The Garth Care Home with Nursing

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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The provider was in breach of the legal regulations relating to person-centred care.

This service scored 25 (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 make sure people’s care and treatment was effective with the people they were supporting because they did not check and discuss people’s health, care and wellbeing needs with them.

People’s care records did not contain the relevant detailed information about their needs, and the provider and registered manager did not have overview of the consistency with which staff were meeting those needs. People told us they were unhappy living at the Garth and found days ‘boring’. We were concerned about the widespread dissatisfaction we encountered when speaking with people during the inspection. There was no consideration in people’s records or the approach of staff to the impact of the lack of engagement and opportunity for people on their cognitive function and mental health. We fed back our findings to the provider, and they have started to take steps to address the issues we identified.

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.

Care and treatment was not always delivered in a way that was best practice or evidence based. Assessments lacked any sound evidence, and where informed and detailed information was needed regarding complex needs peoples care records contained links to external websites including Wikipedia. These are not appropriate sources of evidence-based practice and does not reflect an approach of care and detail in assessing and planning to meet people’s complex needs.

The provider did not always work well across teams and services to support people. The provider did not work effectively with commissioning partners in addressing actions identified as being needed to improve the care for people in the service.

Relatives told us people were supported to access health professionals when required, and we could see in people’s care records where this had taken place. People told us they were able to see the doctor if they felt they needed it.

However, information from health professionals was not always shared effectively in people’s care records for staff to follow. This meant that treatment was not always given as intended by the health professional. One person was receiving ‘as required’ medicines for anxiety without clear information for staff on steps to be taken before giving the medicine. The prescriber’s intention was not for the treatment to be given in isolation of other less restrictive practices. Another person who has seizures had medicines prescribed, however without the clarity around the individual’s seizures it was not possible to be assured the treatment was provided in line with the intentions of the prescribing professional. This did not demonstrate effectively working with other teams and services to ensure treatment was relevant and safe.

We were not assured there was oversight of people’s care needs, and that the provider knew what steps were required to ensure communication was effective amongst staff to identify signs of deterioration and prevent people from being exposed to the risk of harm.

The provider did not have an open, proactive and positive culture towards safety. They did not listen to concerns about safety. Where concerns over the care being provided had been raised by visiting professionals the provider had failed to identify the actions needed to address the concerns. Lessons were not learnt to continually identify and embed good practice.

The provider had not been effective in identifying the areas of improvement in the home environment to reduce the risk of people injuring themselves.

Accidents and incidents were documented; however, information was not clear or accurate showing differing accounts of incidents to what was recounted by people in the service or what was witnessed by other professionals. The clarity in the records needed to effectively detail, review and monitor the frequency of accidents and incidents in the service was not there. This meant opportunities to learn lessons from incidents and take action were missed.

There was no effective mechanism to gather and then act upon feedback from people in the service and their family members. This meant that opportunities to learn from people’s experiences and improve the outcomes for people were being missed.
 

The provider did not routinely monitor people’s care and treatment to improve outcomes. They did not always ensure people’s experiences were positive and consistent.

Falls, accidents and incidents were not accurately documented and records contained conflicting information. Details of a person’s seizures were not recorded and details of accidents and incidents in people’s records did not always match what had been witnessed. There was no effective oversight or monitoring of what was occurring regarding the daily outcomes for people.

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

Staff had received training in mental capacity and consent. There were systems and processes to ensure that where people lacked capacity to make certain decisions applications for Deprivation of Liberty Safeguards (DoLS) had been made. Whilst staff we spoke with understood the principles of capacity and consent, people’s experiences demonstrated that this was not always considered. Staff did not always take the time to act on people’s wishes with some people receiving poor experiences and not being enabled to make active choices around their care. Whilst everyone in the service was subject to DoLs (Deprivation of liberty safeguards) the impact of restrictions on people had not been fully considered and there was no evidence of consideration of least restrictive practice in line with the principles of the Mental Capacity Act 2015 (MCA).

The impact on the freedoms and liberty of people in the service by the use of CCTV with audio recording in communal areas of the service had not been fully considered in order to gain consent. There was no evidence of how people were supported to have a choice and there was no provision to remove recording in communal areas if a person did not consent.