Saxon Lodge Residential Home Limited

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.

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 was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Staff had identified people’s needs but had not fully assessed how these affected people’s daily lives and what support they needed. For example, when people were living with anxiety, hallucinations, Parkinson’s disease or epilepsy, their needs and how these conditions affected their lives had not been clearly identified. When people’s needs had changed these had not been assessed and care plans were not updated to make sure all staff understood their role and there was a risk people would not receive the care they needed in the way they preferred. Where people had capacity staff had discussed their care with them. Following the inspection the provider sent CQC examples of updated care plans.

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 recognised tools such as Malnutrition Universal Screening Tool (MUST). However, staff had not always used it correctly to identify concerns. For example, a person had a MUST score of 0, meaning no or little weight loss, but the person had lost 16% of their body weight since they were admitted to the service. The person was already receiving nutritional supplements from the dietician at the hospital, but staff had not recognised the nutritional risk and the continued weight loss, leaving the person at risk of further weight loss and malnutrition.

When people had specific dietary requirements such as a puree diet, staff were aware of these needs. However, puree meals were not always appetising or of the correct consistency. We observed the lunchtime meal, spending time with a person who required a puree diet. The meal did not meet guidance from East Kent Hospital Foundation which stated the food must be completely smooth with no lumps, hold its shape on a spoon, and not require any chewing, as 1 part was green liquid and the other part had lumps in it. The person did not eat the meal even with staff support. By not ensuring the consistency and presentation of puree meals people were placed at risk of choking and weight loss.

People and relatives told us the food did not meet their needs. A relative told us, they had asked for soup to be offered in a mug instead of a bowl as it was easier for their family member, but this had not been done. Following the inspection the provider told us they had sourced additional training and food moulds to be used when serving pureed meals.

The provider did not always work well across teams and services to support people. Staff contacted external professionals including mental health team and dementia crisis team when incidents had occurred. However, the records and information provided was not always accurate and contemporaneous. For example, we reviewed documents and emails completed by the registered and deputy manager sent to professionals. The information differed in each correspondence; there was a continued risk decisions made by professionals would not be based on accurate information received from the provider.

Relatives told us, they were kept informed of any changes in people’s care and were kept informed about accidents or incidents.

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.

Staff had received training in dementia care. However, relatives told us, they were not confident staff understood dementia and how to support people when they were distressed or anxious. A relative told us, “They don’t recognise (relative) being upset.” Another relative told us, they had to attend the service when staff had not been able to calm their family member.

People who could express themselves told us; they were involved in decisions about their care and support. They attended clinics and had been supported to lose weight to improve their health conditions such as diabetes. Staff contacted the multi-disciplinary teams for support when people's behaviour changed.

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. When people displayed anxiety and distressed behaviours, changes had not been made to the support they received. Staff had not always analysed the incidents to identify possible triggers and take action to reduce the risk of people becoming distressed. For example, a relative told us, they had regularly observed a person walking around the service saying, ‘they wished they were dead’, staff had not reassured the person. We observed a person walking around looking for a relative, staff continually walked past them and did not reassure them.

Relatives told us they did not feel there were enough activities to keep people occupied. There was no cover for when the activities co-ordinator was not there at weekends or on holiday. People told us they were bored and there was not always staff in the communal areas to spend time with people. The registered manager had not ensured people had good outcomes and quality of life.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. People’s capacity had been assessed and recorded in their care plans. When people had capacity to make decisions, they had been involved in making decisions about their care and these decisions had been respected.

When people did not have capacity to make decisions this had been recorded for various aspects of their care and support such as receiving personal care or medicines.

When decisions are made in people’s best interests, these need to be recorded to show how the decision had been made. We observed a person in a wheelchair with a lap belt in place. We checked their care plan and there were no records to show who and how the decision to use a lap belt had been made and there was a risk the person was being restricted. Following the inspection the provider told us the required documentation for the use of a lap belt had been completed.