The Headington 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 inspection 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 medicines management, infection prevention and control, safeguarding, and good governance.

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 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.

While the provider assessed people’s needs, reviews did not always include people’s and their relative’s views. Some care plans we reviewed stated, “Not discussed with [person].” Additionally, the assessments did not always reflect input from professionals who were involved with people’s care and support. People who lived in the home on a short stay basis did not always have consistent and effective assessments of their needs.

People’s care plans did not always contain consistent guidance for staff on their assessed needs. For example, assessments included conflicting information in relation to people’s sensory impairments, mobility requirements and support needs in relation to fluid intake. This meant there was a risk staff may not provide people with consistent support in line with their needs. People’s preferences in relation to meals, cultural and social needs were not always documented. This meant staff did not always have access to information they needed to deliver support that met people’s preferences and beliefs.

The service operated a resident of the day system, where people’s care plans were reviewed monthly. However, whilst people staying at the service on a short stay basis were included in weekly reviews with professional partners, guidance for staff was not always available for their changing needs. This meant their progress and changing needs were not always assessed, putting people at increased risk of receiving ineffective care.

The provider did not always plan or deliver care with people, including what mattered most to them.

The provider did not ensure care plans and risk assessments for people with diabetes consistently included guidance for staff about how to monitor diabetes‑related needs, for example, in relation to people’s eye and foot health. There was no guidance for staff to support people with diagnosed mental health needs.

When people were prescribed a specialist diet, staff did not always record food had been modified. Kitchen staff told us they were not consistently informed of people’s new dietary requirements. Staff also reported not always having enough time to complete required skin checks, although records evidenced they had been completed.

The provider used recognised assessment tools to identify people’s nutrition, hydration and skin integrity needs. As a result, appropriate care tasks were set, such as providing fortified snacks for those at risk of weight loss or setting daily fluid targets. People had access to food and drink, with drinks were accessible to people. Staff had good knowledge of dehydration and malnutrition signs and symptoms. Fluid monitoring was discussed in handovers, and records showed intake and output were tracked. However professionals told us they had seen people unable to access drinks and people with dry mouths, indicating possible dehydration. We did not observe this during our inspection.

Wound care plans and body maps provided guidance for staff, and professionals were involved when needed, helping to prevent skin deterioration.

The provider did not always work well across teams and services to support people. They did not work well with people’s relatives to ensure people’s care was joined up. The service did not always evidence how they worked with people’s external care arrangements who entered the home.

We observed written notes in people’s rooms from family members to support staff to care for their relative. Relatives told us they needed to step in and compensate for gaps in staff practise, by writing written reminders and clear plans for staff to support them to care for loved ones, as their needs were not always being met. A person’s relative told us, “It is a bit annoying that we have had to put up notes to remind them to keep [carrying out care task].” This meant people were placed at increased risk of people receiving inconsistent care.

People’s care records did not always evidence how the service co-ordinated care with external professionals visiting the home.

We received mixed feedback from external professionals about how effectively the provider worked with them. Comments included, “[Staff] provide a comprehensive list of people requiring medical review” and, “Falls and hospital admissions are not always handed over.” Partners told us care had improved since face-to-face training was introduced.

Staff met weekly with external professionals and these meetings were documented. Handovers between staff and management were constructive and communicated well across the home.

When people moved between services, the provider shared their assessment of people’s. Hospital passports were in place, which included people’s medical needs and their latest set of observations. The registered manager told us people were accompanied to access different services by staff if their relatives could not attend.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had access to routine cancer screening services, audiology, and optometry services. The provider had a contract with optometry providers where people received a free pair of glasses after they had an eye test. Staff received training to support people who were temporarily living at the service, this helped people to transition into the community. The provider supported people to attend armchair exercises and receive vaccinations. This meant that people were supported to protect and sustain their health.

The provider did not always monitor people’s care and treatment effectively or ensure outcomes met clinical expectations, or what mattered to people.

The provider’s monitoring approach did not consider people’s quality of life. We observed staff completing tasks efficiently but with little engagement outside of essential care. People and their relatives told us, “[Carer] comes in occasionally but not for very long, they don’t chat very often,” and “Most of the time [person] has no one to talk to, it would be really nice if someone would talk to [person]. They put [person] in the Lounge all day but there is no one to talk to.” A person told us, “My memory goes but I still have a voice.”

One person’s relative told us, “We often meet [person] in a communal area, but we often notice that the carers are not looking at the residents or engaging with them.”

An activities programme was in place, led by a dedicated coordinator who knew people well and offered 1 to 1 sessions throughout the week. External professionals told us people who lived at the service on a short stay basis were not always supported to take part. The provider could not be assured people were being offered opportunities to participate in activities as records did not always include this information. We observed communal televisions were left on all day, showing repetitive content that did not reflect people’s preferences. People and their relatives told us this was often the case.

Clinical monitoring took place, including weight checks, blood sugar monitoring, and assessments of skin integrity, nutrition and hydration. Management told us, “We complete clinical monitoring with the GP.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Mental Capacity Assessments (MCAs) and Best Interest Decisions (BIDs) were recorded for people who had been deemed not to have capacity to specific decisions. Staff had received MCA training, and demonstrated an understanding. One staff member said, “[I provide] clear, accurate information that empowers individuals to advocate for themselves and ensure that professionals understand their legal duties.”

The provider had obtained copies of lasting power of attorney (LPA) documents for people who had them. Staff were observed knocking on doors and asking people discreetly if they could assist them with care tasks.