Falcon House Care 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 Requires Improvement. At this assessment the service the rating has remained Requires Improvement. This meant people’s outcomes were not consistently good, and people’s feedback confirmed this.

Although we found improvements in the management and oversight of the service, the provider remained in breach of the legal regulation in relation to consent.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team 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.

The management team had not ensured people and those close to them were involved in regular assessments and reviews. This left a shortfall in ensuring people’s opinions were respected, listened to and implemented as part of their care planning.

Most people and relatives we spoke with could not remember if they had an assessment completed prior to moving into the service. Documents written by health and social care staff had not been used to create meaningful care plans for people. People and their relatives had not been fully consulted in care planning.

People living with specific clinical conditions did not have updated care plans and risk assessments in place for these. For example, one person had been identified as being at risk due to weight loss. The prescribed fortified shakes and GP guidance were not updated in this person’s eating and drinking care plan. This left people exposed to the risk of staff not understanding their specific needs.

We reviewed care plans and risk assessments for people requiring support with falls risk management. The risk rating assigned to individual people was not reflective of their current level of mobility and risk. The review details for each care plan showed these had not been updated following an incident or event. These care plans and associated risk assessments showed a lack of robust guidance for staff, with actions required or taken to mitigate risk not accurately recorded. The management team had referred onto an external team, for review of falls, dementia and cognition. The guidance from these health professionals was not updated in people’s care plans. This left people exposed to the risk of not receiving the care and support they required.

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

The management team did not ensure best practice in dementia care was being followed. For example, one person was described in their dependency assessment as displaying behaviours which may challenge. The records for this person showed a lack of exploration of the antecedent, behaviour and consequences records, (ABC) of each event. This structured approach allows care staff to understand potential triggers and impacts and can support effective interventions. The person was described as having a poor sleep pattern; yet was being monitored during the night at 2 hourly intervals by staff. The person was described as being continent and independently mobile. The service had not identified the person may benefit from a sensor mat in their bedroom, to alert staff if needed and to support better sleep hygiene.

We found improvements in diabetes risk management and monitoring for people. Multiple people required support to manage type two, diet-managed diabetes, where their sugar intake should be kept as low as possible. The information on the food and nutrition plan in the kitchen was reviewed and accurate. The kitchen staff showed a clear understanding of ensuring people received a low sugar diet, to support good health. Best practice guidance on diabetes management was included in people’s care plans and staff showed an understanding of ensuring this was followed.

We saw staff had a good understanding of people and their individual needs, although the wider care team had not signed to say they had read and understood people’s individual care plans and risk assessments. This left people at risk of harm, as staff may then lack knowledge of what immediate action to take if a person’s needs appeared to have changed.

The management team 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.

Where people had been assessed by an external team prior to moving into the service, we saw this information had not been incorporated into their care plans and risk management records. For example, a person living with Alzheimer’s had a cognition plan which was sparse and not personalised to them. The person had no specific risk assessment in place for their diagnosis. This left the staff team unclear as to what the support needs of this person would be, and how to recognise any changes which may require external review.

Although people had a person-centred care plan, ‘This is Me’, in place, the information in this section had not been updated, even though they had been regularly reviewed. Most sections in care plans which had been reviewed stated ‘no changes’ or ‘assessment remains the same’. There was a lack of consistent approach being maintained between Falcon House and external services, leaving people exposed to the risk of not being effectively supported with their identified needs.

People were supported to access their GP, dentist or optician regularly. Feedback from people and relatives was positive regarding this being accessible for them when required. One person said, “I go to hospital for eye checks and a staff member will go with me. I’ve had the dentist and chiropodist see me here.” A relative told us, “They’ve called the doctor in a few times over the years. I pay for the chiropodist and hairdresser so know my family member gets those done.” However, we saw information from these visits was not being used to inform and update care plans for people.

The management team 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.

Changes in people’s presentation, emotional state or distress, which may indicate a deterioration in their health or wellbeing were not always being recognised. There was a lack of personalised information on pain scales for people who were unable to communicate this.

We found improvements in the provision of good nutrition to support positive health and wellbeing for people. The kitchen team showed a good level of knowledge, and improvements in the quality of food had been noted by people. Feedback on the food was generally positive, with menu choices being offered and snacks available on request and from the tea trolley. One person said, “It’s brilliant. We have choices every day and I like tea the best.” A relative told us, “My family member eats well and hasn’t lost weight, so they seem to enjoy their meals.” However, the documentation for food and fluid intake for each person required improvement, to identify where a person may be at risk of malnutrition or dehydration.

Following our feedback at the last assessment; the management team had improved the policy and processes in place to ensure people were supported to access emergency health care if needed. For example, following a fall where an injury had been sustained.

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.

Feedback we received from people indicated the service worked in partnership with external agencies. However, we found the care plans, risk assessments and daily records for people had not been regularly updated when a review had taken place. This left people living at Falcon House with potential unmet needs.

We found a lack of therapeutic, meaningful engagement available for people. People and relatives gave mixed feedback about the lack of meaningful activities which were offered. In the main, people were observed to be seated in the communal lounge for extended periods of time with a lack of interaction with staff. One person said, “We don’t have something happening every day just lately. Sometimes we get a singer come in. We used to get taken to church in the middle of the week, which was nice, but not now. My family will take me out sometimes in a wheelchair for a change of scenery.” Another person said, “We used to have an activity person who would give us a list of what’s on, but they have left. They’re trying to get more done but it’s not regular. I’ve just been colouring today and playing snap.” We raised our concerns regarding the lack of structured activities available for people with the management team. They advised they were currently recruiting for a person, with a view to them commencing in post promptly.

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 were not always supported to understand consent, what being safe meant to them, and how to raise concerns when they did not feel safe, or they had concerns about the safety of other people. People were not always supported to make choices about their day and night routines. Information on this was not clearly recorded in their care plans and it was unclear if people’s preferences were known or being respected by staff. Therefore, we could not be confident that people were not being unnecessarily restricted.

Documentation related to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) had not been reviewed or followed up by the management team. We found the requirements of the MCA were not being consistently met and applied to ensure people’s rights were being upheld. Records of DoLS applications to the local authority had not been followed up by the management team after an extended period of time. Many applications had holding letters, so people were placed at risk of being subjected to unnecessary restrictions. Some people would be at risk if they did not have continuous supervision and control, where this was the case, we found a lack of application of suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty. We requested an updated DoLS tracker from the management team, we were assured by their response. However, this had not been reviewed and updated prior to our visit.

People who were able to, spoke with us about consent. One person said, “They always ask us first before helping us or giving us anything.” Another person said, “I’m not the easiest person to cope with, but they’re always good and ask if I’m ready to do something.” We observed staff during our visit asking people prior to providing support with personal care or meals.

There was a lack of information to support staff in communicating with people about their choices where they may not use verbal communication. The management team had not included objects of reference, visual aids or equipment to support this. Care records did not include how either through verbal or non-verbal means people were able to refuse or give consent for specific decisions.