Lucketts Farm

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.

At our last assessment we rated this key question good. At this assessment the rating has changed to 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 42 (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. Where people had complex health conditions, the provider could not always demonstrate they had thoroughly assessed their needs when they changed to ensure care was planned effectively. Though some risks were well managed and reflected people’s current needs, this was not always the case. For example, we identified 2 people were at risk of falls and had fallen recently, but the provider had not put in place a risk assessment to explain how staff could support these people to mobilise safely and prevent them from falling in the future. Care planning in place did not always reflect people’s current health and care needs or show evidence that people’s care had been regularly reviewed with them to ensure it met their wishes.

One relative told us, “The care plan has not been reviewed in a couple of years…I feel it should be, but I’m not given the opportunity to discuss that”. There was no clear evidence of how often care plans had been reviewed or who had been involved in these reviews.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We saw the service made referrals to partner organisations where people had health and support needs, and we heard positive feedback from these partners on their interactions with the service. One health and care professional told us, “Recently I discussed a person who had been showing increased signs of distress with (member of management team). We had a good discussion, and they took on board the recommendations that I made. They were clearly concerned about the well-being of the resident that we were discussing”. Despite this, the information available to staff lacked clarity on how the service could support people based on evidence or any guidance from partner organisations. Where people had conditions such as epilepsy there was no information on signs and symptoms for staff to look for, and information on when rescue medication should be given during a seizure was unclear resulting in staff not having a clear knowledge of this. Another person had diabetes and though most staff we spoke to were confident in how to manage this safely, the guidance in place to manage this was limited and unclear. This posed a risk as we could not be assured new or temporary staff would be able to understand to safely provide care to this person, as the information available was not sufficiently detailed.

The provider did not always work well across teams and services to support people. Staff told us they worked effectively as a team to support people’s needs. One staff member said, “Yes I think we work well as a team, and where incidents happens or people’s needs change we learn together”. We received positive feedback from people and their families about the support they received. One person told us “I I like it here. There are always people around when I need help, and (staff name) is a great carer”.

However, we found staffing numbers at the service were low which was acknowledged by the provider, and this sometimes limited people being able to achieve the things they wanted to do. We were told that people were supported to go out into the community, but that staffing and challenges in the services meant this was not always possible.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. People had health action plans in place and we saw detailed evidence of the provider supporting people to access health services. For example, during our inspection we saw a member of staff supporting somebody to visit the dentist and each person had oral health assessments which to determine if they needed to provide any additional support to people in keeping their teeth and mouth healthy. Staff were proactive in supporting physical activity and movement with one staff member saying, “We supports people to go for a walk twice a week to stay active. There are inter-house games every last day of the month to support people in moving, which people enjoy and it gets very competitive”.

However, there was insufficient guidance in place to ensure staff had the knowledge and information to support people in managing their health conditions safely. One person had poor mobility and had a higher risk of a pressure injury as was often stationary, yet there was no risk assessment on how staff could prevent this, recognise signs or symptoms or who they would contact if they were concerned. We found similar gaps in information for a number of health conditions and people where further clarity was needed on how to support people in being healthy.

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.

Where people had complex health conditions, the provider did not always have effective mechanisms in place to monitor how they were being managed to ensure people were being protected from harm. One person was at a significant risk of constipation, which can be a life–threatening issue for people with a learning disability who are at heightened risk from complications if it is left untreated. People with a learning disability may also be less likely to recognise the symptoms of constipation and be able to communicate their symptoms, increasing the risk of serious consequences. This person had their bowel movements monitored to help staff identify when they might be constipated and require medication or treatment. However, this had not been regularly completed meaning the provider had no effective monitoring of the risks to this person and risked delaying access to support as staff could not identify when this person had last been to the toilet.

Where people had personal ambitions or goals these were often not specific with examples including “to have a good social life” or to “developing skills in everyday tasks”, with no clarity on what these meant to people or details of how the provider would monitor these to see if they were being achieved. There was evidence of how these outcomes were being reviewed with people to ensure people were happy with the support they were receiving.

The provider did not tell people about their rights around consent and did not always respect their rights when delivering care and treatment. CCTV equipment had been placed in people’s own homes which the provider explained people had given their consent for, however when we asked for evidence of this management could only provide newly completed consent forms created during the inspection. Therefore, we were concerned that people had been recorded in their own home for a lengthy period of time without appropriate consent being sought. The provider explained this system was to monitor staff and view any incidents, but this use wasn’t proportionate to the impact on people’s privacy or was the least restrictive option. Action was taken to stop using this system once we raised concerns about its usage being proportionate or dignified.

Where people did not have the mental capacity to make decisions for themselves, the service had assessed this and best interest decisions for any restrictions to keep people safe were documented. However, these were not always clear on how decisions were reached including how other less restrictive options were considered first, if people’s representatives had been involved to advocate for them and when decisions should be reviewed to make sure they were still in people’s best interest. One person was placed at risk by fizzy drinks which could severely exacerbate an existing medical condition but we found guidance in place around this was contradictory. Some guidance in their care plan stated that this person “must not have fizzy drinks”, whereas other information stated they could if reminded of the risks. Management told us they were considering assessing this person’s mental capacity to make decisions about their care, however had not recognised that without this they did not have the right to prevent somebody from choosing certain drinks. Another person had a sensor mat in place but had not a seizure for a number of years, but they had not reviewed this usage to ensure it remained the least restrictive option. There were also house rules in place stating people could not drink excessively in their own homes or smoke, which also did not respect that people have the right to make potentially unwise choices should they wish to do so.