Escan Manor

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.This is the first assessment for this newly registered service. This key question has been rated 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 people’s safe care and treatment.

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.

People's needs were assessed and reviewed regularly. However, not all information was included, and care plans lacked detail. The new management team were aware, and action was being taken immediately to review and update care plans and risk assessments. Staff told us they did not always have time to read care plans and were not always involved in people's reviews of care. Not all staff supporting people had been given enough information about peoples’ needs. This had resulted in some staff not feeling confident to care for people living with dementia for example, or understanding dietary needs. New processes were being established and embedded to ensure needs were properly assessed and risks mitigated. The interim manager and clinical lead were now completing all new assessments and would ensure information was shared with appropriate staff.

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

Responses from people and relatives were mixed. One relative said, "‘It took 3 months to refer [person’s name] to the physiotherapist. Their emotional, psychological and social care was not good, my mother is isolated” and one person said they had asked for their regular medication but it had been a week and they had not received it”. Another person said their catheter care had not been good resulting in hospital admissions, but this had now been addressed with staff receiving recent catheter care training.

Care plans detailed where people were diabetic and how to manage this, but we saw people receiving food that was not appropriate. Five relatives commented independently about diabetic diets including too much sugar, such as “[Person’s name is having too much sugar, when do staff stop giving it?”, “[Person’s name] is given lots of sweet things and she is diabetic. They say is it her right to choose, but she has dementia and can’t make a safe choice” and “Diabetes and sugar risk is not always taken into account.” One care plan had recorded blood sugar levels, but no actions had been recorded when levels were high. The interim manager said staff training was being planned. We advised this should include ancillary staff such as hostesses and the activity co-ordinator who had not read the care plans. The chef was knowledgeable about people’s dietary needs and had good records available. Observations of lunchtime confirmed people enjoyed their meals. Meals were presented well and looked appetising and were of a good portion size. People were offered a choice of drinks throughout the day and enjoyed the drinks and snacks available in the Bistro.

We saw examples of staff completing assessments for risk of pressure sores without an understanding of the tool, making the assessment inaccurate. We reviewed these records with the Clinical Lead who confirmed the records were not accurate, but staff had now received training to help them understand the assessment going forward. Equipment to support with pressure care was being used and checked regularly. Bowel management records were poor despite people having been assessed as at risk. However, there had been no negative outcomes and people were receiving appropriate medicines. The lack of consistent monitoring where risks had been identified contributed to a breach in the regulation relating to safe care and treatment.

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.

There had been recent improvement in communication between relevant agencies, the GP and family. The service had begun a new relationship with a different GP surgery with regular ‘ward rounds’ to discuss people’s needs. Relatives told us, “[Person’s name] had a rash, [staff] looked at the rash and the GP came to see it”, “Staff refer him to other professionals if needed, they referred us to a specialist in neurology for some help”, the GP comes once a month and they have looked at the sore on her leg” and “ Staff noticed that she is needing stronger pain relief and they have contacted hospice care so they can up her pain relief more.”

The service was working with the local authority to ensure issues were identified and improvements made. A relative said, “Her care plan now addresses her needs, and this has been because I have had a lot of input into it.” The new management team were working through care plan reviews to ensure people and relatives had input. Meetings for relatives and people living at Escan Manor had not been taking place but were being re-instated to enable views to be shared.

Staff confirmed there was a daily handover meeting in which people’s care, treatment and support needs were discussed and staff were allocated to people or specific care tasks with oversight from the nurses and senior carers. However, this did not include sharing information with ancillary staff. We received feedback from partners there had been a breakdown in communication with external agencies. This was being addressed with support from different stakeholders.

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.

Staff said people were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing, but we saw limited evidence of this, especially in relation to diabetes management. We saw staff appropriately supporting people with mobility, however relatives commented, “[Person’s name] has to use a frame. They assist her to walk up and down the corridor, but they can’t do it now due to staff shortages” and “She’s more independent now, before she was having to wait for assistance”. One person said they had not been outside for 9 months since their admission and would like to go out.

People and relatives all commented there had been a lot of changes in the staff team, so they had not been able to build relationships easily. Staff during our site visit did not wear name badges and some people commented on how they did not know who staff were. We were told these had been ordered One relative said, “[There are] regular carers now who are quick to resolve things.”

We saw there were now policies to support access to healthcare and there were records showing where staff had identified issues to be discussed in the daily meetings or referred to external healthcare agencies. The interim manager said the staff team was more stable and were able to understand peoples’ needs so they could ensure any issues were identified and addressed promptly.

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

The new management team had identified areas for improvement in monitoring peoples’ care and treatment and were taking actions to address these. For example, regular monitoring of people’s weights was not up to date but was being addressed. We saw evidence of body maps and monitoring of falls. Care plan reviews were ongoing but there was no oversight of which ones had been completed as yet. People and relatives’ views were currently being sought as previous surveys had raised issues but these had not been acted upon in the past. The quality manager was addressing these issues.

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

Relatives told us they had been involved in best interest decision making when needed and people told us they were asked if they were ready for personal care support and what they would like to do and when. Staff understood the importance of obtaining consent before they delivered care or treatment. Staff gave appropriate examples of when they would seek consent. Staff seemed to have a good understanding of what their training in the Mental Capacity Act 2005 meant in practice and spoke about people’s right to refuse care and treatment. The service had applied for legal authority to deprive people of their liberty where appropriate and in people's best interests, and this was monitored to re-apply when required.