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 requires improvement. At this assessment the rating has remained 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 governance at the service.

This service scored 58 (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.

Care plans and risk assessments had not always been updated following changes in people’s needs or in line with external guidance. For example, we saw one person’s care plan guided staff to seek medical advice in particular circumstances. The manager told us this guidance had changed and updated the care plan accordingly. However, we identified another section of documentation had not been updated. This meant information for staff was contradictory and unclear.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them.

Some people were at risk associated with poor hydration. Records indicated how much people should be drinking and staff recorded what had been offered and how much people had drunk. Relatives told us their family members always had drinks available. One told us, “They did well in the hot weather, the curtains were closed and there was plenty of water and they had ice lollies.”
People had access to a varied and healthy diet. Kitchen staff were aware of people’s dietary needs and preferences. On the day of the assessment 1 person did not want what was on the menu and asked for eggs on toast; this was provided for them.

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 received handovers when coming on shift and a mid-morning meeting was held to allow staff to exchange information about people’s needs. Staff feedback about how they communicated as a team was mixed. Some staff told us they shared information effectively. Others felt communication throughout the day could be disjointed. One commented, “Communication between staff could be better. Sometimes the different groups of staff are out of synch.” Another told us, “Sometimes I feel like I’m working on my own.”
The service worked with a range of professionals to provide safe care and improve service delivery. The provider had engaged external consultancy support to review governance systems to help drive improvements.

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.

There continued to be a lack of access to safe outdoor spaces and fresh air. There was some limited seating at the front of the building but the door to a back garden was kept locked as it was not considered a safe environment for people to use independently. Although a garden party had been organised in the summer this was an isolated event. A relative commented, “[My relative] has only been out in the garden 3 times since they’ve been here because of a lack of staff. [My relative] loves nature and birds and going into the garden would make them happy.”

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 well-being had improved. Planned care tasks were added to the electronic system and there was an alert if these tasks were not completed. However, there had been a recent period when it appeared checks for 1 person had not been completed as regularly as needed. The manager told us the checks had not been added as planned care because they did not want staff to be over reliant on these prompts. However, this inconsistency in approach meant there was a risk staff would assume no planned care tasks on the system meant no checks were required.
One person had a catheter bag and there was guidance for staff on how to manage this aspect of care safely. The catheter bag was being emptied in line with the guidance. However, not all staff were consistently recording the output as needed.

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

People were asked for their consent before staff provided personal care. Where people lacked the mental capacity to make a decision for themselves, a best interest meeting was held with people’s representatives to make a decision on their behalf.