Shawcross Care 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.

At our last assessment we rated this key question good. At this assessment the rating has remained as good.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Before people moved into the service, a full assessment was completed which ensured the service was able to meet their individual needs. The assessment included the full range of the person’s diverse needs, including their wellbeing, communication needs, mental and physical health. People or relatives were involved in the assessment which ensured their individual needs had been appropriately assessed, fully understood and were confident their needs could be met.

The initial assessments were used to formulate people’s care plans. These contained details on people’s strengths and the nature and level of support they needed to meet their needs, support their independence and to stay safe. The service made sure people’s care records were reviewed monthly.

Senior staff completed a wide range of risk assessments with people including choking and dysphagia, continence assessments, dependency assessments, eating and drinking assessments and falls risk assessments.

Staff ensured the care plans were detailed, they provided a good explanation of the person’s needs, desired outcomes and actions staff needed to take. However, some amendments were required including a person who was being regularly repositioned, and this was not included within the care plan section. In several other care plans, we saw that more detail would be beneficial, for example in the safe environment care planning section of 1 person, it stated the specialist chair and hoisted needed to be checked but did not outline how often.

People and relatives gave a mixed response in relation to whether they felt involved in care planning. For example, a person said they had a care plan and explained how staff had spoken to their family about it. However, a relative said they had “no idea what a care plan is,” whilst another said, “I really have no idea if [person] has a care plan or not.” The registered manager and staff confirmed the service did not complete care plan reviews with relatives and people present but would always update relatives or the person with any changes.

The provider assessed thoroughly which was reflected in detailed care plans, however there were gaps in the safe execution of these care plans, particularly around protocols for medicines which were prescribed when required.

The provider did not always deliver care in line with legislation and current evidence – based good practice and standards.

Overall, the provider adhered to evidenced based practice in dementia care. The provider ensured holistic assessments were carried out before admission, validated assessment tools such as the malnutrition universal screening tool (MUST) for nutrition and the Waterlow for pressure ulcer risks were used, staff were observed using dementia friendly communication techniques and the environment followed dementia-friendly design principles including good lighting and safe wandering routes. Meaningful activities were for people were in place, people’s food was adapted in line with nutritional care in care homes guidance and staff were following IPC guidelines. However, repositioning and oral care were not always recorded or completed in line with people’s risk assessments and care plans.

Some of the policies and procedures we were provided with were not up to date. For example, the provider’s dementia care policy had not been reviewed since 2020 and referenced outdated national guidance (NICE/SCIE 2007) and initiatives. It did not reflect the current NICE dementia guidance (NG97) or the dementia quality standard. This meant staff did not have access to up-to-date, evidence-based guidance to inform their practice, increasing the risk care may not reflect best available evidence. Following feedback to the provider, we received updated policies which we were told had been in place at the time of the inspection.

The registered manager said any changes to best practice or legislation were communicated via the provider.

The chef provided a range of home cooked food based on traditional cooking using fresh produce. Meals were served in the privacy of residents' own rooms or in the dining rooms. There were enough staff to support people eating at lunch time as the service staggered the mealtimes which ensured people who were being supported to eat in their bedrooms had sufficient time and support from staff. People, we observed, enjoyed their food and consumed most or all of what had been offered.

Staff recorded the meals when people ate. The entries were detailed and were appropriate for the person’s dietary needs.

All people and relatives we spoke to were very pleased with the variety and quality of the food. A person said, “The food is good; I can choose what I want to eat and drink, and I get plenty to eat.” A relative said, “[Person] has put weight on since being here as they enjoy the food. Staff make sure [person] is hydrated.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider worked with a range of health care professionals such as district nurses, GP’s, advanced medical and nursing professionals, the crisis resolution team and speech and language therapy (SaLT) teams. The provider had good working relationships with external professionals although the relationship with 1 of the professionals needed improvement. The registered manager had arranged meetings with the professional’s workplace and felt supported by the overall workplace but not the professional themselves.

Staff shared information appropriately between services. We reviewed the online care records system and found appropriate referrals had been made for people in a timely manner. For example, a SaLT referral had been made following a person having a chest infection and the dietician advising an assessment to check whether a certain desired food was appropriate for the person. The service also ensured they were represented at multi – disciplinary team (MDT) meetings to ensure informed decisions were being made about people.

External professionals told us staff provided clear handovers when they visited and appeared to know the people well.

Staff ensured people had a continuity of care by ensuring handovers took place at the start and end of their shifts.

Staff members provided mixed feedback regarding their relationships with one another in the service. Some told us they had very good relationships amongst all the staff, whilst others spoke about a divide between the EMI unit and the nursing unit, divisions between the day and night staff and concerns some had regarding the amount of agency staff being used whom some felt did a less satisfactory job.

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.

Staff ensured regular physical checks were being completed to identify any changes or new needs early (e.g. blood pressure, weight, mobility and cognition).

People were supported to live healthier lives through regular health assessments and timely access to healthcare professionals, including GP’s dentists, and specialists.

Staff ensured preventative care such as vaccinations, falls prevention and nutrition support was in place to reduce health risks. Relatives told us the staff contacted them regarding vaccinations for their loved ones.

Staff demonstrated an understanding of managing long – term conditions and promoting emotional wellbeing. Staff were currently supporting a person with mental health difficulties and outlined how they had supported them to make progress in attending the communal dining area to eat their meals instead of spending their full day isolated in their bedroom. The staff were using encouragement to support the individual.

The provider ensured there were regular physical activities for people to engage in which included a local service, made up of trained personal trainers, who supported people with armchair exercises.

Gaps in record-keeping did not provide assurance that staff consistently met people’s oral health needs. We saw evidence of staff not recording oral care being completed for some people over extended periods. Poor oral care can increase the risk of infection, pain, and difficulty eating, and is a basic aspect of maintaining health and wellbeing.

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

The provider collected information on people’s outcomes, such as falls, weight monitoring and incidents, but we did not see how such incidents were being used to identify patterns or trends.

Care records were updated monthly, but there was evidence the reviews had not identified areas in which staff had not completed tasks, as outlined within the care plan section.

Staff were collecting information about behaviours which challenge, but as mentioned they were not doing so in line with the ABC charts which meant this was more difficult to analyse and inform improvements within the service.

The service conducted audits, but their robustness was called into question, given they had not identified the concerns raised during this inspection.

Some relatives told us about their desired outcomes for their loved ones were for the person to be as safe and as comfortable as possible which they felt they were. They told us staff routinely monitored their loved one’s condition, completed regular checks, updated them when needed and had no concerns people were deteriorating unnecessarily.

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

The provider ensured mental capacity assessments were completed and met the person’s needs. In 1 person’s care record, they had received mental capacity assessments in relation to residing on a unit with a coded locked door, regarding the decision to have a do not attempt cardiac pulmonary rehabilitation and for them to be administered medication.

The provider completed best interest decision meetings for people who lacked mental capacity and did not have a lasting power of attorney for health and welfare.

People told us staff sought consent before delivering care and support. One person said, “They ask me first if I want to do something.” Relatives confirmed this was the case. One relative said, “I hear them [staff] talking to all the residents telling them what they are doing as they are supporting them.”

We observed staff routinely asking people’s consent before giving assistance. When people declined, staff were respectful.

Staff completed training about the Mental Capacity Act (MCA) and DoLS and had a good understanding of these.