Nelson House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The provider was in breach of legal regulation in relation to person centred care.

This service scored 39 (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 were at the centre of their care and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care plans shared with us did not always provide staff with detailed guidance about people’s individual needs. For example, 1 person did not have daily life, skin, mobility, medical needs, and maintaining a safe environment care plans. Where people’s needs had changed, care plans were not always updated to reflect this. For example, in relation to people’s hospital admissions, and incidents. This meant staff did not have the relevant information needed to provide person-centred care. There was limited evidence to support the provider worked in partnership with people and their relatives to decide how to respond to these changes in people’s needs.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Although staff understood how to escalate concerns to external professionals regarding people’s health care and medical needs, this was not always the case in relation to people’s mental health needs. For example, referrals had not been completed for people at risk of self-neglect for not accepting support with their personal care, or by not accepting routine medical check-ups. Information was not routinely recorded in relation to a person’s condition in their DoLS. This meant people did not receive appropriate support and longer-term outcomes were impacted due to issues with record-keeping and monitoring.

Relatives told us staff kept them informed about their loved one’s care and when incidents had occurred. A relative told us, “The staff call and tell me if anything has happened.” Rotas also demonstrated there was a stable and consistent staff team to provide continuity of care to people.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider had some understanding of the accessible information standard (AIS) for meeting the information and communication needs of people with a disability, or sensory loss.While communication needs were recorded in care plans, this did not consistently translate to information being communicated to people in an accessible way.

The provider told us information was not available in alternative formats such as pictorial, easy read, and large text to enable people to understand information, or to make informed choices. The communication needs of people who lived with dementia had not been considered to see whether alternative formats would benefit them, this included information such as the planned menu.

However, we observed staff had a good awareness of people’s communication needs and they demonstrated this in their interactions with people.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

The provider had a complaint’s procedure in place which was displayed within the home. People and relatives told us they knew how to complain if required; however, not all people felt they would be listened to. One person told us, “I know how to complain, but what is the point. Staff listen, but they can’t always change things, can they.” A relative said, “I would speak with a senior if I had any concerns. Last time I raised an issue with the provider I felt like I had to pressure them to act.” Another relative told us, “We are not happy with the frozen meals provided we discussed this with management, but I know nothing will be done about it.”

Information shared with us showed no recent complaints had been received apart from those referred to the provider by CQC. Therefore, we could not be assured concerns and complaints were being recorded as concerns shared with us by relatives had not been recorded.

The provider was unable to show us any evidence to support how they had sought feedback from people, relatives and professionals about the service provided. This meant people and their relatives were not actively involved in the running of the home.

The provider did not make sure that people could access the care, support and treatment they needed when they needed it.

The provider had not considered making reasonable adjustments to ensure equity in access relating to people’s protected characteristics, such as cognitive disability. There were multiple hazards in the environment which could cause injury to people navigating the building, and a lack of clear signage to help people orientate themselves. This meant the provider failed to operate a dementia-friendly or accessible premises.

The provider was unable to demonstrate people had access to routine healthcare services such as opticians, chiropodists, dietitians and other supporting professionals. People did have access to a local GP, who contacted the home on a weekly basis to discuss people’s medical needs.

Leaders did not always actively listened to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider failed to recognise the inequalities people they supported may face. These inequalities and people’s needs were not always considered. People were not supported to access the community unless they were able to do this independently. People did not have access to meaningful activities unless people were able to occupy themselves. This meant people who lived with dementia and those people who remained in their bedrooms did not have anything to occupy their days. Reasonable adjustments had not been made to the environment to enhance the independence of people living with dementia. This included a lack of action taken to make the garden more accessible and safer for people to use independently and enjoy the outside space.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We were told there were no people receiving end of life care at the time of the assessment. Records reviewed showed not all people had been given the opportunity to discuss their end of life wishes as part of their care planning, and limited information was recorded in some people’s care plans. Training records showed most staff had completed end of life training.

People and relatives told us staff were ‘supportive’ and ‘kind’ when people became unwell. One person said, “The staff do look after me when I feel unwell.”