Pittsmead Grange 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.

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 consent.

This service scored 46 (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 people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People told us they were not always involved with planning and assessing their needs and wishes. One person commented, “You can ask what questions you like, and they [staff] are willing to answer them. I have not been involved in my care plan though.”

Assessments and care plans were not always completed, detailed, comprehensive and individualised. Assessments of people’s needs and wishes are conducted upon admission to the service to ensure their needs can be met. Care reviews are conducted daily by way of the provider’s ‘resident of the day’ programme. This meant a person’s care; assessments and care records were reviewed each day. However, the ‘resident of the day’ programme had failed to identify the issues we found with assessments and care records during our assessment.

People needs and risks were assessed for areas such as personal care, communication, life enrichment, nutrition, hydration, well-being, biography, pain management, and cognition and consent amongst others. However, care and support plans and assessments were not always completed, detailed or reflective of people’s needs.

A person’s biography had very little information documented and did not include information in relation to their relationships, nationality, culture and religion. Their well-being support plan had little information documented about their family, despite it being documented in other records that they were very important to them. A person recovering from a fracture had not had a pain assessment completed to help manage pain and aid recovery.

A person had no biography completed about their history, meaning staff had no information on the person’s history and preferences. Their life enrichment assessment documented that they had religious needs, however, there was no information documented to show if support was in place to help them meet this need. Their Waterlow score was recorded as 20, meaning they were at very high risk; however, no action plan was completed and in place to address the concerns and manage the risks. Waterlow risk assessment is a tool used to identify individuals at risk of developing pressure ulcers.

We drew these concerns to the registered manager and provider’s attention who told us they would take action to address our concerns.

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

The provider used evidence-based monitoring tools to help support the delivery of care in line with recognised guidance. Nationally recognised assessment tools, for example the Malnutrition Universal Screening Tool (MUST) for monitoring people’s weight and pain assessment tools to help pain management were available. However, these were not always used where appropriate, and assessments of people’s needs, risks and care and support plans were not always completed, detailed, comprehensive and individualised.

People's nutrition and hydration needs were met. A person told us, “Overall as far as the food is concerned, they could not improve on it. The variety is good, and your needs are more than adequate.” Another person said, “The food is usually pretty good, though they have their off days. We do get a choice, and it is reasonable. I had the head chef round to see me recently to ask me what I would like to see on the menu.” A third person commented, “We can have guests here. I had a table for guests with meals last week which was very pleasant. The menus are always put up, and you get a choice.”

The chef was knowledgeable about people’s nutritional and dietary needs and was informed of any modified dietary requirements to meet people’s needs. The chef told us they had a ‘resident get together’ food meeting every 3 months where people can express their likes and wishes. They told us they also changed the menus a lot, “especially if the residents do not like it”. There was a food and beverage comment book in each dining room providing people with the opportunity to comment on the menus. We noted comments from people were largely positive.

We observed how people were supported at lunch time in serval of the dining rooms. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. There was a calm but vibrant atmosphere in several of the dining rooms, with lots of positive engagement and conversation between people and staff. People discussed menu options together and told staff their choices and chose from a range of beverages on offer. We observed staff taking food to people who ate their meals in their rooms. The registered manager told us the staff team were supported by 2 hosts covering 3 floors who supported the staff team at mealtimes. The regional manager told us they used the ‘whole home approach’ where the activities coordinator, the chef and kitchen staff helped to support people at mealtimes.

The registered manager told us about their ‘Jolly Trolly’ which offered people who had lost weight calorific snacks and drinks. They told us this had a very positive effect on supporting these people to gain weight.

The provider did not always work well across teams and services to support people. We observed that communication with other professionals was not always effective to ensure people’s needs were met. We observed a medicine error during our assessment of the service. We discussed this concern with staff, a visiting healthcare professional, the registered manager, and the provider’s clinical development nurse. One visiting healthcare professional told us they were not confident processes would be followed when attending to administer and manage one person’s medicines. We spoke with the provider’s clinical development nurse who told us, “There was an error made by the staff. Lessons learned from this matter would be shared at standup meetings and actions would cascade down by the care clinical lead.”

There were systems in place to enhance better staff communication. Regular meetings were held including daily staff meetings where information was shared across the staffing team. People told us staff supported them with their health needs. One person said, “It is not ideal, but it exists. I have kept missing the doctor because I maybe have not been here, or maybe they have come in and missed me. It has never been a matter of life-or-death thing though.”

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

Care records and support plans lacked information on preventative strategies to support people’s ongoing health and wellbeing. Care records, risk assessments and support plans were either not completed, detailed or reviewed. For example, a care plan documented the person had asthma. There was no detailed risk assessment in place to manage this risk and their condition, and no guidance in place for staff on what actions to take should the person become breathless or suffer an asthma attack.

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.

Due to the issues we found with medicines management, care records including risk assessments and support plans, and mental capacity assessments we could not be assured that people were experiencing positive and consistent outcomes or that these were being effectively monitored.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. People’s rights and wishes were not always respected in line with the Mental Capacity Act 2005 (MCA) and the Codes of Practice.

The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. We found an inconsistent approach to ensuring the principles of the MCA had been followed. There was limited evidence of capacity assessments or detailed documentation to support specific decisions. Some people had not been appropriately assessed when they lacked capacity to consent to aspects of their care and this required improvement.