Fryers House - Care Home with Nursing Physical Disabilities

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

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.

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 ongoing health, care, wellbeing and communication needs with them.

Initial assessments were holistic and person-centred. People and their relatives confirmed they had been involved in the process prior to admission, with people’s needs assessed at that time. A range of assessment tools were used to understand each person’s health, care, wellbeing and communication needs, supporting the design of care delivery aimed at achieving positive outcomes. However, there was a lack of evidence that people’s changing needs were effectively reviewed or reflected in updated care plans. While initial assessments were thorough and person-centred, ongoing assessments were not always effective, and care planning records were not always reviewed effectively or updated. This meant people’s changing needs were not reliably captured in their records and we could not be assured that care was always delivered in line with people’s current needs. These concerns are explored in more detail elsewhere in the report.

The provider planned and delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards. We observed nationally recognised assessment tools were in use such as for risk of malnutrition. Staff followed advice and guidance from other health and social care professionals.

People’s nutritional and hydration needs were detailed in their care plans and information was held in the kitchen detailing peoples specific dietary needs.

The provider mostly worked well across teams and services to support people. The provider made sure people only needed to tell their story once by sharing assessments of needs when individuals moved between services. Plans for transition, referral, and discharge considered people’s individual circumstances and expected outcomes. Internal collaboration with professionals was strong, supported by regular multidisciplinary meetings that promoted joined-up working. Meetings with external professionals were in place, and the manager worked hard to ensure consistency in attendance to support effective communication and outcomes. Recognising that the local GP surgery had not always been responsive to the needs of the service, the manager was proactively working to strengthen relationships and had identified contingencies to ensure people’s needs were met and communication remained effective. People confirmed they were supported to attend appointments with professionals, which promoted coordinated care and their voices being heard. Tools such as hospital passports supported continuity and helped ensure that relevant information followed the person across services.

The provider did not always support people to manage their health and wellbeing, which impacted their ability to maximise independence, choice, and control. Systems and processes in place at the time of assessment were not always effective in promoting healthier lifestyles or reducing future care needs.

Feedback from some relatives raised concerns that people were not consistently supported to achieve the best possible outcomes, particularly in relation to mental health and overall wellbeing. Relatives noted changes in mood, behaviour, or emotional state which they felt had not been adequately recognised or addressed. This suggested missed opportunities for early intervention and preventative support. Relatives highlighted mental health as an area additional staff training could improve understanding and support better outcomes.

This feedback aligned with our findings that care plans lacked sufficient detail to guide staff in delivering person-centred, preventative care. Some records were inconsistent and lacked detail on key health interventions, such as when to monitor blood glucose levels. We also found examples where ‘when required’ medicines were administered to support mental wellbeing, but daily records did not correspond or provide evidence of appropriate use. This lack of clarity limited staff’s ability to identify emerging risks, intervene early, and prevent deterioration. It also meant people were not consistently empowered to take an active role in managing their own health and wellbeing.

The manager was working to develop staff confidence and capability in care planning, record keeping, and communication. Interim measures had been introduced while these improvements were actioned and embedded. Staff and leaders were working with professionals to ensure people’s support needs had been fully identified and the manager had increased staffing levels above the commissioned hours to provide greater stability and continuity of care while improvements were made.

The provider had systems in place to monitor people’s care and treatment in relation to their identified needs, and staff demonstrated a general understanding of individuals. In some cases, staff recognised when to escalate concerns and seek professional input to support positive outcomes. However, monitoring and escalation were not always consistent or effective, and gaps in practice limited the provider’s ability to ensure care remained responsive and aligned with best practice.

People told us they had access to appropriate equipment and professional advice tailored to their specific health conditions. This supported the delivery of care in line with current best practice and helped maintain positive health outcomes. However, some relatives told us some staff did not always appear confident in using people’s equipment. One relative told us, in relation to equipment their family member used, “There should be regular training for new staff, and refresher training for long-term staff.’

Care records evidenced systems and processes for regular monitoring of key health indicators, including bowel movements, weight, oral hygiene, and food and fluid intake. While monitoring was in place, opportunities for preventative action or escalation were sometimes missed. For example, we found gaps in some monitoring records which indicated a need for escalation. Inconsistent recording of personal care tasks, such as hair washing, raised concerns people may not have been supported consistently with this aspect of care. These gaps had not always been identified or addressed through governance processes at the time of the assessment. We have reported on this in more detail elsewhere in the report.

People told us they consented to the care and treatment they were offered. They described being able to clearly express their consent, provide instruction to staff about how and when they wanted to be supported, and understood their rights and what they were consenting to. This reflected a person-centred approach where people’s views and wishes were respected and acted upon.

However, some people noted that those who may lack capacity or experience communication barriers might not have the same experience. Records viewed varied in the level of detail recorded and highlighted concerns in relation to mental capacity assessments and best interest decisions. For example, some records were not decision specific, lacked detail about how a decision had been determined to be in the person’s best interests, or did not clearly document who had been involved in the process.

Despite this, staff were able to demonstrate a sound understanding of the Mental Capacity Act and how they applied it in practice. For instance, they were able to explain people’s rights to make unwise decisions and how they would support and respect those choices. The provider had identified areas for improvement in relation to documentation and had taken action to address this. This included providing training for staff responsible for carrying out assessments and completing mental capacity and best interest records.