Higher Park Lodge

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.

The service was in breach of legal regulations in relation to peoples’ safe care and treatment, maintaining peoples care records and providing adequate person centred care.

This service scored 42 (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.

Some people who depended on pressure relieving mattresses had not had how to measure the person’s weight adequately planned for in their care planning documentation.People whose nutrition and hydration were at risk if they did not eat and drink enough, had not had these needs adequately planned for. For example, no objectives of how much nutrition and fluid intake the person should aim to consume daily. This meant that these people were being put at risk by the ineffective planning of their care.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

The service had not adequately met care needs related to pressure area care, nutrition, weight assessment and fluid intake measurement. Where people were wholly reliant on continence pads to manage their continence, the service had not identified how much support people might require in a 24-hour period. The frequency of continence pad changes also affected the regular application of creams to prevent skin damage, which was applied at the same time as a continence pad change. For example, a person only had their continence pad changed once in a 24-hour period and therefore cream was also only applied once. This placed them at risk of their skin integrity breaking down.

Peoples’ care was not being planned and delivered to meet the needs of the whole person, including the planning and provision of social and stimulating activities to meet the needs of the individual person.

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 service was working with discharge services at the local NHS hospital, their GP practice and primary care health services. Information was obtained by the management of the service before a person was accepted into the care home to ensure they were able to meet their needs. However, the team within the service was not working well together.

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

Some people needed to have their weight, nutrition and risk of choking closely monitored. However, there was a lack of clarity among the management team about who needed their food specially prepared in line with their assessed needs. During the assessment we identified 2 people who were receiving their food pureed. However, on the first day of our assessment, the deputy manager said no one who used the service had specially prepared foods, such as in pureed form. There was also no direction in the kitchen to ensure people’s dietary needs were easily available to the staff preparing food in the kitchen. This placed people at risk of choking.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Governance and audit processes had not identified where people’s care recording was incomplete. For example, when people were immobile and needed to be repositioned frequently on their mattress to maintain their skin integrity. Some people’s care records did not show they had been repositioned every 2 hours, as we were told was necessary to maintain their skin integrity.

The service’s systems and processes had not identified air pressure mattresses were not being monitored effectively or were being set correctly. People were not having a measurement of their weight carried out monthly and therefore their air pressure mattresses were not being set to reflect their present weight.

People’s care was not being planned and recorded to show how all of a person’s needs were being met. How peoples’ social, emotional and welfare needs were to be met, was not being planned. People commented there was not enough to do and people who needed support to go outside the building were not taken outside, although the home is adjacent to a local public park. Activities were not well designed to meet the individual needs and preferences of each person, and their taking part in each social or stimulating activity was not recorded in their individual records.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The service had a Mental Capacity Act (MCA) Policy that covered all aspects of the MCA. All those who needed to have a Deprivation of Liberty Safeguard (DoLS) in place for their own safety had had one applied for by the service to the Local Authority. However, there was little understanding about how to make decisions in people’s Best Interests or how to record these. For example, the use of bedrails for one person had only been considered in terms of Risk Assessment and no Best Interests discussion had taken place involving the person’s family to consider the use of this restraint was the best approach.

There was no approach to dementia care in use in the service, based on research and best practice. There was no signage in the building to help people who lacked capacity to find rooms important to them, such as their bedroom, bathroom and toilet facilities.