Sandholme Fold

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 did not always make sure people’s care and treatment were effective because care was not always delivered as detailed in the risk assessment or care plan.

A minority of people had assessed needs for which the provider’s registration details did not include, such as younger people and those with a learning disability. We discussed this with the provider who said they would take steps to ensure their registration details reflected the care provision.

People’s needs were assessed using a range of clinical assessment tools and these were used to develop care plans which informed staff how to support people to meet their needs and preferences. However, staff did not always work in line with people’s care plans. For example, some moving and handling practices, use of pressure relieving aids and support at mealtimes were not carried out as described in people’s care plans.

People’s communication needs were assessed and care plans developed. For example, a care plan was in place for a person whose first language was not English. Staff had liaised with the person’s family and had used a translation service and an interpreter when needed.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

One person told us they were concerned about their weight and needed support to change this. There was no evidence of any actions being taken to address this in the person’s care plan. Another person told us they would like to see a dentist because they were losing teeth. We asked a member of care staff about this who did not appear concerned and said this was the responsibility of a team leader. They said they do have a visiting dentist but didn’t know if everyone was offered this service.

One person’s care plan said they were at risk of weight loss and needed to be encouraged with their meals and have their food cut up for them due to recent illness. We observed this did not happen.

Relatives told us they thought the service had a good relationship with the GP and felt staff would always follow up on any health concerns.

We received mixed feedback about the food provided at the service. Some people felt the quality was poor whilst others enjoyed it.

Some care plans were in place which included links for further information. For example, a care plan for use of a particular medicine had links to the NHS website for information about using the medicine.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not have effective systems in place to assess that care delivery was in line with planned care, or to check the effectiveness of care.

There was no effective monitoring of care delivery or care documentation. For example, inconsistencies in some care plans had not been identified and there was no evidence of oversight of care records. Omissions and inconsistencies in records relating to issuessuch as repositioning, had not been picked up and addressed. This meant it would be difficult to assess if the planned care was effective for the person.

The provider told people about their rights around consent but were inconsistent in respecting these when delivering person-centred care and treatment.

Some people had an enduring power of attorney (EPOA) in place which meant another person could make decisions on their behalf because they lacked capacity to do so themselves. One person’s care record said they had an EPOA in place and their relative would guide staff in making decisions about their care. However, when we looked at the EPOA we saw this was in relation to managing financial matters and not decisions about care. It is important staff have a full understanding of people’s EPOAs.

Best interest decisions made for people who lacked capacity to do this themselves were recorded but did not always detail who had been involved in the decision-making process.

Our observations of supporting people to make choices were mixed. Some staff tried hard to encourage people to make choices whilst others did not. For example, we saw staff placing mealtime clothing protectors on people without asking if they would like one and saw staff moving people’s wheelchairs without discussion with them.

We observed staff knocking on people’s doors and a relative who acted as advocate for their family member told us staff involved them wherever possible.