Higher Bank

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 safe care and treatment specifically relating to people’s nutrition and governance.

This service scored 50 (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 and records relating to care was not always as robust as they needed to be.

Appropriate assessments were not always in place in people’s care plans. Care plans were not as detailed as they needed to be in multiple areas. For example, areas relating to nutrition and choking were inconsistent and at times contradictory.

People and their relatives said they had not seen their/their loved one’s care plan, but people’s relatives felt they were kept up to date with their loved one’s care. Staff told us staff and registered managers were involved in creating peoples care plans.

The provider did not always plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

People’s nutritional needs were not appropriately assessed. We found some people were eating modified diets without appropriate assessments, as no referrals to speech and language therapists had been made. We found one person’s care plan said they should be on a soft diet, but they received a pureed diet. One person was who was on a pureed diet was also prescribed a thickener, this had been stopped and it was not initially clear why this had happened. We were not assured appropriate referrals were always being made based on our findings in relation to people’s nutritional needs.

People and their relatives said they or their loved one received enough to eat and enjoyed the food. One relative said, "We have seen the Sunday roasts and curries, and it always smells lovely." Whilst one person said, “We get plenty of food, more than we can eat."

The provider generally worked well across teams and services to support people, though further work was needed in some areas.

People and their relatives felt services worked together and told us that they/their loved one got see healthcare professionals when needed. One relative said, "They keep me up to date with things.”

Staff spoke about how they were told when people’s needs change including at handover. Staff felt the staff team worked well together. Health professionals told us they felt they had a good handover of information from staff at the service. One professional said, “Yes, I find the team work closely and communicate well.” We saw some evidence of handover records.

The provider did not always support people to manage their health and wellbeing in line with guidance.

People were generally able to access healthcare support when they needed it, such as GP support, but referrals to specialist teams such as speech and language therapists were not always appropriately made.

Staff spoke about how they encouraged people to be healthier, a staff member said, “We do chair exercises a couple of times a week.”

The provider did not always robustly 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.

People’s care plans were being regularly reviewed, though the reviews did not identify the issues we found. We were not assured that appropriate tools were in place/being used to manage people’s weights and skin integrity, as records in care plans were not always clear. Information in a weights file did not seem to be appropriately cross referenced nor was information transferred and input into the necessary monitoring tools.

A registered manager told us how they reviewed and monitored people’s care. They spoke about how people’s weights were monitored, they said, "We take weights every week, sometimes we use scales sometimes we do a circumference of the arm."

Some relatives spoke about positive things the home did to promote better outcomes. One relative said, “They sorted out his ears when he needed someone to come and syringe them."

Although the provider did tell people about their rights around consent, we witnessed staff did not always respect their rights when delivering care and treatment.

Some records lacked detail such as best interest and mental capacity assessments. During our lunch time observations, we witnessed one staff member support someone with eating without gaining consent.

Staff said they asked for consent before delivering care, a staff member said, they “Always ask for consent before personal care.” Appropriate consent forms were in place. A registered manager confirmed people could access advocates if they needed this type of support, though no one was using advocates at the time of the inspection.