Franklyn Lodge 9 Grand Avenue

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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.

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.

We found a breach of regulation in relation to person centred care. The provider had not ensured people needs were assessed and reviewed according to their current care needs and in line with evidence-based care and good practice

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.

Where support plans had been recently updated, they did not always reflect the current support staff provided to people. One person’s support plan stated “I currently use my wheelchair to access the community during community activities” such as shopping, bus rides and bowling, and “I particularly enjoy socialising with others “, yet records showed the person had not been supported to leave their room for at least a month prior to our visit. There were no guidelines for staff on how to engage the person who particularly enjoyed socialising, and the support staff provided was solely task-based. This left them at significant risk of not having their social and emotional needs, met.

Some support plans contained contradictory information and could be confusing for support staff. One person’s support plan stated they could use the toilet independently. However, it also stated they had a habit of being incontinent of urine. It was not clear what support the person required to maintain continence safely and effectively.

People’s needs were assessed when they moved into the service and a support plan developed based on their assessed needs. Some support plans we reviewed were updated at six-monthly intervals. People’s communication needs were assessed and documented within their communication dictionaries. Relatives were invited to people’s reviews.

The provider did not always plan and deliver people’s care and treatment in line with evidence based best practice.

People who lived in the home had multiple needs including communication, behavioural and emotional needs. We observed that staff did not engage or communicate with people effectively. For one person, staff did not engage at all, outside of supporting them with meals and personal care. This significantly impacted on the person’s quality of life and left them at significant risk of isolation.

People’s support did not always meet their needs and preferences as there were too few staff, and staff did not have access to information about innovative practices and new developments to improve the support they provided to people.

Notwithstanding the above, relatives told us people were supported safely and could access health professionals if needed.

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.

Staff demonstrated effective teamwork within the service. People’s relatives reported that staff communicated well and coordinated support effectively. One relative told us, “Staff work well as a team, I’ve seen the way they [staff] work, and they [staff] always give me enough information.”

The service was in transition replacing paper-based care plans, with a new digital system to improve consistency in care delivery across shifts and roles. One staff member said, “I can check on the tablet and update the daily notes,” another said, “The new system is much better and more conducive.”

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.

We were not assured that staff always supported people to take exercise or enjoy the outdoors to help ensure they lead healthier lives. Activity records showed that two people had not left the home for the month before our visit, with one of them not leaving their room. A third person left the home for the first time in a month on the day of our visit, for a short walk around the local neighbourhood.

Staff supported people to eat well. Records of meals showed that most meals included fresh vegetables and fruit. Where people required modifications to the set meals due to diabetes, staff were aware of this and supported people to make changes.

One person required their food to be pureed, and staff facilitated this. A support worker told us, “I came up with the idea to blend [person’s] food when she was refusing to eat. [Person] is now able to drink the same nutritious meals as the others and gets all the vitamins she needs.”

One relative told us, “[Person] was putting on a lot of weight so to minimise risk they changed his diet; [person] gets salads and more veg now. They’ve done a good job with the food. I’m very relieved.”

Staff supported people to access healthcare appointments when required. The registered manager had requested domiciliary visits from some health care professionals for some people who found visiting health care providers overwhelming, and these had been facilitated.

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

The provider did not have an effective system in place to monitor, support and improve upon the outcomes for people.

Each person’s support plan identified short and long term goals for each area of life in which staff supported people. Some of these goals were person-centred and were based on what people could learn, however Some goals were also generic and were the same for every person who lived in the home. For example, all six people had the goal of “Manage [their] bank account and personal budget without support” written into their support plan. Due to their level of disability and capacity to understand and make decisions about their finances, this goal was unattainable for many of the people who lived in the home and the care records did not detail how each person would be individually supported to achieve this goal, and what steps staff would take to support them to do so. Other people’s goals had not been updated as their needs had changed. For example, one person’s goal was “It will be a long -term plan/goal for [person] to be able to know how to take [their] medication when [they]require it without support and achieve most of the support required to meet both the medication and the medical health needs.” From December 2024 the person had started to regularly refuse their medicines, but this goal had not been updated.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Family members confirmed discussions were held with them, and we observed in some instances peoples wishes being respected by documenting these in care plans. Staff had a good understanding of people and how they gave consent.

Staff supported people to make day-to-day choices, such as the clothes they wore and the food they ate for meals. Effective strategies for supporting people to make choices were included in each person’s support plan, for example “Though I participate in choosing what clothes to wear; I need staff to help me to make weather- suitable choices of clothes.”

We observed staff asking people for consent before providing care and supported people to understand the care and treatment being offered.