Archived: Quenby Rest Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs. The provider was in breach of legal regulation relating to personalised care.

This service scored 25 (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 demonstrate people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. People’s care and support was not planned and delivered in an individualised or personalised way. Care plans did not inform staff of people’s strengths and the type and level of support they needed to keep their best independence and promote their wellbeing. The service was not pro-active in making sure people did not experience loneliness, boredom, withdrawal and frustration.

People did not have access to activities that promoted and supported their independence, health and wellbeing. One relative told us their family member had become bored from the loss of activities. The inability to access the garden led to high levels of stress and frustration for people. One relative told us, “The garden is a massive asset to the home, and they need to replace the gardener. They (gardener) are sorely missed and [Person] used to be out there helping with planting and weeding and just chatting to them about gardening.” Across all 3 site visits we saw people sat around the walls of each lounge with the television on with loud music. Both lounges were very noisy. People’s choice and preferences about what to watch had not been considered or were seen to be age inappropriate. One relative told us, “Their entertainment nowadays is the TV on loud music all day.”

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity. Our assessment found management and staffs poor understanding of diverse needs and inability to communicate affected people’s care provision, integration and continuity of care. One relative told us “We were approached for permission to scan [Person] in hospital to find out the type of dementia they had. I am not sure who instigated that request, but we refused as they would not cope with the scanning process. It would be far too stressful.”

There were no processes in place to promote a personalised and diverse culture that supported choice and continuity. None of the care records looked at contained a care plan that adequately demonstrated how staff responded to individuals differing needs in terms of interests, social activities and meaningful interventions. They lacked information to guide staff in relation to the varying stage of dementia they were at and their dementia care pathway. The director of care told the Commission if people’s needs required 25 minutes at a time 4-5 times a day it was not workable. He also said the service was currently overstaffed to monitor and maintain the people there, they did not have the resources for people who were more dependent or who had advancing dementia to ensure continuity of care.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The service was not meeting the requirements of the accessible information standard (AIS) for meeting the information and communication needs of people with a disability, or sensory loss. Whilst communication needs were recorded in care plans, this did not consistently translate to information being communicated to people in an accessible way. There was a lack of pictorial, easy read, and large text information to enable people to understand information, or and make informed choices. Where one relative told us they remembered their family member using a white board to support their communication, when we asked staff about it, they confirmed it was not in use now. One staff member told us there were no tools in use for communication. They said that one person used to wear hearing aids but doesn’t know what happened to them and they had not been used for a while. Another staff member told us they “used to use a white board a while ago, but the ink ran out.”

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.Relatives told us that information from the service was not always forthcoming. Some told us they had not been kept informed about incidents that had occurred or changes in people’s needs, which affected their health or wellbeing.

Relatives told us that meetings had taken place to give an update on the position of the service following our last assessment, but some commented on the lack of information for those unable to attend. One relative said, “They (management) have started to have group family meetings now which keep us informed about changes and they listen to our concerns. Mind you, the last one in June was cancelled.” Another relative told us, “It’s good that they have meetings now, but as I work, I missed both and haven’t heard anything about what went on. An update of some kind would be good,” and another said, “They need a system for feedback for those of us working, I always have to ask.”

The manager told us they had developed a newsletter to share with relatives about what was happening in Quenby. However, relatives told us they were not very informative. Comments included, “The new newsletter was something and nothing. A missed opportunity” and “We did get sent a copy of the new newsletter recently, but to be honest, it was very basic and not at all informative. It was a bit of nothing.” Some relatives told us they had access to the service messaging platform which helped them keep up to date with what was happening with their family member; however, others were not aware of it.

The provider did not make sure that people could access the care, support and treatment they needed when they needed it. The provider told us in their PIR (Provider Information Return), “Residents with physical, sensory, or cognitive impairments have personalised care plans that include risk assessments, use of assistive equipment, and adapted communication methods. Environmental adjustments are made where needed, such as use of high-contrast signage, sensor mats, and appropriate seating.” However, our assessment found this was not the case, as detailed within this report.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.The provider had failed to recognise and take steps to minimise barriers to inclusion and promote positive experiences and outcomes for people using the service. The service had not considered the quality of care for people at each stage of their dementia care pathway. The nature and severity of symptoms are likely to change over time. People with dementia were likely to experience poorer care at the latter stages of their care pathway.

The service had not been developed in a way that truly valued and empowered people. There was a lack of understanding on how to deliver good, personalised dementia care in practice. There was a poor culture where there were low expectations and a lack of purposefulness to a person’s day. For example, people were not given opportunities to meet their social and emotional needs to reduce the risk of loneliness, isolation and frustration. The environment was not tailored to meet people’s various needs. Aspects of the building were not in line with guidance on dementia friendly environments. The garden was not safe and accessible for people with poor mobility or people who used wheelchairs.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Whilst plans for end of life where in place for people, they were not personalised or developed together with people or their families. They identified the care that would be delivered to address symptoms but did not demonstrate how staff were to respond to the person’s specific and individual needs, choices and preferences as they approached the final stages of their life. One relative told us, “Nobody has talked to us about final wishes for [Person]. The only thing we have relayed to them is their desire to avoid going into hospital at all costs if possible.” The End of Life care plans did not include any advanced directives such as the decision to not go into hospital for active treatment.

Dementia is a terminal illness. Meaningful conversation with people and/or their family member, as part of their ongoing assessments and reviews, would help to prepare a plan for the delivery of end-of-life care whilst they still had the capacity to do so. Another relative told us, “I had met with a social worker before now but don’t remember being part of a discussion about DNACPR (Do not attempt cardiopulmonary resuscitation), and it is too late now to do a POA (Power of attorney) for health care decisions.” This was because their family member no longer had capacity to appoint an "attorney," to make decisions on their behalf.