk.

Relatives felt communication could be better between them and the home as well as between the home and other services. A relative said, “I feel there is disjoint between them and the doctor.”

Most staff described working well together and felt the team was supportive. A staff member said, “Colleagues and other senior members of team are supportive towards personal and professional development.” However, 1 member of staff felt there were issues in team relationships when the manager left, and we were also told communication could be improved. A staff member said, “I feel that there is room for improvement in terms of efficiency and communication.”

The service had not always worked well with other professionals. We were told staff were not always keen to engage when professionals visited but this was improving.

The provider did not have effective processes to ensure they shared information with other services. They had not always attended MDT meetings to discuss people’s care. Referrals to healthcare professionals had not always been made and where staff had noted a GP review was needed, it was unclear whether this had happened and the outcome.

People were not always supported to access other services; they did not all have a dentist and whilst a chiropodist visited the service, not all people were seen by them when required.

The provider had not ensured people were referred to other health services as required or arranged for them to be reviewed at MDT meetings. However, they told us there were weekly GP ward rounds. Following our site visit the provider told us they had improved records to reflect updates from the GP visits.

The provider did not have effective processes to ensure action was taken to support people’s healthcare needs. We reviewed people’s progress notes and found no evidence a person was supported with exercises as described in their care plan. For another person, notes indicated the GP would be asked to review them However, there was no update to reflect what or if there had been any input from the GP.

People were not supported effectively to ensure they had positive outcomes. During our visit people were sitting in the lounge with the television on but no one was watching it and there were no interactions with staff. A person told us they did nothing with their time and said, “It's awful…it’s prison.” People’s relatives did not share concerns about their quality of life. However, they were unable to provide much detail on how their relatives spent their time. A relative said, "I don't think [person] would particularly join in. [They’ve] never been much of a joiner. [Person] might watch." Another relative said, “Seems to be interacting more now.” We were also told, “Yes [there could be more activities], there is a carer there who tries to involve [person] in things they know what [person] likes. Seems to be the initiative of the staff rather than the provider providing resources.”

Staff had not recognised the impact of the lack of activity and social interaction on people’s quality of life. Most staff gave positive feedback about people’s quality of life at the service and confirmed they would be happy for a relative of their own to live there. Only 1 member of staff said they would not, and another had reservations. We were told by a staff member, “I feel St Audrey’s is incredibly caring. We have a really brilliant activities coordinator who really takes pride in what [they] do.” Another staff member said, “The staff give their best all the time and residents are well looked after.” We were also told by a staff member, “Unfortunately, given the current circumstances, I would not feel comfortable with my family living at St Audreys, but if things improve I would.”

The provider had not monitored the service effectively to ensure people had positive outcomes. They had completed audits which identified a lack of person-centred care; this was recorded in an oversight audit completed in February 2024 and again in a care record audit completed June 2024, but the issues remained during our assessment. This meant we were not assured the audit process was effective to ensure actions taken in response to findings.

People’s capacity to consent to care documentation did not include how they had been involved. We did not see evidence of their input to discussions where it was concluded whether they had capacity to consent. However, people and their relatives confirmed staff asked them before providing care. A person told us, “They always involve me, I wouldn't be happy if they didn't.” A relative said, “I see that in simple things like asking [person] what they would like for lunch. Drinks. Would you like to sit inside, what would you like to do now. They make [person] feel like they have capacity to make choices – I see that with other residents asked too.”

The provider had identified staff required further training. They told us, “We have linked in to training to improve MCA and DoLS knowledge and linking to consent. We have worked with [training provider] and tapped into resources available. We will start sending the team.”

The provider had not ensured people’s mental capacity assessments (MCA) demonstrated if/how they were involved and supported with the decision. MCA were completed and where appropriate best interest decisions and DOLS applications were made. We reviewed their Deprivation of Libery Safeguards (DoLS) tracker and found none of them had been approved and there was limited evidence these had been followed up with the local authority. A person had lived at the service for 4 years and it was only identified in June 2024 the local authority did not have a DOLS application related to them.