Loyd 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 Requires Improvement. At this assessment the rating has remained Requires Improvement.

Requires Improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to reg11 consent.

This service scored 50 (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.

Not all people and their relatives were actively involved in the assessment, planning and reviews of their care. Care plans required more information to evidence that people's communication, wellbeing, health and physical needs had been fully assessed and reviewed regularly to ensure were up to date and contained correct information. This was discussed during this assessment, and the management team had started to review all care plans.

The service used clinical tools such as weight logs and fluid charts. However, these were not always completed.

People's key workers were not always aware how often people's care plans were reviewed but did tell us that they were encouraged to report any changes required.

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 dietary needs were not always identified and recorded correctly. For example, there was conflicting information regarding a person's food level, this was brought to the management teams’ attention and rectified during this assessment, this did not imply the person was put at risk.

People and their relatives mainly told us they were happy with the choice and quality of food. One person told us, "Yes, the food is brilliant." Another told us,"(relative) doesn’t eat much at all and I don’t approve of the diet (relative) is on. I have suggested to the Duty Manager the changes they could make. They told me that as manager’s they cannot tell the kitchen what to serve."

The service used nationally recognised tools such as waterlow (tool used to assess a person's risk of developing pressure ulcers). However not effectively, for example people were not weighed monthly and the was no guidance for staff what the scores meant or what actions were required. This was discussed during this assessment, and the management team assured us new scales had been ordered, and care plans would be updated with the information required.

The provider mainly worked well across teams and services to support people.

Staff told us they were concerned with the number of changes in leadership and poor communication which they found demoralising. However, they appreciated managements current workload. The service held daily handover meetings.

Care plans currently in place did not fully support smooth transitions between services, but management had begun reviewing all care plans which would help to address this.

There was evidence of regular multi-disciplinary meetings.

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

People told us that staff encouraged them to make healthier choices. One person told us, "The Multi-disciplinary team (MDT) encourage me to go to the gym. One of the MDT has diabetes like me; I do cooking sessions with them on a Monday and we do weekly food planning. They encourage me to have a lot of veg. I find that helpful. I don’t like all vegetables, so they suggest different kinds of vegetables that I do like. "Another person told us that they have the option to self-cater and that staff take them food shopping every week.

People were supported to access healthcare services, including the GP and dentist. However, during this assessment, we were aware of a person with a chipped tooth still awaiting a dental appointment. When this was discussed with the management team, they assured us an emergency appointment would be sourced. There were also some conflicting reasons given for a late cancellation of a person's medical appointment.

There were gaps in people's monitoring records for instance, oral care records were very inconsistent, with some lacking an explanation and care records did not indicate that people were receiving adequate food and fluids. This was discussed with the management team who assured us they would be working with staff to ensure recordings would be improved.

Staff had received diabetic training and gave good knowledge of the people they support.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff did not always complete people’s daily logs with the detail required to monitor people’s care. For example, people's bowel movements were not being monitored as per their care plans and no actions recorded as per care plan. The service did not have an effective system of the oversight of people’s daily records as they had not identified these were not completed to a sufficient standard to monitor whether people were receiving their planned care and experienced good outcomes.

People and their relatives were encouraged to feedback about their care.

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

Care plans recorded whether people had Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms in place. Staff gave good examples of how they gained consent before providing support. However, we observed a staff member entering another person's room without asking them. People told us staff entered their rooms without prior consent when they were not in their rooms.

People's care plans did not consistently contain signed consent for care, or holding money in the safe.

Mental capacity assessments (MCA) and best interest decisions required more information to evidence people's involvement, including that the environment had been taken into consideration and that questions had been revisited. This was discussed with the management team who took immediate steps to gain signed consent for care and monies held. The management team told us the Psychologist was currently reviewing people's MCA and best interest forms; however, we were made aware that people had not received meetings with Psychologist despite having requested this.