Archived: Lyme Regis Care Home with Nursing

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 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.

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 ensure that people’s care and treatment were effective, as care plans were not always sufficiently detailed, up to date, or discussed with people and those important to them.

We reviewed care records and plans and found variation in their quality and content. In one example, a person’s care plan stated that staff should ensure their environment was safe, clutter‑free and easily accessible. However, we found the person in an environment that did not reflect this guidance, with items obstructing access and bedding tangled around them. Although the care plan indicated four‑hourly checks were sufficient, the person had a known behaviour of moving their pressure mat away from the bed, increasing the risk of unwitnessed falls. This demonstrated that known risks and changes in presentation were not consistently reflected in care planning and monitoring arrangements.

Feedback from relatives about involvement in care planning was mixed. Some relatives told us they had been involved in or recently received a copy of the care plan, while others said they had not seen or been involved in reviewing care plans. This indicated that people and relatives were not consistently involved in reviewing and discussing care plans to ensure they reflected current needs.

The provider did not always ensure that people’s care and treatment were planned and delivered with them in a way that reflected their current needs and risks.

Regular assessments and reviews of people’s skin integrity took place. However, we identified inconsistencies in recording, review and oversight. A notice at the entrance to the service stated there were ‘0’ wounds, yet we observed a person with a dressed wound on their arm. This was not recorded in their care plan or supported by an incident record.

A second wound had been recorded on a body chart with a planned review date; however, this review did not take place. The person’s overall skin integrity care plan had subsequently been reviewed and stated their skin was intact, which did not reflect the presence of the wounds identified. In addition, the person’s Waterlow assessment had not been updated to include either wound, resulting in an inaccurate assessment and potential risk of unmet need, such as delayed referral or insufficient monitoring.

These findings demonstrated that, while monitoring processes were in place, information was not consistently reviewed or aligned across records to ensure care was planned and delivered in line with people’s current needs.

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The provider did not always work effectively across teams and services to support people when their needs changed.

People told us they could see their GP, who attended the service weekly, and relatives confirmed this. People had been referred to healthcare professionals and specialist services when necessary. However, we identified instances where changes in people’s swallowing ability were not escalated promptly to Speech and Language Therapy (SaLT) for specialist assessment.

In one example, a person requested that their medicines be changed from tablet to liquid form due to difficulties swallowing. While this change was made, there was no referral to SaLT to assess their deteriorating swallow, increasing the risk of choking and further swallowing difficulties.

In another example, a person told us they believed they could not swallow safely and restricted their diet to soft foods. They confirmed that they had not received a SaLT assessment. These findings showed that assessments of people’s needs were not always shared promptly with appropriate specialist services when people moved between or required input from different services.

The provider did not always support people to manage their health and wellbeing so they could maximise their independence, choice and control.

At our previous inspection we identified concerns in relation to people’s oral hygiene. At this inspection we found that people were not consistently supported to maintain good oral hygiene. Toothbrushes were stored in cabinets and cups that were visibly unclean. One person told us their dentures were soaked by staff but not brushed, and their dentures appeared visibly unclean. They also told us they had requested their dentures be repaired, but this had not been actioned at the time of inspection.

Although people were supported to access other services that promoted their wellbeing, including visiting chiropody and hairdressing services, these findings showed that oral health support was not consistently delivered or monitored.

The provider did not always ensure that monitoring of people’s care and treatment was effective in demonstrating positive and consistent outcomes or supporting continuous improvement.

Monthly audits of care delivery tasks and outcomes were completed. For example, monitoring of people’s weight and blood pressure was undertaken, and concerns were shared with relevant healthcare professionals, including escalation to the ageing well team where unplanned weight loss was identified.

However, we reviewed wound audits and found that they were not always sufficiently clear. The recorded severity of wounds did not consistently reflect the healing progress described by registered nurses. This limited assurance that audit processes were being used effectively to monitor outcomes and drive improvement.

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

The provider had an electronic care system that included Mental Capacity Act assessments and best interest decision templates. These had been completed partially for a range of decisions. In a best interest decision, it is stated there was no one who could legally make this decision, then the document stated a relative had a lasting power of attorney. There were also no details as to how people had been supported with decision making, what ways they had information presented and what religious or cultural beliefs they had considered.
A list of Deprivation of Liberties Safeguarding authorisations was maintained. However, this did not contain information about conditions which would have been a useful aide to staff.