North Bay House

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 Inadequate. At this assessment the rating has rating has changed to Good. This meant people’s outcomes were consistently good.

At the previous inspection the provider was in breach of the legal regulation relating to the need for consent. Improvements had been made and the provider was no longer in breach of this regulation.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because some aspects of people’s care were lacking, such as specific risk assessments. Appropriate assessment tools were used to effectively support the assessment of people’s care needs, however, these did not always translate into robust risk assessments. Whilst people’s needs were assessed and included consideration of their physical, mental health, sensory, social and communication needs, we found the information was not always sufficiently detailed, or up to date. There was limited evidence that people were supported in shared decision-making and goal setting to determine the plan of action they needed to move forward or achieve goals. This was an area the registered manager was planning to improve.

The provider 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. Nationally recognised assessment tools were used to assess and monitor people’s needs, for example, MUST (malnutrition universal screening tool) and Waterlow (a risk assessment tool to identify individuals at risk of developing pressure ulcers). However, risk assessments were not always created to support the findings, specifically where people were at high risk.

Staff worked with health professionals, including GP's, district nurses and speech and language therapy, virtual wards, and we saw referrals were made when people’s health changed.

People’s nutritional and hydration needs were met in line with current standards and evidence-based guidance. People had enough to eat and drink to prevent malnutrition or dehydration and were supported to manage their dietary needs and associated risks. This included where people had complex needs with swallowing problems. People and relatives told us that the food was generally very good, and if people wanted something that was not on the menu, this would be prepared for them. We saw this happening in practice and time was taken to ensure the person received their preference. One relative told us, “They are very good at giving [relative] food choices and it has been arranged that if [relative] doesn’t want anything offered, the kitchen keep a supply of his favourite [named foods] for them. It works well.” However, several people told us the food was regularly not hot enough, specifically the vegetables. One person told us, “The vegetable are always cold.” People’s weights were regularly checked to ensure weight loss was identified early.

The provider worked well across teams and services to support people. Staff worked with a wide range of health and care professionals including speech, and language therapists, mental health teams, and hospital specialists. Staff were proactive in working with other services when multidisciplinary involvement was required, and any actions were followed up on as needed. A relative told us, “They [staff] are very good at spotting anomalies and flagging them up to the GP or professionals when necessary. They do keep the family posted too. It would be nice to think they can keep these standards up as resident numbers increase again.”

People’s care records did require updating in some areas to ensure people’s needs were clear and contemporaneous. The provider’s action plan included this, so was already identified as a required improvement.

Whilst documentation was lacking in some areas of people’s care records, staff supported people to live healthier lives and where possible, reduce their future needs for care and support. People accessed healthcare when they needed it. The service identified risks to people’s health and wellbeing and prioritised support to prevent deterioration. The provider commissioned a physiotherapist privately, and they visited the service monthly to review any people whose needs had changed, or if any equipment was required to support safer moving and handling, such as walking frames, hoists etc. We observed the physiotherapist on site reviewing a person during our inspection. There was a weekly ward round with the local GP, and staff added people to their list to be seen when advice was required, or where people needed their medication reviewing.

People were offered activities and encouraged to remain active, and some relatives spoke positively about meaningful activities and social engagement.One relative told us, “They do actually have activities now. It was only the odd activity before if anyone had time. In fact, I think it’s 7 days per week now and we [relatives] are sent a list of what is happening, including trips out.”

The provider had systems in place to monitor people’s care and treatment; however, these were not consistently effective in identifying or addressing areas where improvements were required. While monitoring tools were used to review people’s health and wellbeing, these had not always resulted in risk assessments being created to ensure all risk mitigations were in place. Care plans were not always reviewed robustly to evidence they were meeting people’s needs and that they were still relevant. Some care plans were missing information. Care plans contained limited detail on people’s goals. There was limited evidence that people’s skills and strengths were discussed with them and those involved in their care, to understand how people’s goals and outcomes could be planned and achieved. The registered manager told us this was an area they were developing, and the provider was planning a new electronic system to improve the recording of information. People accessed healthcare services for their physical and mental wellbeing. The service did seek and follow advice from professionals and stakeholders as appropriate when monitoring individual outcomes.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. We did observe at times that staff did not seek consent. For example, we observed a person visibly surprised when a staff member moved them in their wheelchair before first seeking consent to do so. Although staff received training in the Mental Capacity Act 2005, they were not always able to tell us what this meant in practice. Records did not always evidence that consent had been sought prior to assisting with people’s day to day care needs.

The service had received significant support from the DoLS (Deprivation of Liberty Safeguards) team to ensure that documentation was in place where people had restrictions placed upon them in their best interests. This had resulted in improvements relating to the required documentation needed to ensure any restrictions were lawful. People’s capacity had been assessed, and this was documented. When people had been assessed as not having capacity, decisions had been made in their best interest with their family and healthcare professionals. Where DoLS were in place, any conditions within them were being met.