Restgarth Care Home

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• 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 inadequate. 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.

Improvements had been made in this area, and the service was no longer in breach of the regulation relating to consent.

This service scored 54 (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.

Since our previous assessment care plans had been reviewed and updated. However, some people did not have care plans to cover their specific health needs. For example, one person had diabetes. There was no care plan for this and no reference to it in their nutrition care plan. This meant staff may not have been aware of their individual needs in this area.

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

Staff recorded what people ate and drank. We saw one person had very limited fluid intake. This meant they were at risk associated with poor hydration. There was no information for staff on how much the person should be drinking, how they could encourage them to have more and when to escalate concerns.

At our previous assessment we reported the design and layout of the premises did not take the needs of people with dementia into account. For example, there was no signage in the building, this can maximise independence and provide clear orientation and personalisation for both residents and staff. At this assessment we found there was still no signage. However, the deputy manager had started a project with people to support them to create pictures and signs for their bedroom doors.
 

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 had handovers when coming on shift to make them aware of any changes or issues of concern. However, as outlined above the information shared had not always been acted upon. Daily notes were completed although the information was sometimes unclear.

Staff told us they worked more as a team than previously and were better supported. Comments included, “We are all pulling together now, there is more of a team atmosphere” and “We work together well as a team.”
 

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.

At our previous assessment we found people were bored and had limited opportunities to take part in activities and be occupied and engaged. At this assessment we found there were a range of activities available for people. The deputy manager was organising an art project. The activity co-ordinator now had more dedicated time to spend organising activities.

A new chef had been employed. They told us they were planning to start providing home cooked meals using fresh produce. People were provided with plenty of vegetables and fresh fruit. A relative commented, “[Relative] enjoys the breakfast there, with fresh fruits and vegetables always available. They also offer a cup of tea and orange juice. There is always blackcurrant drink and water in their room.”
 

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 and consistent, or that they met both clinical expectations and the expectations of people themselves.

Systems to monitor people’s health and well-being had not been embedded following our previous assessment. We found people were not consistently being checked or receiving personal care in line with care plans or advice. Monitoring records were sometimes confusing. One person’s records stated they were ‘sore and red on wash, they have healthy skin, hurts even more.’ The lack of clarity meant potential signs of deterioration might be missed.

However, air pressure mattresses were set according to people’s weight which was regularly monitored.
 

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were able to make day to day choices, such as how and where they spent their time and what they ate. Staff asked for people’s consent before providing personal care. A relative told us, “The care workers are very good. For example, the carer respectfully asks [relative] for their choice of food. It is not easy to know what [pronoun] wants.”