Harrier Lodge

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 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 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 had been assessed but care plans did not always contain person centred or consistent guidance for staff to follow. When people required equipment to be moved safely it was not always clear what equipment should be used. A person’s care plan stated they were supported using a standing hoist but later in the care plan it stated they were unable to support their weight and required a full hoist. There was a risk staff including agency staff would not use the correct equipment which put the person and staff at risk of harm.

At the time of the assessment, there was a small number of competent staff who could complete people’s care plans and the monthly reviews. Staff told us, they felt under pressure to complete the required documentation for a new admission as agency staff were unable to do this. Staff recorded the care they provided on an electronic system. We reviewed people’s daily care records. Staff completed the records retrospectively, at times at the end of a 12-hour shift, the information included was generic. Staff told us, the care records were completed when staff had time and may not be the staff member who gave the care. There was a risk relevant information about people’s changing needs would not be recorded.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. There were systems in place to assess people’s health using nationally recognised tools such as Waterlow to assess skin integrity and Malnutrition Universal Screening Tool (MUST). These tools were used to help plan people’s care when a risk had been identified. Staff had acted when people were at risk such as losing weight, people had been referred to the dietician. The recommendations from healthcare professionals were followed by staff. However, it was not always clear where the referrals and healthcare professional’s visits were recorded. Staff had recorded these in different places and finding information was problematic. There was a risk guidance would be missed if agency staff had been present when healthcare professionals visited.

People’s diet and fluid intake was recorded by staff on paper charts in their rooms when required. The charts we reviewed during the assessment had been completed and were up to date. However, it was unclear where this information was recorded in people’s electronic care plan to inform the assessment of their needs and identify risk. We observed there were not enough staff to ensure people were supported to eat their meals in a timely way and while they were hot. A relative told us,” Relatives helped residents at supper time because there weren’t enough staff. One day we were helping with a resident that came into the dining room naked, 1 trying to get out of a wheelchair and another that was shouting. There were only 2 staff there.”

The service did not always work well across teams and services to support people. Relatives told us, they were worried agency staff would not recognise when their family member was unwell.This was a bigger concern when individual units were completely staffed by agency staff. A relative described a situation when staff had not recognised their family member was unwell and there had been a delay in the person being referred to the GP.

We reviewed the handover sheets used by staff, these included basic information about people’s needs but there was very little information recorded about what had happened during the previous shift.

Staff told us they worked well with the GP surgery, and there was a practitioner who visited the service each week. We spoke with the practitioner who told us, staff had a list of people for them to see each week and followed their guidance.

The provider did not always support people to manage their health and wellbeing. A relative told us, staff had acted to remove homely remedies from their family members room without discussing it with them, this had caused the person anxiety. They understood there needed to be a process put in place to manage these medicines, but this had not been discussed with the person.

Healthcare professionals told us; staff had referred people to them when their needs had changed and followed their guidance.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. People’s care plans did not always contain details about the outcomes people expected or goals they wanted to reach. For example, there was little information about how people wanted to be supported to improve their independence. People told us there had been times when there had not been enough staff to support them when they want or needed it.

Staff had not always recorded in people’s care notes details about their care or if expected outcome had been met. For example, if catheter bags had been emptied or how much people had drunk, to identify if there was a potential concern such as someone not drinking enough. Following our assessment the target fluid intake has been added to people’s care plans.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. Staff had not always worked within the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed and this had been recorded. However, when people did not have capacity, how decisions had been made had not been recorded. Staff had not always recognised where a best interest decision was required, and it was not evident decisions were person centred. People who had bedrails in place had MCA documentation showing how the decision was made. When people did not have bedrails in place, there was no MCA documentation to show how this decision was made. We discussed this with the registered manager, how the decision to remove bedrails had been made, they stated they were following the provider’s policy to not use bedrails unless it is the only option. We reviewed the provider’s policy, and the registered manager had followed it, however, people’s choice and preference had not been considered. There was no clear documentation to show there had been discussions and what had been discussed with people or their representatives. There was no process in place to review the decisions such as when people repeatedly rolled out of bed, to check if it was still the best option.We reviewed people’s care plans who had been assessed as not having capacity. One person’s care plan there was no MCA documentation relating to the removal of bedrails or any other decision made in relation to the person’s care. We requested our findings were checked by staff who confirmed there were no records of any decisions made for that person. There were no records to show the decisions made were the least restrictive and if the person’s representatives had been involved.People and relatives told us; they had not always been involved in making decisions and their choices had not been considered.

People had been assessed to decide if a Deprivation of Liberty Safeguards (DoLS) application needed to be submitted. When required, applications had been made, and authorisations had been recorded in people’s care plans along with any conditions which may have been put in place.