Hydon Hill - Care Home with Nursing Physical Disabilities

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• 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

People and their relatives were not always involved in assessments around their care, meaning their contributions could be missed. People’s rights were not always protected due to staff not understanding the principles of The Mental Capacity Act (2005). Records around mental capacity and best interest decisions were also lacking important information to ensure the least restrictive practices were used to deliver care. People, relatives and staff felt positive changes had been made to processes since the clinical lead had been in post. People received varied experiences in accessing specialist care to meet their health needs.

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 registered manager and nominated individual for the service did not demonstrate an understanding regarding the RSRCRC principles. This meant people’s needs in relation to this were not being considered. This had led to people’s social and emotional needs not being met. During feedback the manager and nominated individual acknowledged changes to the assessment process would be beneficial. However, staff did inform us they were provided with information from the assessment process prior to supporting people. One staff member told us, “Anyone new we will be told about the care they need before they arrive and it will grow from there.”

One person reflected that on-going assessment meant they had been able to gain skills and were now looking to move on to more independent living. They told us, “I chatted to [staff member] and she suggested the new room and also suggested I talk to the social worker about moving on. The social worker came to see me last week.” However, a review of records and observations showed assessments did not take into account people’s wishes which had led to poor outcomes in some areas such as things people like to do. Families also fed back they did not always feel involved in the assessment and review process. One relative told us “I have made it clear I want to be involved but it doesn’t happen.”

Assessments we reviewed for some people did not evidence their needs were comprehensively assessed prior to them moving into Hydon Hill. Assessments lacked detail in relation to their past lives, social and emotional support, communication needs, maintaining relationships and how they liked to spend their time. Assessments for some people detailed they had a learning disability. The assessment did not show their needs had been assessed in relation to this and consideration had not been given to how they could be supported with regard to RSRCRC as part of the assessment process. Assessments had also not considered how people’s needs could be met in relation to the isolated location of Hydon Hill. This was despite some people’s assessments stating they enjoyed going out and their wish to visit their family regularly. The lack of detailed and comprehensive assessments meant there was a risk people’s needs may not be holistically met or known to staff.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We received mixed feedback from people and relatives in relation to staff supporting people to live healthier lives. Feedback from relatives included they felt their loved ones were not always supported to have health issues reviewed. One relative told us, “The nurses seem nice but I worry [my loved one] is building up to another hospital admission. There have been a few recently and they don’t seem to get to the bottom of the problem. I’m not sure they push it enough.” However, we also received positive feedback. One person felt they had been supported well to increase their independence with support from the onsite physiotherapy team. They told us, “I am getting better with the help of staff. They have put me in a room with an en-suite which means I can now shower myself. I have a shower chair. I’ve got out of pads as I can get to the toilet. I have really improved and hoping to move out of here at some point. They are helping me to walk again, which I can now do.”

Weekly clinical meetings were in place to discuss specific residents needs from their personal care plans, review information from hospital discharges, new residents, and learning from incidents such as falls and accidents. Care plans we reviewed showed everyone had a hospital passport in place, and had completed annual health review and medicines review. Records contained care plans where people had specific health care needs such as diabetes, catheter care, oxygen, mental heath support needs, and epilepsy.

In general there was a very positive response to the new Clinical Lead/Deputy Manager. Staff and the registered manager felt that systems were being developed and continual monitoring was taking place. One staff member told us “I’ve seen the nurses are doing really well and if we say someone is unwell they come and see and check. Another staff member told us, “I think things have improved a lot on the nursing side since [the clinical lead] has been here. Everyone has learnt a lot from her and she tell you what to look for and how to record it. The nurses are all better, more of a team.” The registered manager said, “[The clinical lead] has made a big difference from the nursing side. We’re working together and she’s put in systems so we know what’s going on with everyone now. Things feel safer. It’s definitely getting there now.”

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Not all staff understood the principles of The Mental Capacity Act (2005). One staff member was unable to answer questions around this and a second staff member said “If they have the capacity they can make their decisions. If they do not have capacity we make decisions for them.” They could not give further information on how they would make decisions for them based on the principles of MCA, such as ensuring any decision made was the least restrictive option for the person. This demonstrated they were not aware of the principles which could leave people at risk of not having their rights respected. However, we also observed positive practices in this area. Staff were seen to offer people a choice of food and people were asked if they wished to join in activities. One staff member said, “We have residents with different types of capacity. I am always asking people about food, dress, every part of the day offer choices, giving options. The managers and nurses do all the forms around this.”

Evidence from best interest decisions showed relatives were involved. However, as people's capacity to consent to some restrictions was not assessed this meant there was a risk people's rights would not be protected.

We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. The processes and systems in the service did not always support this practice. Processes for recording people’s capacity assessments and best interest decisions were inconsistent with some people’s being in order and others with missing information or not decision specific. One person’s care plan stated, ‘I need staff to make all decisions for me as I am non-verbal’ and, ‘I need support with making all decisions’. Despite this, the person’s records did not contain capacity assessments or best interest decisions completed in relation to consenting to care, living at Hydon Hill, the use of bed rails or the use of a lap belt. Where capacity assessments and best interest decisions were recorded, these were not always decision specific. Records for two people contained capacity assessments and best interest decisions in relation to high/low beds, bed rails and lap belts all within one document rather than being assessed as separate decisions. This meant there was a risk that least restrictive options would not be considered in relation to each decision. However, we did also identify areas where the principles of MCA had been met. Applications for Deprivation ol Liberty Safeguards had been completed where required. Some capacity assessments were decision specific with best interest decisions to support them. For example, two people both had capacity assessments and best interest decisions in place in relation to lap belts being used on their wheelchairs. The failure to ensure the principles of the Mental Capacity Act were consistently met meant there was a risk people’s rights would not be respected.