Elm Lodge Nursing and Residential 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 rating has remained 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 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were not comprehensively assessed. It was not always clear that people or their relatives were involved in the care planning process because some care plans contained generic statements and lacked personal details and preferences. When care plans identified the importance of personalised activities for people there was a lack of evidence that these had been provided.

One relative told us, “I speak for [family member] and they ask me everything-I don’t know much about care plans, but we talk regularly if I would like anything changed.”

Another relative told us, “We understand the care plan document, and we would like to be more involved”.

People’s communication needs were assessed appropriately, as the provider recorded peoples identified communication needs in their care plans. For example, if staff need to speak to someone slowly and clearly.

The provider had identified some areas of poor practice and standards that they had started to address. Some of these systems still needed embedding to ensure records were to a good standard.
Not all care plans included details of wound care management, equipment in place, external clinical team input, professional recommendations and guidance.
Care plans did not always record if staff had followed up people’s medical needs with appropriate health care professionals. One person told us, “What I would like to see different is that nurses here will follow up and chase doctors if I feel I need more treatment.” The service acknowledged this and had implemented a referrals log.
We also observed a clinical meeting where staff discussed referrals to other services, care and medication reviews, working with other professionals and updated documentation.
Staff we spoke with demonstrated they understood people’s needs for example, regarding the levels of food consistency they needed, and important medication people were prescribed.
 

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.

We observed staff discussing a person’s return to the home following a hospital admission. Staff discussed the importance of a thorough handover from the hospital to ensure they had an up-to date understanding of their needs.

People had urinary catheter care passports in place, and we saw evidence of effective communication and collaboration with other services.

The service did not always support people to manage their health and wellbeing where able, so people could maximise their independence, choice and control.

Desired outcomes were recorded in some care plans; however, these were not person centred with specific detail for the individual. For example, one care plan recorded the desired outcome was “To promote a therapeutic environment that reduces [service user’s] anxiety.”

Daily records detailed how people’s day-to-day health needs were met, however more information was required on how people’s wellbeing needs were met for example their physical activity.

People were encouraged and supported to understand and make healthier choices including their diet, lifestyle, physical activity, personal and oral hygiene. We observed staff offering people choices regarding their meals, drinks and activities.

Some people and their relatives told us they were not involved in monitoring and reviewing their own health and wellbeing needs as possible. For example, one person was unaware why treatment had stopped for a health issue. Another person told us “What they can do better is do the follows up -if my leg needs more treatments.”

Although the service did routinely monitor people’s care and treatment, such as weight monitoring, care plans and daily records did not provide assurance or updates that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

However, weekly nutrition meetings were held to discuss feedback from people regarding the quality of food. They also discussed weight and malnutrition tool records, the menus and people who had modified diets. One relative told us about regular reviews taking place to discuss their family member’s modified diet.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Mental capacity assessments were completed and available. However, some people’s Mental Capacity Act assessments had been completed for multiple decisions at once and although it stated other people were involved in the best interest decision it did not record their views. One person’s care plan contained conflicting information around their capacity and ability to make decisions.

However, staff understood the requirements of the Mental Capacity Act. One staff member told us “We presume they have capacity and make their choices and decisions and should not restrict them from their decisions. Should act in their best interest.” Deprivation of Liberty Safeguard applications and authorisations were in place when required. One staff member told us, “We assume [people] have capacity, guide them in the right direction, advise and support. For their best interest help them make their decision and ensure clear communication.”

One person told us, “I like it here because nobody is forcing me to do things”.

One relative told us, “We do believe staff ask my relative about any actions before doing it-I noticed many times before they ask for permissions-it is not problem for her because she can say what she needs.”