Culrose Residential Home

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 inadequate. 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 had been in breach of legal regulation in relation to consent, meeting nutritional and hydration needs, person centred care, staffing, premises and equipment. At this assessment we found improvements made and the service was no longer in breach of regulation for meeting nutritional and hydration needs, person centred care, staffing, premises and equipment. However, we found they were still in breach of legal regulation with regards to consent.

This service scored 54 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. However, we did not always find the care plans and risk assessments were updated with these reviews.

People’s needs were generally monitored and reviewed regularly. However the recording of such things as fluid intake and bowel monitoring was not accurate, which could impact on the oversight of someone’s care needs. Further work was underway to ensure a review of assessments were being completed accurately to ensure people received the care they required. People had their needs assessed prior to and on admission to the service, which helped ensure staff knew how to provide care on arrival.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider had improved the environment to ensure it was more dementia friendly with coloured zones, artwork and personalised door cards which had been created by consulting people.

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 work closely with each other to share information with daily handovers and ‘flash’ meetings to review any outstanding care each day.

Health care professionals were positive about working with staff in the service. One said, ‘I find the staff including management open and communicative and transparent with all matters. I feel there is a good working relationship. I deal with the senior carers and find them to be experienced and willing to be advised to ensure collaborative working.’

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. However, people’s records did not always reflect consistently updates to care.

Updates to care were regularly recorded within records, but not all relevant care plans had this information reflected in them. This included for updates from referrals to health care professionals and changes to support needed. This meant people were at risk of not receiving the care required. However, the impact of this was limited as staff knew people and how to support them to live healthier lives.

Improvements to records were needed to ensure action around encouraging fluids was reflected and demonstrate appropriate care was delivered. It was felt this was a recording issue more than a lack of drinks being given. This was reflected by a relative who said, ‘The staff encourage [them] to drink. [They] didn’t used to drink at home with me and had a urine infection due to being dehydrated.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

There were systems in place to review such things as weight monitoring and dietary needs with chefs to ensure they were meeting people’s needs. However, the weight monitoring was not happening as consistently as it was suggested in records. There were inconsistencies in whether people should be weighed weekly or monthly, however, some were not weighed as frequently as monthly. This put people at risk of not having timely actions taken to help keep them healthy. The information collected was reviewed and appropriate measures put in place.

People’s bowel movements were also not consistently checked. We identified a person who had 2 bowel movement in 19 days when their records state they should be monitored for 3 bowel movements a week. This had not been identified or escalated which put them at risk of not receiving the medical support they required. The auditing and record keeping systems in place had not identified this issue.

The registered manager responded by seeking medical advice for the person who had not had a bowel movements, and put a system in place to ensure monitoring was more robust and an escalation form for staff to raise any concerns in a timely manner.

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

The provider did not always assess people’s capacity to consent where needed and to ensure any decisions, where a person was assessed as lacking capacity to consent, was made in the person’s best interest, following the principles of the MCA 2005. The answers given during a capacity assessment did not always reflect the question being asked. The assessment did not always state whether the person had an impairment of the mind, reflect there was a deprivation of liberty authorisation in place or detail the names of who was involved in the assessment, just titles, for example, family members. Capacity assessments were not in place for people who were on covert medication or had visiting restrictions. This meant people’s consent was not being assessed or decisions made in their best interest using the principles laid out in the MCA 2005.