Kitwood House Care Residence Also known as 1-11337159380

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

At our last assessment we rated this key question good at this inspection 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 provider was in breach of regulation in relation to consent to care.

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 always check and discuss people’s health, care, wellbeing and communication needs with them. Some people did not have care plans in place for a known medical condition. This included people with complex health conditions. This meant staff lacked information and guidance on what support people required with regards to these conditions, and how to identify and respond to signs of change. Some care plans contained information not specific to the person and some were inconsistent, meaning that information about people’s needs and care was not always clear. People’s daily records were not adequately maintained to enable staff to monitor and be assured people’s needs were being met. For example, staff had completed duplicate charts to monitor a person’s bowel movements. One set of charts indicated the person’s bowel habits were regular, the other set indicated the person’s bowel habits were irregular and may require medical advice to be sought. This lack of accurate record keeping meant people were at risk of not receiving the support they needed to keep them safe and well.

Relatives told us they were involved in reviewing care plans. One relative said, “I was invited to review the care plan, it’s very good, it’s nice to involve us in the care plan.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. The Mental Capacity assessment did not follow evidence-based practice, which meant the correct processes were not in place to properly assess people’s capacity. This included not evidencing people had been supported to make their own decisions wherever possible, and the relevant people had been involved in best interest decisions.

The use and monitoring of medicines did not follow the NICE (National Institute for Health and Care Excellence) guidelines to ensure people received their medicines safely. This included the use of covert medicines.

Clinical tools such as malnutrition universal screening tool (MUST) were in place to assess people's needs.

The provider did not always work well across teams and services to support people. The information sharing between permanent staff and agency staff was not always effective. The provider told us agency staff were provided with an induction when they started and had access to the digital care system. However, these were not always effective. One agency staff member told us they were only given the handover sheet with information on about people’s needs in the morning when they started. However, the handover sheet shared with us by the staff member, did not record people’s needs and risks, which meant not all staff were aware of these important details. Staff told us they felt they worked well as a team. One staff member said, “We have a good team, and good residents and work in unity.” There were daily heads of department meetings so all information could be shared across each department within the service.

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, or where possible, reduce their future needs for care and support. When people had been involved in incidents there was not always learning or exploration of ways to reduce risk and improve the outcomes for people. There was no evidence people were encouraged to participate in planning their care however, relatives told us they were involved, one relative told us, “I've seen the care plan. I was asked to write about their life for the care plan.” Observations at mealtimes identified staff did not have enough time to support people with their meals. We observed meals being placed in front of some people with no encouragement or support being provided. A staff member told us they were struggling during mealtimes as they didn’t have enough staff. Kitchen staff were aware of peoples’ dietary needs and meals were prepared appropriately.

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 they met both clinical expectations and the expectations of people themselves. Outcomes for people were not person centred. There was no evidence people had been involved in discussions about their care and the outcomes they would like to achieve Care plan reviews did not evidence outcomes were reviewed or updated.

Records were not always made at the time support was provided. For example, records in relation to one person’s dietary intake at breakfast and lunctime, had still not been made by midafternoon.

Information about what people could do for themselves in respect of their day to day care was not always contained in care plans for staff to be aware of. This increased the risk of opportunities to support and maintain the person’s independence, being missed.

The provider did not tell people about their rights around consent or respect these. Where a person lacked capacity to make specific decisions about their care the principles of the Mental Capacity Act had not been followed to ensure decisions made were in the person’s best interests. There was no evidence to demonstrate people with communication difficulties were supported to participate in decisions made about their care, as no alternative methods of communication were available to enable them to do so. When restrictions were implemented the provider did not ensure they involved the right people in the decision-making process to ensure decisions were made in the person’s best interest. For some people, restrictions were implemented without evidence of a Mental Capacity Assessment or best interest decision being in place.