Strode Park House

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 inadequate. This meant the effectiveness of people’s care, treatment and support did not achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent.

This service scored 38 (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 check and discuss people’s health, care, wellbeing and communication needs with them. The management team did not meet with people before they were admitted to the service. People’s pre-admission assessment did not include people’s goals or expectations of their admission to the service.

Some people’s care plans contained contradictory information throughout. The care plans were unclear what their assessed needs were, and did not provide clear guidance for staff to be able to meet them. Staff completed recognised assessment tools such as Waterlow and Malnutrition Universal Support Tool (Must) to identify risks to people’s skin integrity and weight loss. However, there was no evidence these assessments were accurate, or the outcomes were used to inform people’s care plans.

People were not involved in their care or treatment plans. The provider did not follow legislation and current evidence-based good practice and standards. For example, there were systems in place to review people’s care plans and complete checks, such as monthly weights. However, these had not been used effectively to make sure people’s needs were met. We reviewed people’s monthly weights and found them to fluctuate including large weight losses, people had not been re-weighed to check what the correct weight was. Following our inspection the provider told us they had acted to improve the monitoring of people’s weight to include a monthly audit to identify any inconsistencies. People’s nutrition and hydration needs were not always met. For example, a person’s liquid feed regime had not been documented when they were admitted for respite care. Staff had not identified this and the person received limited hydration and no nutrition for 3 days, before the error was identified, placing them at risk of dehydration and weight loss.

The provider did not always work well across teams and services to support people. The staff team did not always work well together, the processes in place did not always promote effective support for people. Staff often communicated by email, even when the topic was time sensitive, this could, at times, lead to action not being taken quickly. There had been times where people had run out of medicines because the staff member responsible for ordering had not read the email immediately. There were times when people’s medicines were in the service but had not been checked in by the medicines lead. Staff told us they could not access them until they were recorded as being received, this had meant staff had, at times, needed to contact the out of hours service for an emergency prescription to make sure people received their medicines as prescribed.

Relatives told us, they were kept informed of any changes to their family members care and support. A relative told us, “(Person) has been in hospital numerous times. We always attend doesn’t matter what time the care home will always ring us, and we will make our way to the hospital. They have a hospital pack which contains everything regarding their health. The home hand the pack to AE staff and I am kept up to date with everything.”

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. People had raised concerns about lack of cutlery and crockery at times. One person raised concerns about people in wheelchairs not being able to make drinks independently, as they could not reach the cups or get their wheelchair under the work surface to use the kettle. The kettle on the Basil Jones unit had been replaced with a tilt kettle, to promote people’s independence. However, people had to rely on staff to make their drinks until a risk assessment had been completed.

People had access to health professionals such as the dentist and their oral health was monitored regularly. The GP visited the service regularly to review people’s needs.

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 that they met both clinical expectations and the expectations of people themselves. People’s care plans did not include goals or outcomes which people wanted to achieve. Staff had completed reviews of people’s care plans. However, nurses had not always had the opportunity to complete reviews of clinical needs to check the clinical outcome had been met or if changes needed to be made. When people had been referred to health professionals such as dieticians, there was no clear system to check the intervention had been successful.

Staff described how they supported people and how they recognised if, for example, people had not drunk enough or were unwell. We observed staff checking people’s feeding tubes to make sure they continued to be patent and were free from infection, to make sure people received their nutrition as prescribed.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. Staff had completed mental capacity assessment’s (MCA) documents within people’s care plans, but these had not always been person centred. Some MCA documents had been completed with further actions required such as ‘to seek approval from the pharmacist.’ There was no record these actions had been completed to make sure the decision was appropriate and least restrictive.

The management team were aware there needed to be a best interest decision meeting when people had been assessed as not having capacity. When decisions were made in people’s best interest, they should involve people’s representative and appropriate professionals such as a GP. However, there were no records to confirm these meetings had taken place. There were plans ongoing to split the service into nursing and residential units according to people’s level of funding. The manager explained there had been a general consultation, so they had not completed specific capacity assessments or best interest decision meetings. People had not been given a choice of room, the manager had made the decision for them without consultation, based on room size. People who lacked capacity had already been moved at the time of the inspection.

The service had a social media presence, where they shared photographs of people at events or taking part in activities. There had been no consent or best interest decisions recorded, about sharing people’s images on the provider’s social media sites. The manager told us, they spoke with relatives about decisions, but they had not checked their legal status such as having lasting power of attorney or appointed Deputy by the Court of Protection, to act on people’s behalf.

There was a system in place to apply for Deprivation of Liberty Safeguards (DoLS). However, when these had been authorised and conditions had been imposed, there was no system to check the conditions had been met. There was a risk people would not receive support in the least restrictive way.