Ingleside Residential Care 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 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 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service 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 care needs were assessed and reviewed on a regular basis. However, we found some care plans had contradictory or missing information about people’s needs. For example, the reason why people had bedrails in place, whether people were at risk of falling and if people required visual aids. This meant staff did not always have clear guidance on how to provide safe and consistent care, which increased the risk of harm or unmet needs.

We found no evidence to demonstrate people had been involved in their assessment process, however relatives confirmed they felt involved in people’s care. A relative said, “I am involved in [person’s] care. We are fully engaged in the care planning and kept informed.”

We received mixed feedback from staff in relation to having sufficient information about people’s assessed needs. Comments included, “I don't feel as though we are given enough information about new clients”, “I am provided with information about people’s risks and how to keep them safe through detailed care plans, risk assessments, and shift handovers. These include clear instructions for managing complex behaviour, supporting people with swallowing difficulties, and monitoring conditions such as diabetes. I follow these documents and escalate any concerns to senior staff or healthcare professionals as needed” and “Where someone has difficulty communicating, I use their known preferences, care plans, and guidance from family or professionals to support choice and independence.”

The registered manager told us the service had introduced a new care planning system which meant all care plans were going to be rewritten. The registered manager was aware that more work was needed to ensure the care plans were reflective of people’s needs.

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

The service did not plan meals in advance and did not have a have a set menu. The registered manager told us a lot of the time the same meals were served on specific days of the week, and the food options were discussed with people. However, we found no evidence of this or that people had any input in what food they have. People told us they enjoyed their food. A relative told us, “There is really good attention to detail in this respect, the team know [person’s] likes and dislikes with food and respect their choices. I know that [person] is helped with their nutritional needs, there are always drinks available in their room and I know [person] is helped with them. When extra fluids are required, such as in times of excess heat, I have been present when these are offered regularly.”

However, we observed they were not always offered snacks between meals and their drinks were not always being topped up. This is important because many older people experience a reduced appetite, snacks improve nutritional intake, and fluids help to maintain hydration.

We also found staff did not always have opportunity to engage with people in a meaningful way as they were often busy supporting people who required their care provided in bed. This meant people were left on their own for periods of time without support from staff.

We were not assured the provider effectively monitored people’s health conditions. For example, there was no system or process in place to ensure people’s nutrition and hydration were monitored to ensure they remained healthy. People living with dementia often require regular monitoring of their nutrition and hydration to ensure their health and well‑being.

The service worked well across teams and services to support people. They made sure assessment of needs was shared when people moved between different services.

Relatives told us they were kept informed and felt involved in their family members’ care. A relative said, “Good feedback of outcomes is given, often the health care professional will speak to us directly also.”

Health and social care professionals told us they had effective working relationships with the service. A health and social care professional said, “Staff usually have a good knowledge of the resident and recent events, which suggests good continuity of care from these senior staff. They are usually clear with the concerns and background and show a good understanding of the individual needs of the resident.”

Staff confirmed they knew how to contact health and social care professionals when required.

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Health and social care professionals regularly visited the service. Relatives told us they were happy with how their loved ones’ health was being managed by staff at the service. A relative said, “I have always been impressed with the knowledge the staff have around [person’s] current state of health and what the treatment/management plans are. On one occasion when [person] was very unwell over night, I know that one member of staff, stayed sitting with [person] on the floor for quite a long time whilst they were waiting for an ambulance.”

People were not always supported to be as physically active as possible to retain their mobility. People were not always supported to access the community or enjoy meaningful activities. A person told us they rarely see staff outside of personal care or providing meals. We observed people spent prolonged periods of time without access to activity or interaction. Care staff were busy supporting people with their daily care needs so did not have the time or opportunity to support people to maintain their independence.

People whose care was provided in bed were left alone for long periods of time. The registered manager told us they were checked on hourly; however, this was not evidenced in people’s daily records. The registered manager could not demonstrate how staff had the time to check on people on an hourly basis whilst providing care and supporting people in communal areas with food and drink.

People were not provided with the opportunity to access wider health services such as a dentist which would help promote their general health.

The service 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, or that they met both clinical expectations and the expectations of people themselves.

We found air flow mattresses were not checked to ensure they were set at the right level for the person using them. This was because the provider did not have a consistent system in place to ensure people were weighed regularly. This placed people at increased risk of developing pressure sores.

Care plans were not always detailed enough to reflect people’s current needs. People living with dementia had limited information in their care plans to support staff to understand how their dementia impacted them as a person and how to support them through their dementia journey.

The provider lacked systems to monitor the accuracy of care records and address concerns. For example, when care had not been delivered or recorded.

The service had some monitoring systems in place. These were completed on paper, however record keeping and monitoring of people’s ongoing health needed to improve to ensure staff had an overview of people’s changing needs to ensure concerns were identified and addressed in a timely manner.

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

The registered manager told us they were in the process of completing capacity assessments for people living at the service. Many people living at the service had a diagnosis of dementia which could impact their ability to make informed decisions and understand risks. However, there was only 1 MCA assessment present, and it was completed incorrectly. There were no best interest decisions in place for anyone living at the service.

Where necessary, people with legal authority or responsibility can make decisions within the requirements of the MCA. The provider did not have an overview of who can lawfully act on people’s behalf and did not hold the required documentation. This meant that some relatives had signed as giving consent on behalf of people, however there was no evidence they had the legal right to make those decisions. For example, 1 person had a plan in place to avoid hospital admission in case they became unwell. The service had not assessed this person’s capacity and had not verified the relative who made the decision had the legal authority to do so.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met.

Where DoLS applications were applied for MCA assessments were not completed which meant people’s capacity was not assessed. The registered manager had a system in place to record DoLS applications, however we found this was not completed correctly. This meant we could not be assured staff protected people's human rights in line with the MCA.

Staff told us they respected people’s right to choose and followed the principles of the MCA. One staff member said, “I always assume capacity and follow The Mental Capacity Act 2005 and the wishes laid out in the client’s care plan. I allow clients to choose how they receive personal care, giving options of the clothes and shoes they have, also giving choices of food and drink. I support where they wish to reside in the home and support them to feel comfortable, happy and relaxed.”

Mental capacity training was in place for all staff.

Due to the shortfalls found during this inspection we could not be assured that, where people had an impairment to the mind or brain, full consideration had been given to their abilities to consent to care and treatment, or they were given the opportunity to make informed choices. We raised our concerns with the local authority safeguarding team during the inspection.