Gibson's Lodge Limited

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

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 regulation in relation to person centred care and need for consent.

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.

A family member told us “At the beginning, yes, I was involved in [relative] care planning. They have become worse over the last 6 months, and I don’t know if the plan is updated.” Another family member said, “I was involved at the beginning; I don’t know if it is reviewed now their back is healed”.

We reviewed people’s care plans and found that many care plans and subsequent reviews held were conducted by staff. We found there was a lack of involvement of people and their relatives which meant important information known to relatives was not consistently incorporated into care planning. As a result, people’s care plans did not always fully reflect their needs, preferences or risks, limiting the provider’s ability to ensure care was accurately assessed and personal. The care plans did not give staff clear guidance on how to meet people’s needs safely. They lacked detail, were not consistently updated to reflect people’s current health conditions or risks.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

There was a lack of relevant information pertaining to people’s care and treatment in care documentation, for example, for those who presented with behaviours that challenge. Staff did not always utilise relevant tools to document or review behaviours, to deliver evidence-based care to people.

People’s care records were not always consistent with how people needed to be supported, or how the support would be delivered to the person. For example, we saw no information in care plans as to how people were to be supported with mental health issues and the possible impact on the person if staff did not provide support appropriately and another example

Many care plans lacked clear information about what triggered people’s distress or which strategies were effective in reassuring them. Staff had not explored the underlying causes of behaviours and there was no evidence that increased use of PRN medicines led to reviews, identification of triggers or engagement with heath care professionals.

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.

Staff did not always have the reliable details they needed to coordinate care effectively. Information needed to support people’s care was recorded in various documents, including GP’s communication book, care records, on plans. However, these records were sometimes inaccurate or not used effectively. For example, people’s hospital passport did not include key information for hospital staff, and at times the detail was inconsistent with people’s care plans and risk assessments.

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.

People and their relatives told us there was a lack of activities within the service. One relative told us, “They [people] need a lot of activities. There were some activities when [ my relative] moved in but not so good now.” Another relative told us “[My relative] is in bed with no telly. Doesn’t leave the home. Not enough staff to go outside.”

People did not have activity plans to support physical and emotional wellbeing.

People did not have person-centred activity plans in place to support their physical and emotional wellbeing. During our site visit, staff facilitated some group activities on the second day; however, these were limited. People who required one-to-one support were left without staff engagement for periods of time, which reduced their opportunities to participate in meaningful activities.

We observed a significant lack of activities within the service. We reviewed documentation regarding activities with people and found these to be limited. The registered manager told us the activities coordinator position was vacant at present, and they were currently recruiting for one

The absence of a structured activity programme meant that people’s physical, emotional, and mental health needs were not consistently supported through meaningful occupation. Where people required one-to-one support to access activities, staffing arrangements did not always allow this to be provided.

Despite these gaps, people were supported to attend healthcare appointments, including those who found this difficult due to distressed behaviours. Staff worked with health professionals and their recommendations were followed and people were supported to manage their health conditions and this contributed to improving their long-term health outcomes.

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

Care and risk assessment plans were in place. However, they did not always contain the information staff needed to monitor people’s health conditions effectively. For example, in a person with epilepsy’s care plan staff were advised to prevent deterioration to look out for specific symptoms. However, there were no monitoring records of these. This meant staff did not have a clear or consistent approach to supporting the person’s health. The lack of monitoring of people’s health was not identified by the manager’s audits and therefore the managers were not driving safe or effective service delivery.

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

We were told that people’s consent to their care and support was documented at the assessment and during their stay at review meetings. However, when we reviewed care plans information about consent was either not there for many people or was not clearly documented in all the records that we reviewed.

We reviewed care records that referenced “best interest” decisions. There was limited evidence of capacity assessments or detailed documentation to support these decisions. The care plans reviewed did not consistently demonstrate a clear understanding or proper application of the Mental Capacity Act (MCA) framework. Mental capacity assessments lacked detailed information including what had been discussed or whether the person could retain information. For example, one person’s mental capacity assessment relating to their overall care and treatment did not evidence any discussion with the person’s representative.

Care plan records and consent forms were contradictory. For example, one person had signed a consent form consenting to various decisions about their care. However, their care plan documented that they lacked capacity in these areas. We also found that closed circuit television (CCTV) had been installed in shared areas of the home, including the lounge, dining and hallway areas. There were no cameras in bathrooms or people’s bedrooms. We were not provided with an impact capacity assessment despite our requests for these.