St James's 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 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 legal regulation in relation to consent to care and treatment.

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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs had been assessed; however, this information had not always been used effectively to develop care plans that supported staff to meet people’s needs safely. Care plans were not always effectively updated and at times they contained conflicting or outdated information. This meant staff did not always have up to date and detailed information about people’s assessed needs. This placed people at risk of receiving inappropriate care and treatment.

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

Although people’s needs had been assessed, this information was not consistently used to develop clear and effective care plans. This meant staff did not always have the guidance they needed to deliver care in line with current standards.

The provider used nationally recognised tools to assess people’s needs. However, these had not always been completed correctly, for example, the ‘Waterlow’ skin assessment tool that was used to assess people’s risk of developing pressure ulcers. Within some care records the score of the risk assessment was conflicting, which meant there was an increased risk of people’s skin integrity needs not being met.

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

The service management did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Staff provided mixed feedback on the communication within the service which impacted on the care provided to people. Meetings and communication from the registered manager was described as limited, and some staff told us the registered manager was hard to communicate with. However, other staff said they worked well together as a team. One said, “I do like it here and I like the environment and the team.”

Health professionals we spoke with did not raise any concerns about the service or communication.

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.

People who may have been at greater risk of malnutrition had regular weights recorded. However, we saw that where required, appropriate escalation and referrals had not always taken place. One person had been recorded on the weight record as suffering a noticeable weight loss over a month. This had not been escalated to any health professionals. We spoke with the registered manager about this who told us this had not been escalated due to the person being in hospital, however the records we reviewed did not support this information provided to us.

People and relatives told us they had good access to healthcare professionals. This included weekly visits from the GP where required and regular appointments with a chiropodist were available. However, there was no clear evidence to show that people had been involved in planning their own care. This meant people were not always supported to make informed choices about their health and wellbeing.

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

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

Systems to monitor and improve outcomes for people were not always effective. Care records did not consistently show people’s health and wellbeing were routinely monitored. There was also a lack of clear information about expected outcomes, which meant it was not always possible to measure whether people’s care and support had been effective.

Records viewed did not consistently contain clear and accurate information relating to a person’s requirement for liquid thickeners in their drinks, which were used to support swallowing and reduce the risk of choking. This had led to the person receiving both a drink with thickened fluids and without, placing them at risk. One person received a drink from staff, and the drink was recorded as being given and consumed, however the drink had not been consumed. This could lead to inaccurate fluid level recording or the risk of dehydration not being identified.

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

People were not always supported in line with the principles of The Mental Capacity Act 2005. Where people had restrictions in place, for example bed rails, there was no evidence of mental capacity assessments or best interest decisions being completed. Where medicines may be required to be administered covertly without people’s knowledge, there was no framework in place to ensure this was done in line with legislation. This meant it was not always clear whether restrictions were lawful or in people’s best interests.

There was no recorded consultation or, where required, best interest decision for people who lacked capacity to consent to the surveillance the provider operated within the service. Some communal areas of the service were under 24 hour visual surveillance, meaning people could not be afforded privacy in some areas of the service.

This contributed to the continued breach of regulation in relation to consent to care and treatment.