Archived: Quenby Rest 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 Good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 38 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. People's needs were not pro-actively assessed, reviewed and re-assessed. Associated care planning was not person-centred and did not reflect best practice to ensure effective outcomes were achieved. People and /or their relatives were not involved in the process. We found little evidence relatives were involved in the assessment of people’s needs, or reviews of their care. One relative told us, “There hasn’t been a care plan review that I can remember, but I do get told things that I need to know.” Other relatives’ comments included, “There have been a handful of care plan reviews over the years I think,” and “I think I remember doing a care plan review about 6 months ago, but that was the first I remember doing.”

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.People’s care, treatment and support was not planned for and delivered in line with national standards and evidence based good practice guidance. People’s relatives told us the service did not work with outside agencies to support people with good cognitive ability or specialist needs, such as stroke and Parkinson’s disease. We received mixed feedback from people and their relatives about the quality of food. Comments included, “[Person] enjoys the food there and the cook goes out of their way to make it as personable as possible for residents. The cook finds out what they would like and follows it through,” and “Staff organised a pie and mash meal which [Person] really enjoyed. I hope they do more meals like that.” However, people who could eat normal diets had more choice and preferences than those who required specialised diets. One relative said, ‘I feed [Person] some days, I have seen the soft diet. They don’t use food moulds, but the soft food items are put on the plate separately. It tastes okay as I have tasted it when I wasn’t sure what it was.” Another relative told us, “Staff know that [Person] can be a bit fussy with their food and they do offer different things. I go at lunchtimes to feed them as they are on a soft diet now, so I can tell them what it is.” Whilst jugs of fresh juice were put out each morning in the lounges people could not access these independently. Over our 3 visits we saw staff did not consistently give drinks out or encourage people to drink.

The provider 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.We found there was a poor awareness of the risks to people using the service across their care journeys, and a lack of advocacy and communication. Hospital support plans were not in place for people who were unable to communicate their needs to support emergency transitions out of the service to hospital. A hospital support plan, a best practice initiative, would help provide information that is relevant and detailed enough to inform healthcare professionals about their immediate needs such as how a person expresses their anxiety, how their needs impact on their day to day living and include the type and level of support they need. Relatives gave mixed feedback about how the service shared information with them about their family member. Some people told us they were not updated following deterioration of health and following some hospital admissions.

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 were not always supported to be as physically active as possible to retain mobility and prevent further deterioration. One relative told us, “Due to a stroke [Person] had lost their ability to walk. They liked doing exercises, but currently had no access to physio, or given exercises to prevent further deterioration in their mobility. They were doing armchair exercises, but as there is no activities coordinator this appears to have stopped.”

A relative told us, “They (Quenby) seem to have a very good relationship with the local GP.” The senior’s communication book and review of ‘correspondence summary’s’ in people’s care records reflected they were supported to access healthcare services, where appropriate and necessary. People were supported to receive vaccinations to help them stay well. One relative told us, “I know [Person’s] Covid and Flu jabs have been done as they have asked for permission to do those.” However, there was minimal evidence to reflect people were being supported to access routine health checks, such as dentist, opticians, and hearing clinics.

Care plans held information about people’s specific health conditions however they were copied from websites, such as NHS and therefore were generalised and contained difficult terminology for non-medical staff to understand. Additionally, health conditions such as stroke, Parkinson’s Disease, Epilepsy and Hiatus Hernia can affect people in different ways. Care plans lacked personalised information about how the health condition affected the individual and did not guide staff on how to deliver safe and effective care tailored to the individual.

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.There was a lack of effective processes for monitoring people’s care, treatment and outcomes to ensure continuous improvements. This included daily care records, which were task-led, they did not give any information about how the person's day was spent, nor did they give any reference to personalised care, promoting independence or their wellbeing. They therefore did not offer any opportunity to review and improve people’s quality of life. There was an absence of inclusive activity. People sat for long periods of time; lack of mobility causes stiffness and poor balance reducing confidence and independence and increases risks of falls. We saw people struggling to walk with their frames along the corridor to the dining room at the furthest end of the building.

We received mixed feedback from relatives about their expectations of the service. Whilst some were happy with the service their family members received, our assessment found elements of care did not support positive outcomes for people, in line with national standards and evidence based good practice.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.The provider told us in their Provider Information Return (PIR) that for residents with capacity, their choices are recorded and followed. For those who lack capacity, decisions are made in line with the Mental Capacity Act (MCA) and always consider the least restrictive option. We found this was not always the case. MCA and best interest decisions records for people contained conflicting information. Where people were deemed to lack capacity, were unable to retain, use and weigh up information given to them records stated they had given consent for the assessment and decision made. Records did not show, where required, in relation to bed rails and sensor mats any less restrictive or alternative options were considered, which may have led to a different decision. Such as identifying the risks and benefits of each option, the likelihood of those occurring, seriousness and/or importance of those risks, and the benefits to the person. In some cases where capacity had been assessed and a decision made, although reviewed, did not demonstrate a fresh assessment had been carried out again or if it was not necessary as the persons condition was unchanged. In one case the initial assessment was carried out on 12 October 2023.