Frenchay House

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.

People and staff gave mixed feedback about food and dining experiences. Changes had recently been made to the way food was prepared, and improvements were still being made. Concerns about the monitoring and control of food safety had been identified by the local authority food safety team. Although a Hygiene Improvement Notice had been served, all necessary changes were made promptly, and the provider was found to have achieved compliance with the standards immediately after our inspection.Several people told us they did not have sufficient choices at mealtimes, although people also noted meals had improved recently.

Staff supported people to ensure their health and wellbeing needs were met, for example by attending appointments or administering medicines. There was good support from other professionals, although some professionals said information was not always detailed or clear enough to enable them to effectively assess or treat people. Training was provided to ensure staff understood best care and practice, although some staff had not yet attended this.

People’s relatives were usually involved in reviewing care plans. This was an ongoing process because all care records and risk assessments were being updated at the time of our assessment. Records such as food and fluid charts were in place and being completed.

Peoples’ rights and their decisions about consent were understood and respected by staff. Records described decisions about consent and the best interests of the person were appropriately recorded.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not remember being involved in assessments or care plan reviews, but the registered manager assured us relatives or people were involved wherever possible to ensure their needs and preferences had been captured and understood. The new management team were reviewing and updating all care records and risk assessments. They told us these would then be regularly reviewed to make sure information remained current and care and support continued to meet people’s needs. The care plans we saw demonstrated that people’s physical, health, wellbeing and communication needs had been assessed.

Before this assessment, CQC had received concerns that clinical assessment tools were not always up to date or reviewed. This could mean changes were not always monitored. We saw examples of tools such as food and fluid charts and bowel records. Paper documents had been completed as required and staff added actions or changes to the electronic record system.

People’s communication methods were outlined in care records to enable staff to deliver care and support which met individual needs.

The provider did not always plan and deliver people’s care in line with legislation and current evidence-based good practice and standards.

Concerns had been raised about whether people’s nutritional and hydration needs were met in line with current best practice. Feedback from people and relatives were mixed. Comments included, “The food is ok, but there is no choice, everybody gets the same thing”, “We do have a different meal every day, but they are all cooked the same way, so I can’t see what’s in it. It all tastes the same”, “I think that the food is good and varied” and “The food has improved quite a lot.” A staff member told us, “There have been issues with the food and certain residents have been quite vocal about it. They are being reasonable about what they say, the standard’s not good enough.” At a recent resident’s meeting, people reported that meals had been improving.

Several people told us they did not feel they had sufficient choices at mealtimes. Meals were prepared off site, but the management team told us alternatives were available and could be made at the service if someone did not like or want the meal offered. However, people and staff told us alternative meals were not routinely available. Although menus displayed meal choices, we observed people being given the same meal and most were not offered choices of food or drink. We highlighted this to the management team.

Staff said they did not have enough time to effectively support people at mealtimes and told us this was often the busiest time of the day. We observed 1 person being supported to eat a meal. Staff were repeatedly called away and the task was shared between a number of different staff. The staff did not engage with the person and the support for the person was inconsistent.

In 1 person’s room we observed 3 drinks on a table which was out of this person’s reach. We spoke with the person around lunchtime and asked if they would like a drink. They told us they had not had a drink since breakfast.

Staff used nationally recognised tools to assess and monitor people’s needs. For example, the Malnutrition Universal Screening Tool (MUST) was used to identify people who were at risk of malnutrition and to support care planning.

 

Staff told us there was effective communication, coordination and collaboration with external partners to help them deliver joined up care which met the full range of people’s needs. However, professionals who worked with the service found information was not always detailed or clear enough to enable them to assess or treat people. One professional said, “There is clear difficulty in communication between staff in the home and it is often difficult to get the information needed to assess residents well.” Another told us, “Changes to people's needs are not consistently communicated clearly, I've often learned about changes from family members. When relaying this onto staff, they can seem unaware of this themselves.”

One professional said, “Some staff present with accurate knowledge and understanding of the service users' needs” but added this was not the case with all staff. Some professionals were concerned that people’s needs were not always understood, and therefore the right care or treatment may not always be provided effectively. The provider had recently been involved in multi-disciplinary meetings to improve the service and standards.

Staff supported people to ensure their health and wellbeing needs were met. Some people were able to manage their own health and wellbeing needs for example, by administering their own medication or carrying out some activities of daily living. Others were in control of decisions about their routines or day to day choices.

A paramedic carried out weekly visits at the service and liaised with the named GP to address concerns and confirm plans of care. This helped identify risks to people’s health and wellbeing early and reduce future needs or prevent further deterioration where possible. District nurses attended regularly to meet people’s ongoing treatment needs.

People were encouraged and supported to understand and make healthier choices including those relating to diet, lifestyle and physical activity. Some people were able to access the local community to engage with activities and exercise.

Before this assessment, we had received feedback that the service did not always routinely monitor people's care or outcomes to ensure needs or expectations were met. However, we found the management team understood current legislation and standards and had made changes to improve the effectiveness of people's care and support. For example, advocates supported some people to achieve positive outcomes and care plans were being reviewed and updated.

Staff received training about monitoring clinical outcomes related to areas such as malnutrition and pressure care. Some staff had not yet received this training, but we saw this was booked in the near future. Nationally recognised tools were available and used to monitor specific health and wellbeing needs.

The provider was a member of local and national networks which aimed to improve care, follow current best practice and meet people's expectations.

Peoples’ rights and their decisions about consent were understood by staff. Staff received training, and were able to tell us why it was important to gain consent from people and help them make decisions. For example, about what they wanted to do or where they wanted to go.

The management team had identified whether people had the mental capacity to give consent about specific decisions. Where necessary, decisions were made in people’s best interests, and relatives or others were involved, in line with legislation. Some people received support from independent advocates to ensure their views were taken account of. Staff appropriately recorded assessments and decisions about consent and the best interests of the person.

Some people had advanced decisions about their care and support in their records and staff documented people’s wishes relating to resuscitation.