Teamcare Limited t/a Highcliffe 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 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 found to be in breach of legal regulation in relation to consent.

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 comprehensively assess and review people’s health, care, wellbeing and communication needs with them.

Senior staff did not ensure assessments of people’s needs were robust and we noted a high number of concerns about the lack of information in care plans we reviewed. People with underlying health conditions such as Parkinson’s, arthritis, asthma or cancer had no information about how the conditions impacted them, the signs of deterioration or the required support or interventions. We found some key care plans had not been completed at all. For example, 1 person had diabetes and was at risk of constipation. They did not have a nutrition and hydration care plan to guide staff about any adjustments to their diet or fluid intake needed to help manage these conditions.

The electronic care planning system showed reviews had been carried out regularly, but information had not always been updated to reflect changes to people’s health and care needs. One person had been in hospital. Staff confirmed their health, care and mobility needs had changed significantly, but this was not reflected in their care plan.

Staff did not always ensure people received support in line with their assessed needs. We noted several gaps to people’s hourly welfare checks and repositing was not consistently carried out.

People and their relatives confirmed they had been involved in creating people’s care plans, but we received mixed feedback about their involvement in reviews. One person told us, “My daughter helped devise my care plan, it has been reviewed and updated.” Another added, “I have a care plan but I’m not sure if it has been reviewed.”

The provider did not always plan and deliver people’s care and treatment in line with best practice guidance.

The provider did not ensure training or information sharing was robust so we could not be assured staff were kept up to date with changes to legislation or best practice guidance.

Senior staff had not always completed nutrition and hydration care plans for people, or ensure they were adequately detailed. Whilst we observed people in communal areas had drinks available, records indicated fluid levels were often low, and we saw evidence of large gaps between meals for several people. This placed them at greater risk of dehydration or malnutrition.

Delegation sheets were used to effectively assign different tasks to staff, including helping people to eat and drink. Staff confirmed they had enough time to support people at mealtimes and people were not rushed.

Most people spoke positively about the food. A relative said, “[Person] likes the food, it looks very nice with Sunday roasts and fish on Fridays. It looks like a very well-balanced diet. [Person] gets plenty to eat.” A person living at the home said, “Yes I like the food, it is pretty good, we get enough to eat.”

The provider did not always work well across the team to support people, but they did share their assessment of people’s needs when people moved between different services.

Staff did not always have access to the information they needed to understand people’s needs and deliver care and support effectively, and we received mixed feedback about information sharing within the team. For example, when people’s needs changed or new systems were introduced. A staff member said, “I wouldn’t say communication is amazing, team meetings aren’t held very often.”

Senior staff carried out handovers between themselves, with staff receiving updates via the electronic care planning system. Whilst this ensured basic information was shared, it reduced the opportunities for staff to discuss people’s needs or discuss concerns in more depth.

There were systems in place to document people’s health concerns in advance of the weekly home rounds, and record advice or guidance given by the advanced nurse practitioner.

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

Staff worked closely with various healthcare partners to ensure people’s healthcare needs were met. Throughout the inspection we observed healthcare partners visiting people at the home. For example, district nurses and physiotherapists. An advanced nurse practitioner visited weekly to assess people with new or ongoing health concerns.

Staff encouraged people to exercise and improve their mobility where possible. The home ran activities such as chair exercises for people regularly. One person told us, “[Staff] try to encourage me when I am walking with the occupational therapist or physio.”

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Senior staff did not always ensure people’s needs were adequately reviewed, to ensure support was effective and appropriate actions were in place to improve outcomes (see the ‘Assessing needs’ section of this report for more details)

Assessment tools were used inconsistently, meaning people were not always monitored adequately. For example, we were advised that a person with diabetes needed their blood glucose levels monitoring twice daily by staff, but there were occasions this had only been recorded once. Others at risk of weight loss or pressure injuries had not been reviewed for several months, to check whether there had been any deterioration.

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

The registered manager did not ensure consent to care and treatment was sought in line with best practice guidance. Consent forms were not in place for several people living at the home. For those who had dementia or had shown signs of confusion, capacity assessments were not always in place and/or were not decision specific. There was a lack of evidence people or their relatives had been involved in making decisions about people’s care, or that people’s best interests had been fully considered.

People’s care plans did not always include details about their capacity. This meant staff did not have access to information about people’s cognition or the support they needed with day-to-day decision making. Staff we spoke to did not have a clear understanding of who did and did not have capacity.

Staff received MCA training and could explain how they sought consent from people. People and their relatives confirmed staff sought consent prior to care interactions. One person said, “[Staff] ask me, they are very polite.”

Following feedback, the registered manager assured us consent forms and capacity assessments were being reviewed. Care plans were to be updated to include more guidance for staff.