Pilgrims Way Care Home with Nursing

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 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 and person centred care.

This service scored 42 (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.

Staff assessed people’s needs prior to people moving into the service. The service provided both permanent placements and short-term placements where people’s longer term care needs were further assessed. Assessments including speaking to people about needs such as equality and diversity needs. However, the care plans in place for people did not always reflect their needs. For example, where people were at risk from emotional distress this was not clearly reflected and planned for in their care plan.

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

People’s needs were assessed using a variety of risk-based tools. For example, to assess risks from low body weight or skin fragility. However, these assessments were not always used to develop a comprehensive, complete and accurate care plan. Guidance was not always being followed. For example, national institute for health and care excellence (NICE) guidance was not always being followed for managing medicines in care homes.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Feedback from partners was mixed with regards to communication. For example, one partner told us, “Staff provide a comprehensive handover of relevant information.” However, another partner expressed frustration with regards to communication with the service and accessing information.

Staff shared information with partners when people moved between services. However, gaps in care plans meant not all relevant information that was important to that person was included. For example, the service was not able to provide assurance they were aware of who should have deprivation of liberty safeguards in place.

We also identified concerns within the staff team. There were clear tensions between some members of staff. This was expressed by staff in a staff survey. One person also told us they were aware of this and said some staff were rude to other staff and got “agitated far too quickly” at other staff.

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.

There was an inconsistent approach to supporting people to live healthier lives. For example, one person asked a staff member for some fruit. The staff member told the person, “Not today, maybe tomorrow”. This was then corrected by another member of staff who told the staff member bananas and yoghurt were available. When we asked staff about snacks, they told us people were offered biscuits and cakes and only mentioned fruit when we specifically asked. We raised this with the management team who agreed fruit could be offered more and had gone down well when offered in the past.

Activities offered to people included exercise and movement to encourage people to keep active and mobile.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Care records were poor and there was a lack of monitoring and oversight to ensure people’s care was being effectively delivered. For example, where people were at risk from pressure sores there were gaps in their records and we could not be assured staff were providing the care needed. If this was being monitored by managers, these gaps in the records would have been identified and they were not. This meant there was a risk poor care would not be identified.

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

Care was not being delivered in line with the mental capacity act 2005 (MCA). Whilst we saw people were offered day to day choices during the inspection there was no evidence more complex decisions had been made in line with the MCA. For example, one person had no best interest decisions recorded at all when they should have. Another person had a decision recorded to show how it had been decided it was in their best interests to move into the service. However, an alert mat had been put in place to let staff know when the person got out of bed. There were no records to show how this decision had been made. Whilst we did not identify any decisions we were concerned about, the appropriate processes had not been followed to ensure people’s rights were respected and in compliance with the law.