Eversleigh Nursing Home

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.

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 made sure people’s care and treatment was effective by undertaking a pre assessment for people, prior to them moving to the home. This included assessing people’s health needs, care preferences and identifying what support they wanted. People’s future plans for their care were also considered as part of this process.

The registered manager said they preferred to see and meet people face to face, especially if they were still living in their own home. This meant they could make sure they could meet the person’s needs. Any new assessments were completed and the provider’s care plan system updated so staff had the information they required. Staff gave us examples showing how information from people’s initial assessments were communicated to them. One staff member told us, “[Senior staff] at the time of admission inform us. Relatives also input into these.” People’s care plans continued to be reviewed as their needs changed.

The provider planned and delivered people’s care and treatment with them, taking into account their preferences. They did not always do this in line with legislation and current evidence-based good practice and standards.

People were encouraged to have enough to eat and drink as staff offered them a range of choices based on people’s individual preferences, including where they wished to eat. One person said, “The [staff] come round and say what do you want to eat, they say there is two choices usually.” Another person told us, “I have lunch in my room I prefer that.” We saw people had drinks within reach.

Staff monitored people’s fluid and food intake, so they could be sure people had enough to eat and drink. However, 1 person had 3 different daily fluid targets recorded in their care records. Staff were unable to advise us which target to follow and how the fluid target for each person was decided. One staff member told us it was completed on the person’s initial assessment and based on the person’s weight and height. The person’s care plan had been recorded as reviewed, but the provider had not recalculated the fluid intake to reflect the person’s current weight and health needs. This meant there was no clear guidance for staff about when to encourage more fluids. In addition, staff were not always given consistent guidance within people’s care plans about levels of thickeners people may require in their drinks. We also found inconsistencies in guidance provided to staff about the texture of food people may require. Whilst we found no harm to people, this increased the risk people would not be supported to have the levels of fluids and nutrition they needed to maintain their health, safely.

The provider worked across teams and services to support people. They shared their assessment of needs when people moved between different services.

People told us they were supported to see other health and social care professionals when they wanted to. People said they were assisted to seek support for both routine and emergency healthcare. A relative told us, “[Person’s name] gets GP visits, no problems. An eye test was done here. I take them to the dentist.”

Staff gave examples showing how they had escalated healthcare concerns to people’s GPs, speech and language therapists, and social care professionals. Staff communicated changes in people’s needs at regular meetings at the start and end of each shift. In addition, senior staff from each of the departments within the home met each day to communicate information about the running of the home and to escalate any concerns for people. This also provided an opportunity for staff to focus on the needs of the people they cared for.

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.

Improvements were required to consistently ensure people’s opportunities for continuing to live healthy lives was maximised. For example, through best practice in administering people’s medicines, so their therapeutic value was maintained. Improvement was also required to ensure people with specific health conditions and diagnosis had access to important healthcare screening. This included regular eye tests and annual health checks, or to ensure any clinical decisions were clearly recorded, if this was not appropriate.

However, people were supported to manage some aspects of their health, including accessing some health assessments and checks where appropriate with health and care professionals. For example, people were supported through referrals to tissue viability teams, where people had developed wounds or pressure sores. Guidance had been sought from podiatrists, where appropriate. In addition, people were now supported by staff to undertake gentle exercise.

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

We could not be confident people’s needs were routinely monitored. For example, 1 person required an element of their care to be regularly checked. One area of the person’s care plan guided staff to do this every 30 minutes, but another area of the person’s care plan said this should be done hourly. A senior staff member told us this should be done every 30 minutes. The person’s care records confirmed the checks had not been undertaken every 30 minutes.

In addition, further improvements were required to ensure people’s wounds were consistently managed. For example, staff had regularly checked people’s wounds but not always followed their own processes to confirm how the wound was progressing.

However, we found monitoring of people’s outcomes was more effective in other areas. For example, in relation to some specific health conditions, where staff were monitoring people’s health in line with their assessed needs and as planned. Risk of malnourishment was also assessed and where people had lost weight guidance was sought from health professionals such as Speech and language therapists (SALT).

The provider did not always promote people’s rights around consent and did not always respect their rights when delivering care and treatment. While people’s capacity to make their own decisions had been considered, people’s mental capacity assessments did not consistently evidence people had been given the best opportunity to make their own decisions. For example, there was limited information about how people had been supported to understand the decision to be made. There was no evidence to indicate staff had provided people with the chance to undertake mental capacity assessments at different times of the day, or under different circumstances. Doing so may give people greater opportunity to understand the decision to be made.

The registered manager had begun to consult and involve people and their relatives on a broader range of best interest decisions. For example, there was a long standing CCTV installation at the home. In relation to people and visitors, this was limited to the reception area of the home. At the time of the inspection, the registered manager had consulted with 1 relative about the installation of CCTV, but was not able to provide us with a timescale for the completion of the consultation.

However, people’s relatives were appropriately consulted when key decisions needed to be made about their care, such as their liberty being restricted. One relative gave us an example showing how they had been updated on the outcome of a Deprivation of Liberty Safeguard, which had been put in place for their family member. There were examples where decisions had been made which were in the person’s best interests. Others who knew the person well had been consulted as part of this process. The provider had made appropriate referrals where people were potentially being deprived of their liberties.