Evergreen Lodge

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 changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to regulation 11 consent to care.
 

This service scored 33 (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 ensure that people’s care and treatment was effective, as they had not consistently assessed, reviewed, or discussed people’s health, care, wellbeing, and communication needs with them. There was no evidence people, or their relatives had been involved in discussions about the care and support needs to meet people’s needs safely. We also found that staff were consenting to peoples care with no evidence of any consultation with the person.Care plan records demonstrated care needs had not been discussed with the person or their appropriate representative.

We identified care plans required improvement, they, included contradictory information such as different amounts of 1:1 support recorded within the same document. Some care plans contained other people’s names, indicating they were not person-centred.

Some care plans recorded information about the triggers that could contribute to people becoming distressed and what staff could do to support them, however through our observations and analysis of those records, we identified that staff were not following the guidance as to how people should be supported, within the care plans.

Following our feedback the registered manager has informed CQC that all care plans have been reviewed and updated.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care was largely task driven with fixed schedules in place. There was limited evidence of people being involved in decisions about their care or that their individual preferences had been considered. For example, people had set shower days, cigarette breaks, restricted movement within the home with routines dictating time for personal care and mealtimes. People’s goals were not always personalised; we identified one person’s goal in relation to their medical care, was for staff to be aware of their past and present medical history to enable them to care for the person, this evidences a focus on their medical condition rather than a meaningful or outcome focused aim.

There was evidence within the handover records to demonstrate some information was shared between day and night staff, however it lacked detail. Meetings were held daily with the heads of departments for information to be shared however, there was not always a representative from each department and actions were not always recorded. As a result, it is not clear how the information shared during this meeting was cascaded to all staff. Staff meetings took place, but these were unit specific and staff told us they worked across multiple units if required.
Staff told us they felt they worked well as a team. One staff member said, “We have a good team.” A professional we spoke with was happy with the information they received from the service, one health professional stated, “I have a good relationship with the nursing staff team”, and “they communicate well.”

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

We observed limited activities to promote people’s wellbeing. People were observed sitting in communal areas with no television or radio on. This lack of activities did not support people to maintain their wellbeing, and they are at risk of social isolation. A professional we spoke with said, “I think people are just bored and have no sense of purposelessness. I know a lot of people are just bored; for example, in the lounge they are just left sat in chairs. Sometimes there is a fish tank or an animal programme on the TV, but there is never any sound on.”

Lack of stimulation did not support people’s wellbeing or help to reduce future needs for care and support.

The provider did not 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. Goals and outcomes recorded within care plans were not individualised or personalised, and there was no evidence these goals had been made in consultation with people. Although reviews did take place monthly, they did not evidence whether outcomes had been achieved, whether there was any need for change or whether they were still appropriate. By not ensuring outcomes were updated it was not clear that the support being provided was meaningful and effective in supporting people to achieve them.

The provider did not ensure people were informed of their rights around consent, nor were these rights consistently respected when care and treatment was delivered.
Where people lacked capacity to make specific decisions about their care, the principles of the Mental Capacity Act 2005 was not followed to ensure decisions were made in the persons best interests. There was no evidence to demonstrate that all practical steps had been taken to support people with decision making for example, for people with communication difficulties there was no records of alternative methods of communication being utilised and we did not observe any being used during the assessment.
Additionally, when restrictions were implemented, the service did not ensure that the appropriate people were involved in the decision making process to support a best interest decision being made.
For some people, restrictions had been implemented without evidence of a mental capacity assessment or a best interest decision making process.
Following our assessment the provider has informed CQC they have reviewed their Mental Capacity processes.