Sholden Hall 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 50 (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 they did not always check and discuss people’s health, care and wellbeing needs with them. People gave mixed feedback about whether they had been involved in the development of their care plan. Care plans were not always robust to ensure people’s assessed needs were effectively met by staff. There were systems in place to continually assess and review people’s needs, however, these had not always been operated effectively to ensure care records contained consistent and up-to-date information for staff to follow. This meant people may not experience consistent care from staff who supported them.

However, people’s needs were assessed before they moved into the service and the provider used recognised assessment tools to understand people’s needs and any risks to them. Assessments included people’s physical and emotional well-being as well as their communication needs. Staff were knowledgeable about most people’s needs and gave examples of how they supported people based on their needs.

The provider did not always plan and deliver people’s care and treatment in consultation with them. People had not always received care that was in line with legislation or best practice. For example, the provider had not ensured staff always followed the principles of the Mental Capacity Act when supporting people.

People living at the service were having their fluid intake monitored. However, only 1 of the people being monitored had a fluid target and was flagged on the electronic system as needing their intake monitored.Fluid targets support staff to know how much fluid a person requires to reduce the risk of dehydration. Where people are not at risk of dehydration or assessed as needing their intake monitored this should not be in place.

The provider did not always deliver care in line with what was important and mattered to people. Some people commented that their food preferences were not always respected by staff, and they were given items of food they did not like.

Professionals were positive about their experience of working with the service and felt they were consulted on people’s care however staff had not always followed the guidance given by healthcare professionals to ensure people received effective care and treatment. For example, staff supported a person with their blood sugar level monitoring, they had been asked to follow a regime of monitoring, and this was not being consistently completed as instructed.

The provider did not always work well across teams and services to support people. Systems and processes in place to support staff teams and services to work together had not always been effective. Professionals told us that the service made referrals to support people’s physical health needs. We found that although referrals were made, advice was not always followed for example, to contact the diabetic nurse team each time a person’s blood glucose levels were in double digits.

The provider had been supporting some people with high anxieties and although there had been some communication between the service and other professionals and partner agencies, people did not always receive care to meet their specific needs to ensure their safety.

The provider told us they had not always felt supported by partner agencies to ensure people’s holistic needs were met and to support people safely.

Staff told us they worked together well as a team. They told us there were systems in place to ensure important information about people’s needs were shared such as during handover between shifts.

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.

There was mixed feedback from people and relatives about how the service supported people’s social well-being. Some people felt there were not activities that they would enjoy available to them. A person told us, “There’s nothing that I’m interested in and it’s difficult to socialise…” and other people commented, “There’s nothing that I like.” There was an activities co-ordinator however they only worked 2 days a week. Staff were expected to engage people in activities at other times. There was outside entertainment that helped to provide some more meaningful activities for people and promote their well-being.

Staff told us they monitored people’s health and knew how to escalate concerns if people were unwell. People gave examples of times they had been unwell and how staff had supported them back to good health. A person said, “staff involve other health professionals, and I had blood tests when required."

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.

People’s care was not always well monitored as records about people’s care was sometimes poor. For example, records in relation to a person’s catheter care were not always recorded to provide clear oversight of the person’s fluid intake and output effectively. Monitoring charts such as hourly checks on people’s wellbeing contained gaps. The monitoring chart’s for people also sometimes contained conflicting information to what was recorded in daily notes. When we asked staff about planned care that should have taken place, they told us it happened, but it was not always recorded. This included when care, treatment or interventions had been offered and declined such as declined fluids or declined activities. This meant the provider and registered manager could not be assured people were receiving their right care as planned.

However, the registered manager had been working with a person to try to achieve their goal of moving back home with a package of care. They were encouraging the person to be as independent as possible while living at the service.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Staff told us they offered people choices and respected their wishes and right to decline care. However, people told us staff did not always ask for their consent before they supported them with their personal care. A person said, “They don’t ask me. They just do it, I’m a bit embarrassed about it.” Another person said, “No they don’t ask, they say ‘Come on, we’re going to shower you.”

People’s capacity was assessed in line with the Mental Capacity Act 2005 (MCA). However, where people were assessed as having capacity they had not always had their choices respected. For example, where a decision was deemed to be unwise around people forming a relationship; people had experienced restrictions, and staff had intervened to discourage interactions.

Where people were assessed to lack capacity to make specific decisions, best interest decision meetings were held where required for most decisions. However, some people’s rights had not always been upheld in line with the MCA. This has been reported on under the safeguarding quality statement in the safe domain in relation to some people experiencing unauthorised restraint which had not been identified as a concern or addressed by the registered manager or provider.

Other Deprivation of Liberty Safeguards (DoLS) had been applied for as necessary. There was a process in place to track and monitor applications and when authorisations needed to be renewed.