Job's Close Residential Home for the Elderly Limited

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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 as 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 46 (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 check and discuss people’s health, care, wellbeing needs and communication needs with them.

The provider failed to always involve people and their relatives in reviews of their care to ensure their support continued to reflect people's needs. For example, 1 relative told us “They asked me questions about [my loved ones] care when [my loved one] first went in. I’ve not been involved in any reviews since then.”. One person told us “I haven’t had a review since coming here. I’ve not had a review of my medication either. I don’t have any choice of carers.” This meant that support plans were not reflective of people as individuals, to demonstrate a holistic, person-centered approach.

The provider planned to implement an electronic care management system but experienced delays in putting this into place. This contributed to poor systems and processes to ensure people’s care and support was reviewed to ensure it remained relevant and up to date. In response to our assessment, the registered manager implemented training for staff on the new system in preparation for it going live.

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

People's needs were not always assessed, and their care and support were not always delivered in line with current standards. The provider’s processes for ensuring people were consistently involved in their care planning and that the information recorded in support plans was accurate, were not effective. Important information about people’s care and support needs had been omitted from some support plans and monitoring charts. Some people’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs. This included people prescribed anti coagulants who may require additional monitoring. For some people who required enhanced monitoring in relation to their skin integrity or hydration there was a lack of evidence this had been consistently provided and monitored.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The lack of robust systems and documentation meant that information available to share with other services and health professionals was not robust. 1 person was at high risk of developing pressure sores and their skin required additional monitoring to reduce the risk of it deteriorating. Records did not evidence this monitoring took place. This meant in the event of a deterioration of the skin condition, the information available to help understand how, when and why the skin had deteriorated was not available. Effective treatment could be delayed due to this lack of information when the person transferred between services.

Handover meetings took place at each shift change, where staff shared verbal updates, including any concerns from the previous shift.

A visiting health professional told us that staff sought health advice whenever needed and followed guidance provided. There were weekly GP visits to review people’s health concerns and plan for future care needs. These visits were recorded in a communication book for staff to read. However, care plans were not updated in a timely way to reflect service users changing needs and GP guidance.

Staff spoke positively about teamwork. New staff said they felt welcomed from their first day, which helped them settle in smoothly. Some staff told us that they felt supported by the management team, however some staff told us that concerns raised would not always be acted upon.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

Systems and processes to ensure care records and risk assessments were reflective of the support people required with their health needs were not robust. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence.

Staff could tell us how they would access additional support from healthcare professionals to help people manage their health and support needs, should this be required. One person told us “The GP visits every week I have a physiotherapist and the chiropodist visits.” People told us they were able to make choices and decisions, but not all people were involved in reviewing or consulted about their health and well-being needs.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent.

 We found inconsistent information in some people’s care plans. 1 person experienced hallucinations but there was no guidance for staff to support and offer reassurance to this person. The registered manager told us this person no longer experienced hallucinations. However, this had not been removed from the care plan. Care plans did not always provide sufficient information around the impact of people’s health conditions on their outcomes and monitoring needs. The registered manager told us they would undertake an immediate review of care plans and ensure accurate information was available on the new digital care planning system.

When carrying out reviews of care plans the provider did not always include people or relatives. The robustness of these reviews needed to be improved. We identified areas where changes and updates to reflect people’s current support needs had not been made in care plans and risk assessments. Staff received supervision and appraisals. However, we were not assured

staff were given the opportunity to raise concerns about people’s care or suggest improvements.

The provider failed to consistently carry out any investigations when incidents occurred. This was a missed opportunity to take lessons from these to drive improvements, ensuring positive and effective outcomes for people. Such lessons could be used to ensure people were safe and received appropriate care and support.

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

Improvements were needed in relation to Deprivation of Liberty Safeguards (DOLs). DOLs applications were made to the authorising body for people who might be deprived of their liberty. However, there was no evidence that contact had been made to gain updates on the progress of DOLs applications, some of which were 6 months old. This meant the provider could not assure themselves people were being supported in the least restrictive way or being deprived of their liberty unlawfully.

The registered manager told us when a person was unable to consent to their own care and treatment, they completed mental capacity assessments and made best interest decisions in accordance with the Mental Capacity Act.  However, there was no evidence of this in relation to covert medicines. In response to our assessment, action was taken to address this and ensure mental capacity assessment and best interest decisions were undertaken for decisions that people were unable to make themselves.

People told us staff sought consent before providing care and they were supported to make choices and decisions, which staff respected. Staff understood the legislation and associated principles in relation to people and consent. Staff respected people’s choices and were receptive when people shared their views and wishes. However, the provider was unable to assure us they had gained consent from people regarding the CCTV used in communal areas in the home.