Abbeydale - Derby

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 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment and consent and decision making under the Mental Capacity Act 2005 (MCA).

This service scored 42 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

People were at risk of inconsistent care as care plans were not always in place or accurate. One person did not have a care plan and risk assessment in place for their specific medical condition, how they managed this, and what care was required from staff. We found other discrepancies in people’s care plans and risk assessments. These included, differing repositioning frequencies specified in people’s care records compared to what staff told us they should receive. One person’s mental capacity assessment stated they were unable to eat and drink independently whilst their medical care plan stated they were mostly independent with eating and drinking which staff also confirmed. Their care plan for pain People stated they were no longer able to verbalise pain however staff told us they were able to express pain.

People and relatives told us there had been some communication about their care needs when they first moved to the home. However, not everyone we spoke with felt involved in assessments and on-going reviews of their care needs. For example, one person told us, “Nobody has been to ask me [about my care]. No-one writes it down. Right from the start.” Records did not show how people and when appropriate, their relatives, had been given the opportunity to discuss whether their care plans and risk assessments remained up to date and relevant or whether any changes were required.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Records of people’s food and fluid did not always show they had been offered meals in line with their care plans and risk assessments. Whilst the registered manager told us they had met with staff to try to improve record keeping in this area however, we found continuing examples of inconsistent records and risk assessments. For example, one risk assessment stated a person had no difficulties eating when they were actually following a modified texture diet in response to swallowing and choking risks.

We observed people could choose different meal choices and were offered alternatives and different portion sizes. However, we observed staff offered a person menu choices they told us they were unable to eat. Later, the person was provided with a pudding they had not requested and also said they could not eat. Whilst alternatives were offered, staff had not initially offered choices that were suitable for this person’s needs.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us they felt supported to work together well. For example, one staff member told us the staff team would help to cover any shifts between them before they used any agency staff. They said they had regular briefings to help them keep up to date on any changes, for example, in the way the digital care records system was used. We observed staff worked well together. For example, we saw 2 staff assisting a person to transfer with a stand aid and they changed over roles so the person received reassurance and instructions with the staff member they were looking at.

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

Staff told us how people were supported with their health and wellbeing and to live healthier lives. For example, a staff member told us about one person who was doing well after coming back from a hospital admission. Activities were planned to support people’s physical activity and health and the local GP surgery visited people to help support their health and well-being.

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, or that they met both clinical expectations and the expectations of people themselves.

Full descriptions of what people had been given to eat had also not always been recorded. For example, records would often just state, had ‘tea’ for the teatime meal. This meant the provider could not reliably demonstrate what people had eaten. This is important as this information would allow the provider to monitor people’s health and care and treatment decisions.

One staff member told us about a person’s bowel movements. What they described had not been recorded on the person’s bowel monitoring chart. This chart showed they had opened their bowels infrequently and there had been a period of 14 days without a bowel movement recorded. Medicines records showed when medicine had been effective in producing a bowel movement, however this had not been recorded on the person’s bowel monitoring chart. As such, this meant records were not accurate and could not be relied on to effectively monitor this person’s health needs.

Another person’s Mental Capacity Assessment for eating and drinking stated staff must encourage them to eat and drink as they do not reliably initiate this themselves and were at risk of poor intake without prompting. However, the registered manager told us they were not on any food or fluid monitoring charts and there was no target fluid level identified on their fluid charts. These showed staff had offered varying levels of fluids, on some days the fluids offered had been as low as 840mls. We found their kitchen records stated their fluids should be limited however, staff told us this was incorrect and told us they would update this record. Another person had a mental capacity assessment in place and their care plan stated staff were to ensure they had had a sufficient amount to drink. Staff told us they would notice any change in their acceptance of fluids. However, the person’s fluid records varied, and some days staff had recorded they had taken just 500ml (plus a portion of soup). There was no evidence that any review and monitoring had identified when fluid levels had been low or varied. Records did not demonstrate that when people required assistance from staff with their eating and drinking, they were offered sufficient amounts of fluids and that these were effectively monitored so actions were taken in response to low fluid intake.

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

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Closed Circuit Television (CCTV) was used in certain communal areas in the home. However, there was no mental capacity assessments and best interest decisions in place for people who were not able to understand and agree to this being used in their home.

Other mental capacity assessments and best interests’ decision-making records for people’s care decisions were in place. However, not all of these were decision specific. This meant they had not been completed in line with the principles of the MCA.