Alandale Residential Home

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• 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 Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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 provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Each person had a care plan that was regularly updated to reflect their current health and care needs, and was discussed with people and their representatives to ensure it reflected their wishes. In the majority of instances there was clear guidance for staff to follow, however there were some areas were not detailed enough or reflected in practice. This included around diabetes and falls, which meant people were exposed to greater risk of harm through inconsistent practice or lack of clarity.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Some areas of people’s care were not well planned, and it was not clear how certain conditions should be managed safely in line with clinical advice which reflected their specific needs. This risked delay in identification, escalation and treatment which posed a risk of harm to people. However, we saw other examples where there was greater clarity of information, and staff were knowledgeable for example about how to safely support people with invasive treatments such as catheters or stomas. Staff could clearly communicate signs of concern they would look out for and how they would escalate those. We also saw staff thinking on their feet to support people in line with best practice. For example, one person was struggling to eat, so to ensure they had an opportunity to get adequate nutrition a staff member with their consent replaced the meal with a smaller plate of cold items. This gave them the opportunity to eat at their own pace without worrying about food going cold, and later in the day we saw their plate was empty.

The provider did not always work well across teams and services to support people.

We received mixed feedback about how well staff worked together to ensure people received consistent and proactive support that was delivered with kindness. Several staff raised concerns about divisions within the staffing team that made it difficult to work together. One staff member told us “I just focus on what I’m doing. Some of the staff are mean, some are on their high horse. I just tell myself I am here for work”. Another told us, “It can be cliquey here. Some people you feel it more with then others. The next day it could not be cliquey”. Some people and relatives also raised concerns about the staffing team, with one relative stating “Some people who work there seem like they are just there for the money rather than actually caring about their job”. The provider had not ensured staff consistently worked together well to safeguard people from harm, and had not identified that this was not being achieved in practice. However, we did see that when people’s health needs changed, the provider worked positively with other agencies to support them in getting the help they needed.

The provider supported people to manage their health and wellbeing, so people could maximise their independence, choice and control. Staff supported people to live healthier lives, and where possible, reduce their future needs for care and support.

We saw positive examples of how the service worked collaboratively to support people in staying healthy. The were varied meal options available including fruit and a hydration station to make sure people had adequate fluid in the hot summer weather. There were frequent physical and social activities to support people in staying active and having meaningful engagement that was personalised to them, such as walking into the village with staff.

The provider monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There were systems in place to monitor people’s outcomes, which were effective at identifying areas where people’s care was poorly managed. There was strong monitoring in certain elements of care, such as ensuring people remained hydrated, maintained a healthy weight and risks such as constipation were managed. People were involved in regular reviews of their care and change made to ensure this continued to meet their wishes and preferences, although we received some mixed feedback from people and relatives about the care they received.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Where people lacked the mental capacity to make a decision for themselves, a best interest meeting was held with people’s representatives to make a decision on their behalf. However, the provider had not consistently followed the principles of the Mental Capacity Act when doing so. For example, a mental capacity assessment had been undertaken with one individual, despite it being documented that at the time they were in a greater state of confusion, due to an infection. People must be given all reasonable opportunity to demonstrate capacity or make a decision, and the provider should have reconvened this meeting at another time but at not done so. However, when these meetings took place it was clear who was involved in the decision, and they were regularly reviewed to ensure they remained the least restrictive option.