Garsewednack Residential Home

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• 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 out last assessment, we rated this key question good. At this assessment, the rating has changed to inadequate.

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

The provider and registered manager was in breach of the legal regulation relating to safe care and treatment, consent and governance.

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 consistently ensure people received effective care and treatment. People’s health, care, wellbeing, and communication needs were not always discussed or reviewed with them.

Care plans were being reviewed, but the process was not effective in identifying or addressing concerns found during this assessment. Plans often lacked consistency and key information, meaning staff did not always have clear, up-to-date guidance to deliver care tailored to individual needs, putting people at risk of not receiving effective care and support.

The provider did not always assess specific risks to people. For more information, see Involving people to manage risks quality statement.

There was no evidence in care records that people, their relatives, or advocates had been involved in creating or reviewing care plans. By not involving the person, their relatives or advocates the service cannot always be assured care and treatment is appropriate, meets the person’s needs and reflects their personal preferences. A staff member responsible for reviewing care plans told us there was currently no documentation of such involvement. People we spoke with did not know what their care plan was.

Whilst we did not identify anyone who had come to harm, this contributed to a breach of regulations relating to safe care and treatment and governance.

The provider did not consistently plan or deliver care and treatment in partnership with people, including what was important to them.

Although staff understood IDDIS (The International Dysphagia Diet Standardisation Initiative) guidance. We saw one person’s IDDIS guidance had not been followed or recorded in relation to delivering care and treatment which had been assessed for the person.

We found that MUST (Malnutrition Universal Screening Tool) assessments were not completed for people identified as at high risk of weight loss. The provider was not using weight loss, acute illness and nutritional intake to calculate a score and guide further assessment.

The provider systems did not always ensure national legislation, good practice and required standards were being followed. For example, HSE (Health and Safety Executive) guidance and Mental Capacity Act Code of Practice.

This contributed to a breach of regulation relating to safe care and treatment.

A relative told us, “I think staff are communicating well between each other, there are plenty of notices in her room about her fluid charts, repositioning charts, body map charts, all sorts of things they need to check”. Another told us, “(Person’s name) enjoys food, meals are really good”.

The provider did not always work together well with teams and services to provide safe care that met individual needs. The concerns identified during this assessment identified that staff did not have access to the information they needed to ensure, consistent, timely and person centred care.

We contacted several professionals who work with the service, but did not receive any feedback about how the service worked with them.

Staff told us they felt the care team worked well together. However, feedback was mixed regarding how well the care team and management team worked in partnership. A staff member told us, the care team tried their best, however morale was low and they did not feel the management team always respected and worked with them.

One relative told us, “Staff are working well together, and any changes are reported and fedback to team”.

The provider did not always support people to manage their health and wellbeing. Staff did not always support people to live healthier lives.

Staff were not always aware of people’s food allergies, and kitchen staff did not have a complete record of all known allergies. Care records were inconsistent, which placed people at risk of allergic reactions. We advised the management team to contact medical professionals to confirm people’s allergies and ensure records were accurate and up to date.

Whilst we did not identify anyone who had come to harm, this contributed to a breach of regulation relating to safe care and treatment.

Food was prepared freshly on site, and people were offered some choice in their meals.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

One person’s care plan contained contradictory information about the correct setting for their pressure-relieving mattress. As a result, staff did not have consistent guidance on how to minimise the risk of skin damage or what action should be taken following a fault. We observed the mattress was set incorrectly, placing the person at potential risk of harm.

This contributed to a breach of regulations relating to safe care and treatment.

Staff monitored some people’s food and fluid intake, but we found significant gaps in the records. In one case, there was a 16-hour gap between recorded drinks. This meant the monitoring system did not always protect people from the risks of dehydration.

One relative told us, “I think they are managing him so well that when I saw him last time I noticed improvements”.

The provider did not consistently inform people of their rights around consent or respect those rights when delivering care and treatment. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack capacity. It requires that people are supported to make their own decisions wherever possible, and that any decisions made on their behalf are in their best interests and the least restrictive option.

Records did not show whether people had been asked about their legal authority to make decisions on behalf of relatives, such as providing copies of an Lasting Power of Attorney for finances and/or health and welfare. This meant there was a risk that relatives and friends with the legal power to make decisions on their loved one’s behalf would not have been involved appropriately in decision making. We raised this with the provider, who confirmed they had since requested this documentation from all relevant individuals.

Decision-specific mental capacity assessments had not been completed. However, some best interest decisions were recorded in care plans. This put people at risk of decisions and restrictions being made on their behalf, without any consideration as to whether the person could be supported to make the decision themselves. This was unlawful.

This contributed to a breach of regulation relating to consent to care and treatment.

Deprivation of Liberty Safeguards (DoLS) applications had been submitted. For more information, see the Safeguarding quality statement.