Lark View 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.

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 ensure people’s care and treatment were effective because they did not always check and discuss their health, care, wellbeing, and communication needs with them. People’s care plans had been reviewed, but some changes recorded during the review had not been transferred to the main care plan. Some people’s care plans were inconsistent and confusing, including, for example, a person’s mobility needs. The review section stated the person had been advised to walk twice a day with a stick and 2 staff following with a wheelchair, but in the care plan it stated a stand aid should be used. We discussed this concern with the registered manager, who told us the physio was working with the person to build their strength, but the staff only used the stand aid; the staff confirmed this.

When sections of people’s care plans were linked, the information did not always match. Some sections had been reviewed and changes made, but these had not always been transferred to other sections. For example, people’s medical care plans had information about equipment needed to manage a condition, but in the sleeping care plan, it says people may not use them. There was no indication of this in other care plans and there was no guidance about how not using the equipment would need to be managed.

The provider did not always plan or deliver people’s care and treatment in partnership with them, including what was important and mattered to them. Care was not always provided in line with legislation or current evidence‑based practice. Some people were living with dementia on a dedicated floor within the service.

The registered manager had not ensured the environment met best practice guidance, such as NHS England's Health Building Note 08-02: Dementia-friendly health and social care environments. People living with dementia can have difficulty identifying furniture or doors, and guidance recommends using a strong colour contrast to make identification easier. The furniture and carpets in the lounge were in different shades of cream and did not provide the required colour contrast. All the doors within the unit were the same including the frame around them which did not support people who may not be able to understand signs to find their way around the unit. The wellbeing co-ordinators had completed a monthly audit but had not identified the shortfalls inspectors found during the inspection.

People’s needs had been assessed using recognised clinical tools, including the Waterlow score to identify risks to skin integrity and the Malnutrition Universal Screening Tool (MUST) to assess the risk of malnutrition or weight loss. The Waterlow score helps staff identify how likely a person is to develop a pressure ulcer, while the MUST tool identifies adults who are malnourished, at risk of malnutrition, or obese. Staff followed the guidance associated with these assessments, such as using pressure‑relieving mattresses for people at higher risk or weighing people weekly when required.

When people required modified diets, such as pureed meals, they were provided with food at the correct consistency. During the lunchtime meal, we observed staff demonstrating a good awareness of who needed specific diets and supported people appropriately.

Some people’s wounds were managed by the nursing staff following evidence-based practice. People’s wound records showed dressings, and the frequency of their being changed had been adjusted according to the wound. For example, when wounds appeared to be infected, the dressing was changed to include an antibacterial agent to promote healing. People were included as much as possible to promote healing. Nurses explained why a change had been made and how they could help, such as elevating their legs.

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. Staff told us they felt they all worked well together, there were written handovers for each shift, and these included any actions which needed to be completed, such as calling the GP or district nurse.

People had been referred to other health professionals, such as the dietician or speech and language therapist, as needed. Staff followed their guidance, including making sure people received nutritional supplements when required. We observed staff working with the community mental health team to make sure they had the information they needed to make decisions about the person’s support needs. Relatives told us people had been referred to the GP when they were unwell or their needs changed.

The provider supported people to manage their health and wellbeing, maximising their independence, choice and control. Staff supported people to live healthier lives and, where possible, reduce their future needs for care and support. People were supported to use equipment to support their health. Some people with diabetes used a system to monitor their blood sugar without having to test their blood. This had enabled people and staff to recognise when their blood sugar was rising or falling, and to take appropriate action before they became unwell. The readings from the equipment provided evidence supporting a change in people’s insulin to help maintain a consistent level.

People and relatives told us they were supported to attend the optician and dentist when needed. Health professionals such as physiotherapists visited people at the service to support them in becoming more mobile or increasing their strength.

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. People’s care plans did not always include their goals and the expected outcomes of the care being provided. When people had fallen, the measures put in place were not always recorded in the care plan, nor was guidance on how to check whether the measures had been effective.

Some people’s diet and fluids were recorded to check they were eating and drinking enough to remain healthy. However, there was no evidence that the charts were being reviewed to check that people were meeting their fluid intake goals. This had been identified in the October audits; there was a plan in place to address the issue at staff supervisions.

The provider did not always tell people about their rights regarding consent and did not always respect their rights when delivering care and treatment. When people were assessed as not having the capacity to make decisions, staff did not always follow the principles of the Mental Capacity Act 2005 (MCA). Best interest decisions should be recorded with accurate records of how decisions were made and who was involved; this had not always been completed when decisions had been made. For example, a person had moved room to another area of the service and had 1-2-1 support. Staff had not recorded what had led up to this decision, why it was made, and why this was the least restrictive option. We discussed our concerns with the registered manager, who explained the person had been anxious and at times distressed in their previous environment and did not like sharing staff attention. This had been identified as the root cause of a series of incidents, since the changes these incidents had stopped, and the person was happy.

Staff did not always display an understanding of their responsibilities under the MCA. Some people had been assessed as not having the capacity to make complex decisions but could make day-to-day decisions. However, staff had not always respected and supported people’s choices. A person had requested that their door be locked at night when they were in bed. Staff had ignored this when writing their care plan, stating that it was important and in their best interests for staff to enter their room every 2 hours. Staff had written that the person did not understand the associated risks of locking their door. Staff had not recorded the risks and why the decision was made that this was the least restrictive option, especially given that staff had a master key to open the door if needed. There was no record of what other options had been considered, such as an alarm mat, a sound monitor, or whether staff had discussed this with the person or their representative.