Archived: Shore Lodge - Care Home Learning Disabilities

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 of this key question we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met. The service was in breach of legal regulation in relation to person-centred care.

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 provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Although people had care plans and positive behaviour support (PBS) plans in place, these were not consistently being followed. Some people’s care plans referred to ‘him’ or ‘her’ or other people’s names. We saw staff consistently not following people’s care plans. For example, 1 person’s PBS plan showed a proactive strategy that helped the person to have a good day. This stated they liked to bath twice a week in the evening on a Tuesday and a Friday. The person did not have a bath on Tuesday 18 February which was the second day of our assessment visit. The bath was out of use. Staff told us the person only had showers. The person was not having a good day and may have benefitted from relaxing in the bath. They had been very upset and tearful relating to the up-and-coming funeral of their house mate. Another person was supported by staff with a teeth brushing plan which had been put together by health and social care professionals. This was designed to support the person to get used to having their teeth brushed to improve their dental hygiene. Records of the desensitisation plan stages and what actions staff should be taking at each stage of the plan were poor. The plan was not supported by a care plan and guidance for staff. Records showed that the plan was not effective as staff had tried to do this when the person was sleeping and so it was recorded as not done or declined.

The provider mostly understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. The service worked with other health professionals involved in people’s care. During the assessment, local authority care managers visited to carry out reviews with people. A speech and language therapist also visited to carry out some reviews and assessments. A healthcare professional gave us feedback that staff did not always listen or appear to understand what they have been asked to do. They had given guidance to staff whilst we were there on how long the person should stay in bed. We observed staff then asked them after 10 minutes whether they could now support the person to get up. The healthcare professional had to explain again it was important for the person to be in bed for 30 minutes. Information was shared with staff during handover regarding any changes to people’s health or care needs. Relatives told us, they felt staff supported people to ensure they were aware of upcoming appointments and communicated well with GPs and health specialists to ensure people received continuity of care. The manager had contacted services for visually impaired people to explore options for day care and equipment to try and meet a person’s needs.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication. The accessible information standards were followed for most people. We noted that the display notice boards were placed high up on walls around the service which was not ideal as most people used a wheelchair to move around the service, this meant the noticeboards were above head height. There was no way marking to help people to navigate around the service, all the corridors and doors were the same colour, there was nothing available to support 1 person who had a visual impairment to move around the service and know where they were. Care plans detailed people's communication needs. Staff were able to describe how people communicated. Complaints processes were on display, as well as keeping safe information and advocacy services. A staffing board was on display showing pictures of who was on shift.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. The management team and staff had supported people to understand that one of their house mates had passed away. A social story was used and easy to read information had been used to explain what happened and some people were able to understand this. Some people were supported to attend the funeral which took place during the assessment. However, we observed times during the assessment where people were not listened to. For example, people being referred to as different names, being moved into different rooms without being asked and requests to go somewhere else either verbally or through actions (such as sitting down) not being responded to.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. Most people were supported with medical appointments and follow up appointments. We observed people receiving visits from healthcare professionals during the assessment visit. People’s care records showed that they had received medical help. However, one person’s records showed they sustained a head injury following a fall. Their records showed they had not seen a GP or minor injury unit despite the wound being 2cm long. The nominated individual for the provider told us, medical support had been obtained from 111. This person has a visual impairment which restricted them from taking part in most activities and events in the service. A co-ordinated approach was not advocated to support this person with their specific environmental needs to promote their well-being and life experiences. We discussed with the management team that this person did not have the same equity of access as other people. During the assessment the provider served the person notice as they felt they were no longer able to meet their needs. A relative told us their loved one had appropriate support from healthcare professionals. They said, “[Person] has seizures, the last one a male carer was with him, they administered Buccal, called 999 and informed me. I am pleased with how they cope with his seizures.” Staff gave us examples of when they had recognised people were not acting in their usual manner and the action they took. For example, when a person had a seizure. Staff were knowledgeable about how to recognise signs of deterioration and said they would report health changes.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. The manager and staff looked for different ways to meet people’s needs. Staff were aware people could be vulnerable due to their isolation. The manager had worked to seek out appropriate networks and support groups to meet a person’s individual needs. Equality and diversity was considered to make sure people were included in how their care was delivered. Some people were encouraged to access day activity groups and support networks and to help foster new friendships and were supported to maintain important relationships with family and friends.

People were 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. No one living at the service was currently in receipt of end-of-life care. However, the provider was working with people and their relatives to discuss people’s preferences and choices. Some people’s care plans did not provide information about their choices around this. For example, a person’s care file showed that they were Catholic, and this recorded that their relatives wanted them to have the last rites read to them if they were at the end of their life. Despite this information about their religion found in the care file, this had not been added to the person’s end of life care plan. The nominated individual for the provider said, “You will see on our action plan that end-of-life plans was raised at our last audit, and we are working with the families and advocates to develop these, it’s always a difficult subject for families.” A relative told us they had been contacted about their loved one’s end of life plan. Another relative said, “[Person] has a funeral plan in place.” A staff member told us, “We have been discussing end of life care, [Person] has been talking about it a lot since [housemate] died and since the funeral.”