Drumconner Lancing

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 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.

Preadmission assessment forms contained basic information and an overview of health needs; there was little information gained about people’s preferences and communication. The registered manager did not always ensure care and support plans were developed following people’s admission to Drumconner Lancing. One persons’ record indicated they had dementia and they had lived at the service for 3 years; the care plan included some details of their communication needs but gave no guidance for staff in how to support them or what strategies to deploy to support the person when they communicated distress. The lack of guidance increased the risk of people not receiving effective care and support.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always follow legislation and current evidence-based good practice and standards. The National Institute for Health and Care Excellence (NICE) guidance was not followed in respect of falls. Comprehensive falls assessments would ensure individual risk factors were assessed and considered. A number of incidents of falls had been recorded, there was limited detail of any risk reduction interventions deployed as a result of learning from incidents. One person had been assessed as high risk of falls, was known to have a high risk of developing infection and lived with dementia; these were risk factors that could increase their risk of falls. There were no measures in place to reduce the risk.

Staff and management were not following CQC’s Right Support, Right Care, Right Culture (RSRCRC) guidance, this guidance sets out expectations where a service supports people with a learning disability. We discussed RSRCRC with the provider following our assessment, they provided assurance of new ways of working for any person they support with a learning disability. Staff and management utilised other nationally recognised tools such as the Waterlow, the Waterlow assessment tools identify people’s risk of sustaining pressure damage to their skin. These assessments were used appropriately, and staff were supporting people well with pressure area care.

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.

The registered manager did not ensure that people’s needs were always, fully assessed in relation to whether the service was suitable for the person and that care plans were updated, contained guidance for staff including when people’s needs changed. This meant staff did not always have the information they needed to provide safe and effective care. Following feedback at this inspection the registered manager told us they intended to review their admission processes to fully consider whether they were equipped to support people living with dementia and ensure the staff possessed the knowledge and skills to support people. The provider’s systems had failed to identify, review and manage risks, including when people’s needs changed. This meant the provider’s systems did not always support a planned approach to managing changes in people’s needs.

Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported people with their dietary needs well. People’s nutritional needs were met, catering staff were aware of people’s individual requirements including allergies and intolerances. Where people experienced swallowing difficulties, they were assessed by the Speech and Language Therapists (SaLT), advice was detailed on to people’s care records and catering staff were informed. We observed, when needed, meals were prepared according to SaLT advice, for example, some people were assessed to receive a modified diet. People told us they enjoyed the food, and the service accommodated their individual dietary requirements. One person told us, “They do very well with my gluten and dairy free food, I spoke to the chef, and they made some special bread for me.” The provider told us, “We provide everything, whatever people want.” They gave an example of accommodating a person’s specific choices for their birthday.

We saw people had been offered opportunities to try new foods for example, it was a Spanish themed day, and we saw people trying new foods. Staff monitored people’s weights and where needed made referrals to the dietitians.

Staff and managers 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.

Whilst people’s care records were regularly reviewed; the reviews did not highlight where outcomes could be improved. Care delivery and staff practices were not always aligned to people’s care records which meant there were missed opportunities to improve people’s everyday lives.

One person with a learning disability was described as not wanting to engage in activities provided at the service. Staff told us how the person liked their routines and enjoyed certain activities and preferred to stay on the edge of things. One staff member told us, “We don’t know how much person gets or understands from activities, they love colouring, we are taking person closer they like to watch and if they want can participate.” This persons’ care plan had been reviewed, however; staff had not highlighted potential areas for improvements to this person’s outcomes. This resulted in potentially missed opportunities to develop this persons’ plan further with more details of activities they enjoyed and engaged with.

The provider did not always tell people about their rights around consent or respect these when delivering care and treatment. We observed people being asked for consent and offered choices by staff. However, staff did not always respect people’s right to decline support. Some people’s care records evidenced staff continued to provide personal care, continence care and support to move and position despite people displaying behaviours of distress. Some staff described support being provided, “In the person best interest” however, failed to understand the need to ensure this was the least restrictive intervention which respected the persons rights to decline support.

Staff and managers did not always work within the principles of the Mental Capacity Act 2005 (MCA), where staff had assessed people to lack mental capacity, MCA assessments were not completed to evidence robust decision making. Best interest decisions were made for people without their backgrounds and experience being fully considered and without consultation with Lasting Power of Attorneys and/or professionals where appropriate. We raised our concerns with the provider told us they would arrange for staff to review their practices and update care plans.