Shangri-La Residential 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 inspection we rated this key question was Good. At this inspection the rating has changed to Requires improvement. This meant the effectiveness of the provider’s processes where they provided care to people in their best interest were inconsistent. The service was in breach of legal regulation in relation to Need for consent.

This service scored 62 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them. People were assessed prior to moving to the service to ensure their needs could be met. One staff member said, “We always do pre-assessments before accepting people to come here. We do turn people down if we can’t meet their needs.”

People’s relatives told us they were involved in the planning and reviewing of their care. Comments included, “My sister and I meet up with deputy manager every year to go through the care pans and any updates” and “[Relative] has had a couple of fractures, so I know all about the mobility care plan.” Records showed people’s plans were regularly reviewed.

People’s communication methods were outlined within their care plans to enable them to receive care and treatment which worked for them. Care plans we looked at identified any difficulties with communication, such as sight, hearing or speech and gave examples of how people should be communicated with. For example, we looked at the care plan for one person with a condition that affected their sight and the plan informed staff to support the person whilst also promoting their independence. The plan for another person with limited verbal communication detailed how they would make their feelings known to staff.

Staff told us they were informed of people’s changing support needs during handover or by reading care plans. The handover sheet we looked at was detailed and included updates covering several weeks to ensure staff could easily access information. One staff member said, “I’m made aware of any changes. I can see the handover on the tablet device, and I get told verbally. If I am off duty, they would tell me when I get back and it would be on the handover. All of us are responsible to update the dietary needs form so I would do it immediately, but the manager would too.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with current evidence-based good practice and standards. Nationally recognised assessment tools were used. Concerns about people’s health needs were escalated to healthcare professionals and recommendations were acted on.

Drinks and snacks were in place around the service to encourage people to eat and drink enough. We saw people’s dietary needs including diabetes, allergies and dislikes were displayed in the kitchen for staff there to be aware of. Care plans included information for staff such as food preferences, frequency of monitoring people’s weight and any specialist advice that had been sought. The guidance was clear and informative such as which size utensils staff should use to support people with food. When people were having their food intake monitored, records showed people were provided with enough to eat.

The provider worked across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service worked closely with other teams, including for example, the older persons mental health (OPMH) team. Records we looked at showed that staff kept the OPMH up to date with how people were presenting, and whether medicines prescribed were effective or not.

Feedback from health professionals included, “We tell [staff] about any plan we have devised and then they follow it. They do follow our guidance” and “Staff at the home are very responsive in reaching out with concerns over residents' health. They utilise our services and those of 111 and the ambulance service when needed. I have no issue with staff following our recommendations. I cannot recall any instances of them not following our advice.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice, and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People told us they received support to access healthcare, inside and outside of the service.

We saw records that showed one person had been supported by staff to attend the dentist and other appointments at the local hospital.

People had access to activities which focused on movement such as armchair exercises. This promoted their physical health and mental wellbeing.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Some staff had “champion” roles at the service where they had specific responsibilities for areas of people’s support plans. For example, the registered manager showed us how staff assessed risks such as malnutrition, and we also saw how staff monitored and reviewed the reasons why people might be losing weight, including any actions taken.

One person’s relative said, “When [relative] went into the home, [relative] was very thin as had not been eating well. Now [relative] has a good appetite, and I’ve had to buy some new clothes [in a bigger size].”

Staff worked with other health professionals to provide the best possible care for people. Records showed that staff had recorded when people’s general wellbeing had changed and had sought appropriate advice or referrals.

The provider failed to ensure care and treatment was provided with the consent of the relevant person, and/or to act in accordance with the legal requirements under the Mental Capacity Act 2005 and associated code of practice. We identified multiple shortfalls in the providers MCA processes and practices were not always in line with their legal requirements. For example, we identified some people had MCA assessments started for specific decisions, but the process had not been completed to reach an outcome. We found examples where outcomes of people lacking capacity had been recorded, however best interest decision making involving relevant people had not been recorded. Another person had been assessed to have capacity; however outcomes were recorded to be undertaken in their best interest and there was misleading information regarding their assessment to provide informed consent with their medicines and the level of care provided in their best interest. Where people were identified in their care plans to have elected representatives to make decisions on their behalf, the provider could not always demonstrate that they were assured this legal power was in place. We also found some examples where people who had been assessed as lacking capacity had consent to treatment records in place signed by leaders without the relevant legal authority to do so. We reviewed the providers policy on consent to treatment. The policy was not robust to ensure staff had clear information on their legal requirements.