Tolson Grange

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 remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to them going to live at the service and an initial, temporary care plan was developed for staff to work from until they got to know the person and their needs better.

Care plans were reviewed regularly to make sure they reflected any changes to people’s needs. reviews sometimes lacked evidence of the involvement of the person or, where appropriate, their family, although some relatives told us how they were involved in the process.

Care plans reflected people’s communication needs and abilities.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People’s dietary and nutritional needs were shared with kitchen staff to make sure they were provided with a diet that met their needs and preferences. Feedback about the food provided was mixed. One person told us the food was ‘OK’ and they could have their meal when they chose, another person said, “There used to be cakes in the afternoon and now it’s just a biscuit. I don’t get a menu; they just ask when they come in. Sometimes the meal is cold. Puddings seem to have gone down.” A relative told us they had to bring food in as their family member couldn’t eat the food provided.

The management team responded well to our feedback about the food and immediately put actions in place to address this.

Recognised clinical tools were used to assess people’s needs and evidence-based information about people’s specific health conditions had been included in care plans to help staff’s understanding.

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.

The provider had systems in place to liaise with health and social care professionals. Weekly virtual ward rounds were in place so that staff could discuss any non-urgent concerns they had about people with the GP. A single point of access was in place for staff to make referrals to health care professionals such as speech and language or district nurses.

A member of care staff had been praised by paramedics when they made a second visit to the service. They commented on the person-centred approach demonstrated by the member of care staff.

The service held a weekly ‘Blue Light Breakfast’ where health professionals were invited to the service to enjoy a breakfast.

Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Requests for support from appropriate health and social care professionals were not always made in a timely way. For example, we observed one person displaying behaviours that might indicate a difficulty with eating. This had been recorded in the person’s care notes, and a member of staff told us the person had been displaying these behaviours for several months, but no action had been taken to address the possible cause of their behaviour. Following our feedback managers made immediate referrals for the person to be seen by appropriate healthcare professionals.

One person’s care records gave conflicting information about their allergies. Their medical care plan said the person had known allergies that must be included on their medication administration record sheet, but other areas of the person’s electronic care record said the person did not have any allergies.

Records of visits from health care professionals needed to be clear about advice given. For example, one record said, the person had been seen by the district nurse who said they would provide cream and had advised the person “keep this clean and dry”. The record did not say where on the body the cream was being provided for or what the issue was.

The registered manager had secured the services of a dentist to provide care to people living at the service.

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Care charts for fluid intake were not monitored effectively. For example, one person’s intake chart showed the person was not always offered the fluids they needed to meet their target intake. On one occasion records indicated the person had only been offered 4 drinks in a period of 21 hours and on another occasion had not been offered a drink in a period of 11 hours. The person’s care plan said they preferred milky drinks and charts showed when these were offered the person drank all of them. However, the fluid charts for 2 consecutive days showed the person had not been offered any milky drinks and had taken little of the fluids offered. There was no evidence of these issues having been picked up through monitoring.

This issue was addressed by the management team following our feedback.

Reviews of people’s care varied. Whilst some included good detail about whether the care was still appropriate, others lacked evidence of a thorough review. For example, an emotional support care plan had been developed for a person experiencing grief. The care plan said the person may benefit from spiritual support as their faith played an important role in their life. The review of this care plan just said, ‘No change’ and did not include any evidence of discussion with the person about how they were feeling or any reference to spiritual support being sought.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Where people had been assessed as lacking capacity to make decisions about their care and treatment and had Deprivation of Liberty Safeguards [DoLS] including requirements known as conditions in place, care plans had been developed to inform staff about the conditions and what they needed to do to make sure they were met. Where Lasting Powers of Attorney were in place, this was clearly documented so that staff knew who to involve in planning people’s care and making decisions about their health and wellbeing.

Decision specific mental capacity assessments were completed and where people lacked capacity records were made of decisions made in their best interests.

People’s consent to, for example, staff managing their medicines, was recorded in care plans.