Holly Tree Lodge Residential Home 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.

This service scored 58 (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.

We saw examples where the registered manager had completed pre-admission assessments in consultation with people and their relatives. This helped to ensure the needs of prospective new residents could be met. However, no further reviews had been completed following the initial assessment.

Care plans did not always reflect the person’s current support needs. Relatives told us they discussed with the provider any changes in their family member’s needs. However, these were not always documented. Changes in people’s care needs and the support required was not always reflected in the care plan to enable staff to provide appropriate care and support. None of the people we spoke with had been involved in any formal reviews of care provision.

The provider assured us this would be addressed.

Staff understood how people expressed themselves through facial expressions and body language. One relative told us, “They understand her completely.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. While staff understood people well and aimed to provide supportive care, this was not consistently supported by accurate or comprehensive documentation.

When staff identified changes in a person’s health, they sought advice from GPs and community services and followed the guidance provided. However, this information was not always accurately reflected in care plans. In some cases, care plans were not developed to reflect people’s changing needs.

People were not always involved in planning their care. However, the impact of this was reduced because staff knew people well. Staff we spoke with demonstrated a good understanding of people’s individual needs, for example dietary requirements and important medicines people were prescribed.

Most people told us they enjoyed home-cooked food and said there was plenty of choice. One relative told us, “At first, [my family member] complained about the food but the staff have now found out what they like to eat."

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.

The provider communicated well with other healthcare professionals and shared the information with the rest of the team at the team handover meetings. The service had regular ‘ward rounds.’ This was a meeting held with a team of health professionals to review people’s needs. This helped ensure people received person centred care that promoted their wellbeing.

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.

The process to ensure care records and risk assessments were reflective of the support people required with their health needs was not robust. Staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence. Desired outcomes were recorded in some care plans; however, these were not person centred with specific detail for the individual. For example, one care plan recorded the desired outcome as “To keep [person’s name] safe.”

We observed staff offering people choices regarding their meals and drinks. People were asked to choose their meals from a menu and could also have an alternative meal. People were happy with the meal provision and could access drinks and snacks, including fresh fruit, at regular intervals during the day.

People had access to GPs and other professionals if required. However, not all people living at the service had access to a dentist. One relative told us, “We had to arrange to pay for a private dentist to visit my [family member] at the home.”

Although the service did routinely monitor people’s care and treatment, care plans and daily records did not provide assurance or updates that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We saw evidence that people’s care was not always monitored. For example, one person’s care record showed consistently low fluid intake, but no action had been taken to address this. This meant there was a risk the person’s healthcare needs may not have been identified or responded to appropriately.

Relatives told us staff monitored their family member’s care and health and kept them informed of any changes. One person told us, “My [family member] tells me they like the food, they were not eating at home. They look better now that they are eating properly, they are improving.” Professionals told us staff escalated concerns and followed instructions when people’s health deteriorated or caused concern. This showed staff recognised when people needed additional input and sought advice. However, this was not always documented in people’s care records.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

As described in the Safeguarding section of this report, the MCA was understood and followed by staff. We found most staff had received training in MCA and DoLS. The staff we spoke with understood what these were and what this meant for people. Relatives told us staff contacted them when important discussions were needed. We saw staff recognise when people could make their own decisions and support them to do so.