Cheybassa Lodge Rest 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.

This is the first assessment for this newly registered service. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The provider was in breach of legal regulation in relation to consent.

This service scored 29 (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.

There was no evidence people had been involved in their assessments or care planning. Care plans did not always reflect people's needs and preferences and no person or their significant other told us they had been involved or seen their care plan.

Assessments were in place, but these did not always contain personalised or detailed guidance for staff or ensure the care people received was effective. For example, pre-assessments contained a lack of information as detailed in the ‘Safe systems, pathways and transitions’ section of the report. Other ongoing assessments in relation to malnutrition, skin integrity and falls, for example had not prompted safe and effective care as detailed in the ‘Involving people to manage risk’ section of the report. There was a lack of evidence that people’s wellbeing was reviewed, and we observed some people to be not to be experiencing wellbeing at the time of our inspection.

The registered manager told us they were aware of some of these issues. They had begun updating assessments and care plans and had plans to involve people and their relatives when reviewing 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.

Some people had a diagnosis of dementia. There was a lack of information their care plans to support staff to understand how their dementia impacted on them as a person and how to support them through their dementia journey. We observed some people to be frequently withdrawn, agitated or distressed during our inspection. Evidence-based good practice had not been utilised when supporting people with dementia.

People’s nutrition and hydration needs were not met in line with current guidance. Staff lacked a good understanding of current guidance in relation to people with swallowing problems. The International Dysphagia Diet Standardisation Initiative (IDDSI) is a set of descriptors describing textured modified food and drink for people with eating and drinking problems. During our inspection, people did not receive the correct texture of food. A partner agency shared our views and raised concerns with us about the lack of knowledge from staff. Some people, staff and professionals from a partner agency provided negative feedback about the food people received. This included it being presented in an unappetising way, not cooked properly, a lack of choice and small portions. The nominated individual told us they were surprised by this feedback as they had undertaken work to make improvements in this area. However, they said they would review the current arrangements. This put people at risk of harm and poor outcomes.

The provider did not always work well across teams and services to support people. For example, a partner agency told us staff at Cheybassa Lodge Rest Home needed to be better at raising concerns about people with them and providing the relevant information. However, we also received feedback that indicated a staff member was knowledgeable about a person and their changing condition.

Staff mostly told us they were a good team and worked well together. However, some staff said there was a day and night staff divide on occasion. We discussed this with the manager who said they were in the process of improving the culture in the service.

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

Although people had been reviewed by specialist health teams, including mental health teams, staff at Cheybassa Lodge Rest Home did not always provide the necessary ongoing support to ensure people’s health and wellbeing. For example, people who required support to manage distress or regulate their emotions were not supported effectively. Furthermore, staff did not keep effective monitoring records, which meant they were unable to identify triggers or implement appropriate strategies to prevent repeated incidents.

We saw evidence that other professionals were involved in people’s care, including GPs and mental health teams. However, support for people to maintain healthier lifestyles, particularly with personal hygiene, was inconsistent.For example, care plans did not always demonstrate how people’s nails, hair or teeth would be kept clean, and we observed this to be an area for improvement during our inspection. 1 person required staff support to improve [an area of need] but they told us staff did not have the time to support them with this. This meant they were not supported to maximise their independence.

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.

People’s goals and wishes were not always recorded in care plans or assessed during reviews. This meant staff did not have clear oversight of whether people’s care was safe, effective or meeting their needs.

We were not assured care records kept by staff were always accurate or reliable, with occasions where records did not reflect a person’s presentation or support given. For example, staff had recorded that people had eaten most of their meal, but we and a partner agency observed this was not the case. Other people’s records stated they were content, but we observed them not to be, or they told us they were not. As a result, there was a risk that care was not fully tailored or responsive, and people could receive support that did not reflect their needs or preferences.

There was no clear oversight or review of behaviour records and no evidence that lessons had been learned, or improvements implemented. The provider failed to demonstrate how people’s anxiety was monitored, so they could look at ways of reducing this for better outcomes for people.

We saw from care records that fluid charts were used to monitor people’s hydration. However, we found there was a lack of oversight of these, or actions taken when people had not reached their target fluid amounts. This meant people were at risk of dehydration.

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

Although the registered manager was in the process of improving records in relation to consent and mental capacity, we identified shortfalls in these areas. For example, some mental capacity assessments stated people lacked the mental capacity to make a particular decision. However, the records used to make this assessment were not always clear or complete. When people are deemed to lack capacity, a record should be kept demonstrating decisions are made in their best interests. However, some of these had not been completed. We talked to 1 person who was upset some of their belongings had been taken away from them. Although a mental capacity assessment demonstrated they lacked the capacity in this area, we were not assured this was correct or action had been taken in the least restrictive way because the person showed a good level of understanding.

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 Mental Capacity Act (MCA). In care homes this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for DoLS for some people in the home. However, their mental capacity had not been assessed prior to this. This meant relevant legislation was not being followed. Staff did not always have a good understanding of how to apply the MCA in their day to day work. This concern was shared by partner agencies.

Staff were not always able to provide choices to all people about how they spent their day due to a lack of staff, but we did observe occasions where they offered basic choices like what they wanted to eat and drink.