Charnwood Oaks Nursing Home

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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 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 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.

The provider did not always make sure people’s care and treatment was effective because people’s needs were not consistently assessed and translated into clear, accurate guidance for staff. Some care plans contained useful information about people’s preferences and day-to-day support needs, and relatives described that staff often knew their loved one well. However, we found important areas where assessments and care planning did not consistently provide staff with the detail they needed to deliver safe and effective care. For example, care plans did not always clearly describe key health needs and how these should be managed in practice, including areas such as diabetes and other long-term conditions. This meant staff did not always have reliable, up-to-date information to follow, particularly where people’s health needs were complex or required consistent monitoring and escalation.

We also found the quality of assessments and recording was inconsistent. Some records demonstrated good assessment and planning, but others did not clearly show how information had been gathered, how risks had been considered, or whether people and those important to them had been fully involved in reviewing care plans. This reduced assurance that people’s needs were consistently understood, reviewed and responded to, and it limited leaders’ ability to be confident that care plans always reflected people’s current needs.

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

Pressure wound information was not always recorded clearly or accurately, and repositioning records did not always demonstrate people had been repositioned in line with their care plan, including repositioning required every two hours. A stoma care plan lacked key information needed to guide staff safely, such as foods to avoid and baseline bowel patterns to help identify deterioration. In addition, clinical monitoring did not always include baseline information, such as blood pressure readings being taken without baseline statistics, which reduced assurance that monitoring could be interpreted and escalated appropriately.

Fluid records showed a significant lack of fluids being offered to, and therefore able to be consumed by people. Staff told us people were thirsty in the morning, and some relatives told us their family members were thirsty when they arrived to visit them.

There were some examples of good escalation, such as SALT referrals following choking incidents.

The provider did not always work well across teams and services to support people.

The service had experienced an outbreak of illness, which had affected multiple people across the service. The service remained in outbreak for several weeks, despite input from local infection prevention control teams.

There were examples of good partnership working with external healthcare professionals. Relatives told us medical professionals visited regularly and felt the service worked well with external professionals. One relative said, “A medication review took place a couple of weeks ago. The doctor had been in. The home called me and told me what the doctor had said.” Staff described nurses being hands-on, supportive and willing to share knowledge.

The provider mostly supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff mostly supported people to live healthier lives and where possible, reduce their future needs for care and support.

Relatives described outcomes such as limited hospital admissions and many people maintaining a healthy weight. The service also demonstrated escalation to specialist services following choking incidents. These features supported people to access healthcare input and maintain their health, though this was not consistent across all clinical risks and monitoring systems.

Feedback on meals, and mealtime experience was mixed. Whilst some relatives felt the food provided was usually good, a number of relatives raised concerns such as, “It doesn’t look very appetising. It is either too salty or too bland. [Family member] often refuses to eat it.” and “The food is terrible. I wouldn’t say it is a healthy diet [family member] was given. [Family member] seems to be given a lot of pastry and cakes.” Another relative expressed concerns around a lack of staff interaction when staff were supporting their family member to eat.

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

The provider did not effectively monitor outcomes or use monitoring to drive improvement. There was a lack of contemporaneous records, and records did not consistently demonstrate that care was delivered as planned, including hydration support, oral care and repositioning.

Audits were not completed robustly and did not identify the concerns found by inspectors. Where repeated themes were identified, actions were not consistently implemented or checked for effectiveness. The service did not have robust systems or processes in place to ensure oversight of people's clinical needs. This reduced clinical oversight of risks such as diabetes instability, seizure risk, hydration risk and pressure care risk. This meant deterioration of peoples’ heath could have occurred without effective oversight or timely action. Following the inspection, the provider implemented a clinical risk register.

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

Some mental capacity assessments were good and detailed, but others lacked clear evidence of why the assessment was needed, how the assessment had been completed, or the support used to help the person make the decision. For example, records for 1 person stated visual prompts had been used but did not describe what these were. We also found the same person did not have a mental capacity assessment in place for a medical intervention that staff carried out regularly. Best interest decision-making records also lacked consistent detail about who had been consulted. These gaps reduced assurance that the Mental Capacity Act was consistently applied and documented.