St James's Lodge

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• 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 an 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.

The provider and registered manager were in breach of the legal regulations relating to safe care and treatment, consent and governance.

This service scored 42 (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.

We found no evidence of a robust pre-admission process.

The registered manager told us they did not always have essential details, such as allergies or date of birth, before a person moved in. One staff member said,“We just get the basics on handover – care plans aren’t always completed.”

Care plans lacked guidance on individual needs, such as mattress checks for pressure care or falls risk management.

This contributed to the breach of regulation in relation to safe care and treatment and governance.

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

Records and staff feedback confirmed gaps in care practice, particularly for people needing support to move and reduce the risk of skin breakdown. One person’s records showed pressure damage and contained significant gaps, with a lack of evidence they were supported with regular movement. The registered manager told us the electronic care planning system were difficult to navigate and acknowledged checks were not always effective in identifying these shortfalls. Care delivery did not consistently follow evidence-based standards.

This contributed to the breach of regulation in relation to safe care and treatment and governance.

The providers training matrix showed outdated training in key areas such as dysphagia and dementia care. Only 41% of staff had up-to-date dysphagia training, and only 66% had completed dementia training.

The provider did not always work well across teams.

Staff described poor communication and lack of structured handovers. One said, “We never get a chance to read care plans – everything is word of mouth.” Feedback highlighted low morale and concerns about management support.

There was no evidence of lessons learned from incidents.

While some staff praised teamwork, others said, “We’re so short-staffed – it’s conveyor-belt care.” This concerns within this quality statement affected collaborative working and continuity of care.

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

People told us they enjoyed the food and relatives confirmed this, but relatives also raised concerns in relation to people not always getting the support they needed to finish their meals. This put them at risk of poor nutrition. Comments included, “The food is good, they are clued up on the generation and food they like to eat” and, “Food is just left and they are not supported to eat when they need it”.

Observations showed people were left for long periods with no meaningful engagement after activities ended. A lack of social interaction can impact people’s mental health and emotional well-being.

We saw records of people having access to chiropodists and GPs.

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.

Records used by staff to monitor people’s fluid intake was not completed consistently, putting people at risk of dehydration.

An action plan had been developed to drive improvement in the service. The registered manager acknowledged the action plan was “in early stages” and lacked timeframes. Provider level oversight was not evident. This meant risks and poor outcomes were not addressed promptly.

This contributed to the breach of regulation in relation to governance.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

Care plans lacked mental capacity assessments and best interest decisions. Care plans contained DoLS applications that were not compliant with legislation.

Staff said they relied on verbal consent but had no formal documentation, such as mental capacity assessments.

Records did not clearly indicate when people lacked capacity to make decisions. This meant staff did not have the information they needed to support people in line with the Mental Capacity Act 2005.

One staff member told us: “We always assume they have capacity unless proven otherwise.”

This contributed to a breach in regulations in relation to consent to care and treatment.