Archived: Parkhill Nursing 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.

The service was in breach of one legal regulation in relation to how the provider ensured people were supported safely to eat and drink.

This service scored 46 (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 ensure people’s care and treatment was effective because they did not consistently check and discuss people’s health, care, wellbeing, and communication needs with them.

The provider had introduced a ‘resident of the day’ scheme to review risk assessments and care plans regularly. While this process was in place and followed, we found care plans and risk assessments were not updated promptly when people’s needs changed or did not reflect the persons current needs.

The provider’s own checks had identified missing information in records, including moving and handling risk assessments. However, there was no evidence these gaps had been addressed by the provider by the time of our visit. Although general details about people’s moving and handling needs were included in care plans, they often lacked specific guidance for tasks such as supporting people to shower or bathe safely.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider had recognised the need to make the service more dementia-friendly and included this in a three-year action plan. However, aspects of the environment and care had not been prioritised to ensure timely support for people already living at the service.

Referrals were made to services such as dietitians and speech and language therapists when needs were identified. However, where assessments and advice had been provided, there was limited evidence action had been taken. For example, some people had dietitian care plans recommending regular high-calorie snacks two to three times a day, milky drinks, and fortified meals. Records did not show people consistently received high-calorie snacks or milky drinks. While the chef told us meals were fortified, care records did not demonstrate other meals provided by care staff were fortified to increase calorie intake.

We found staff had not been given sufficient guidance to understand modified diets and identify high-risk textures. They relied on examples listed in the framework, which did not provide a comprehensive list of all high-risk foods for each type of modified diet. As a result, 2 people assessed as needing a modified diet were given food which was not suitable for their needs. We also found examples where people assessed as needing encouragement or prompting to eat were not consistently supported, and this was not always reflected in care plans. In addition, people who chose to eat meals in bed did not have clear guidance in their care plans to ensure risks were mitigated. One person assessed as high risk when eating should have received regular checks during mealtimes, but we found no evidence this was happening in records or through our observations.

The provider did not always work effectively across teams and services to support people. They did not consistently share assessments of people’s needs when individuals moved between different services.

Staff generally knew people well and sought medical assistance when required. However, advice from external professionals was not always clearly recorded in care records. We found conflicting or missing information across care plans, handover notes, flash meeting minutes, and snapshots. In several cases, this lack of clarity meant advice was not followed. Examples included guidance on repositioning and dietary information for people on specific diets, including modified diets. Staff wanted to provide the best possible care but did not always have the training, knowledge, guidance, or support needed to do so.

The provider did not always support people to manage their health and wellbeing, which meant people could not always maximise their independence, choice, and control.

Staff were generally good at identifying when people became unwell, and records showed medical attention was sought promptly, with appropriate contact made with doctors or out-of-hours services. However, there was limited evidence action was taken to reduce future risks. For example, records were not always reviewed after a person had fallen or when their needs changed.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Systems were in place to monitor people’s care needs, but these were not always implemented effectively. For example, there was a section in handover records to record people’s fluid intake, but this was not consistently completed. People did not always have an overall fluid target, making it difficult for staff to understand what good fluid intake looked like for each person. Reviews of fluid records showed significant fluctuation in people’s intake over the previous month. People at higher risk, due to health needs, such as those with catheters or at risk of urinary tract infections, were not always encouraged to maintain good fluid intake to reduce the risk of complications.

One person had lost a significant amount of weight over the previous three months but did not have an accurate assessment of the risk relating to weight loss. There was little evidence that action had been taken to encourage calorie intake through increased provision of high-calorie food and drink. Although the provider advised that this person’s weight fluctuated and a referral had recently been made to a dietitian, we did not find evidence of this in care records, including handover notes, flash meeting minutes, or care plans.

The provider did not always inform people about their rights regarding consent and did not consistently respect those rights when delivering care and treatment.

Where people had capacity, consent records were in place as required. However, for people who lacked capacity, although mental capacity assessments and best-interest decisions were recorded, there was not always a clear record of who the decision-maker was. Where a lasting power of attorney existed, this was not always clearly documented in the records.

Consent was not consistently requested when providing support. For example, during mealtimes, plastic clothes protectors were often applied without seeking people’s consent.