Carrstone House 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 service. This key question has been rated inadequate.

This meant there were widespread and significant shortfalls in people’s care, support, and outcomes.

The service was in breach of legal regulation in relation to consent.

This service scored 38 (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 did not always have risk assessments in place to meet their needs, where they were in place, they did not always include enough information. Care and support plans were in place, however we found they were not always updated quickly when people's needs changed. Care plans included if they needed moving and handling equipment but did not include which sling loops should be used. We found discrepancies in care plans which meant it was not always clear how much support people needed. For example, 1 person’s care plan recorded different amounts of insulin which was being administered by the community nurses and discrepancies around the frequency that their blood glucose should be monitored.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We viewed daily notes which were task focused and lacked person centred recording. We found some also included some large gaps in the recording of checks and in repositioning records. The service used clinical tools such as weight logs, food and fluid charts and bowel monitoring.

The provider did not always work well across teams and services to support people. We received some concerns and mixed feedback from health professionals. 1 health professional said, "Staff training needs to be more holistic and again match the needs of the older person. Robust care plans for the patients need to be followed and escalation of any deterioration needs to be taken," and "on some occasions, the management does not appear to take our concerns seriously, such as equipment or providing cotemporaneous record keeping. While another health professional said, " On the whole, the staff there do a good job; it has been the support they haven't been getting from [provider] which is a concern."

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support. We found that referrals were not always made in a timely manner. We received feedback from an OT that they had provided the service with some exercises for 2 people, and these had not been completed by staff with them. We found that care plans did not include details of health professionals involved in their care. We received concerns about the quality and quantity of food available to people, daily notes included some entries where people had declined food due to it not being appealing. Some feedback we received included meals and snacks not being offered or missed.

The provider was aware of the concerns relating to the quality of food and had recently recruited a new chef.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. We found that care plans included if people required repositioning to reduce the risk of pressure sores, however there were some large gaps in the recording of peoples repositions. Weight logs were used by the service; however, we found that there were some large discrepancies in weight recordings and that the monthly weight analysis also included discrepancies which had not been identified by the service. Food and fluid monitoring was not always in place where needed and some daily notes recorded what meals were offered but not the amount that was eaten. The lack of detailed records placed people at risk of increased risk of harm and delays to referrals being made. There was not a clear process of monitoring daily notes. Meaning that opportunities to improve care and treatment could have been missed.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. The service had a consent form in place; however, we found that not all decisions were included on the form and that they had not been regularly reviewed. For example, consent forms viewed only included sharing information with family or friends and use of photography for health conditions. We also found that where needed corresponding mental capacity assessments had not been completed for the decisions recorded on the consent form.

Mental capacity assessments had not always been completed and those that had been completed often included information that contradicted other information recorded in peoples care plans. We received feedback from people and relatives saying they had not always been involved or informed about mental capacity assessments or best interest decisions. Some Deprivation of Liberty (DoLs) applications had been applied for.