Hope Valley Nursing 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 safe care and treatment, staff training, person centred care and governance at this inspection.

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. Whilst care plans and risk assessments were reviewed, these were not always reviewed with people and those important to them. Some relatives shared they were not assured staff understood people’s holistic needs. One relative shared, “There have in fact been several instances where we've had some concerns that [staff] don't know how to deal with dementia properly.” Another said, “I do think that the care plan is not detailed enough, the care plan changes seemed to have been done internally but not so much with involving me.” The provider explained the implementation of a resident of the day initiative will ensure involvement in the review process going forward. People and relatives were supported to see their care plans when they asked.

However, one relative shared, “We had a meeting with the management regarding the care plan and it was useful, we felt listened to and included. They also ring us if there are any issues and keep us up to date.”

Whilst a range of clinical evidence-based tools were used, records were not always clear if care was delivered in line with people's assessed needs. For example, where people had modified diets, recording of meals did not always confirm that food had been appropriately modified, and fluid charts were not fully completed. We found no evidence people had come to harm, and our observations showed people had access to appropriately modified meals and drinks. However, lack of recording meant we could not be assured that care was consistently delivered as planned, or that leaders had sufficient oversight to identify and respond to emerging risks such as dehydration, choking, or malnutrition.

Some relatives were not sure if staff always encouraged people to eat and drink enough. Others fed back positively on the food and drink provided at the service. Feedback included, “They make things like strawberry milkshakes, and I think they do try to encourage [person] to drink.” And “Staff take [person] down to the dining room in their wheelchair and they tell me what they’ve eaten, and [person] seems to enjoy the food.”

Staff told us they worked well together and supported one another in delivering care. This reflected a positive team culture and a willingness to collaborate. However, the provider had not yet embedded effective systems to support and strengthen teamworking across the service. At the time of our inspection, the service had just introduced its first “flash meeting”, a short, focused team huddle intended to improve communication and coordination. While this is a positive step, it was too early to determine whether this approach had been embedded or was having a sustained impact on team effectiveness.

The provider was working to recruit a full team and establish senior roles to ensure accountability. This included heads of departments and a clinical lead. Staff reported positively on these steps, one told us “We have got more permanent staff and it's making a difference, we feel like a team now.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Due to lack of audits and systems to oversee people’s care and support, this meant we could not be assured deterioration in health and well-being were effectively monitored. Furthermore, some relative’s felt health and well-being issues were not always swiftly escalated, and action only taken when prompted. Many expressed concern that people had not been supported to see a chiropodist. We fed this back to the provider who assured us chiropody was being sourced.

People were supported to see the GP who visited the service on a weekly basis. Additionally, people had been supported to see other healthcare professionals such as physiotherapy, speech and language therapy and the mental health team. We identified some improvements required to ensure care records clearly reflected any change in recommendations from healthcare professionals. Staff reflected positively on their working relationships with visiting healthcare professionals and felt able to seek advice as required.

The provider did not have effective systems in place to monitor and manage wounds. There was insufficient evidence that wound care was being consistently and accurately assessed, documented, or reviewed. This lack of oversight meant that changes in wound condition, such as deterioration, infection risk, or delayed healing were not promptly identified. Furthermore, some relatives shared concerns their loved ones had experienced pressure sores whilst living at the service and this had not always been effectively communicated with them. Following our inspection, a wound audit was completed, however this audit failed to demonstrate accurate oversight of all wounds at the service, and clear actions to ensure risks to people’s skin were mitigated. This placed people at risk of health deterioration.

The provider had systems in place to assess people’s ability to make decisions about their care and treatment. Overall, mental capacity assessments were in place and generally followed the principles the Mental Capacity Act 2005. However, some assessments lacked sufficient detail, such as the rationale for decisions made or evidence of consultation with relevant parties. We observed staff seek consent from people when supporting them.