Agnes Court - 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

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 in breach of legal regulation in relation to consent to care.

This service scored 58 (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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed when they moved into the service for areas of care and support such as nutrition, mobility, skin integrity and health conditions, and staff demonstrated an understanding of people's assessed needs. However, a recent quality audit completed by the provider identified that the ‘Person of the Day’ review process was not fully embedded into the service to ensure people’s support plans are reflective of their assessed needs. Not all relatives had experienced being involved in the review of their loved one’s care. A relative said, “No one has ever asked me if I am happy with [Person’s] care.” Another relative said, “I have not been directly asked if I am happy with [Person’s] care.” This meant the provider could not fully demonstrate they were always involving people and their representatives in assessing and reviewing their care to ensure it remained effective.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service had systems in place to support people's nutritional needs, including modified diets and consistency checks before meals. People and their relatives gave positive feedback about the meals on offer and told inspectors there was a daily choice. Staff used recognised assessment tools, such as Waterlow and MUST assessments, to monitor health risks. However, for autistic people or people with a learning disability, the Right Support, Right Care, Right Culture guidance (RSRCRC) was not embedded into care planning or review processes. This meant not everyone’s care and support was planned and developed using evidence-based good practice standards.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There were processes in place for staff to communicate information about people’s care and support needs. For example, daily flash meetings took place for staff to share and communicate any relevant updates or changes to people’s needs. However, inspectors found the meetings took place later in the morning, which meant there could be delays in sharing important information and acting on people’s needs. This was shared with the registered manager for review.

The service had links with community healthcare services, and a weekly visit from the GP supported people’s ongoing health monitoring. Staff sought advice and support from other professionals when required. A professional working with the service said, “Referrals are made when required and communication around residents clinical needs is usually timely and appropriate.”

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

Care records demonstrated nursing and care staff monitored people's health needs and supported them to attend appointments and access healthcare services. Staff recognised changes in people's health and worked with healthcare professionals to respond appropriately. A relative said, “The doctor visits regularly and [person] is seen when requested.” Another relative told us, “They (staff) are aware that [person] is diabetic and they are watching [Person’s] weight, which has been falling.”

The provider did not always routinely monitor people’s care and treatment to drive continuous improvement or demonstrate that people were consistently achieving positive outcomes.Care planning and review records required improvement as the provider was unable demonstrate and evidence how personal and clinical outcomes for all people using the service were identified, monitored and reviewed for progress and achievement. People received support from healthcare professionals and there were examples of positive outcomes for people, for example, one person no longer relied on their percutaneous endoscopic gastrostomy (PEG) feeding tube for all of their nutrition and fluids. Although therapeutic support had reduced, and people and relatives expressed their disappointment in the reduction, people had access to weekly physiotherapy sessions supporting people to achieve outcomes with their mobility.

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

While staff understood the importance of acting in people's best interests, records did not always demonstrate compliance with the Mental Capacity Act 2005. Mental capacity assessments and best interest decisions were not consistently decision-specific, personalised or supported by evidence that all practicable steps had been taken to enable people to make their own decisions. During the inspection, the registered manager completed documentation relating to existing restrictions and decisions. This demonstrated that these measures had previously been implemented without evidence that the person's capacity had been assessed, or that the restrictions had been considered necessary, proportionate and in their best interests. A review of records also identified examples where best interest decisions had been completed without an accompanying mental capacity assessment, meaning there was not always evidence that a person's capacity had been assessed before decisions were made on their behalf. This meant the provider could not always demonstrate that decisions made on behalf of people who lacked capacity were lawful, proportionate and in their best interests.