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 our last assessment we rated this key question inadequate. 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 provider was in previously in breach of the legal regulations in relation to safe care and treatment, dignity and governance. Some improvements were found at this assessment; however, the provider remained in breach of the legal regulations in relation to safe care and treatment and governance.

The provider was no longer in breach of the legal regulation in relation to dignity.

This service scored 50 (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 assess people’s needs in a timely or consistent way, and assessments did not always give staff the clear guidance they needed.

Care plans had improved since the previous assessment and contained more detail, but gaps remained. Staff told us plans needed further updates to ensure they were specific and personalised, including where people had diabetes or swallowing needs. We saw one person with no moving and handling assessment, another with an out‑of‑date assessment, and a third person without a choking risk assessment. Some people’s care plans did not include SALT guidance, despite them receiving texture‑modified diets.
We also found large gaps in fluid monitoring records and inconsistent repositioning records for people at high risk of skin breakdown. People and staff confirmed bathing and showering were not consistently offered in line with assessed needs. These issues contributed to the assessment of people’s needs not being understood or met.

This contributed to the breach of regulation in relation to safe care and treatment.

People were not able to tell us if they were involved in the writing of their care plans and risk assessments and one relative said, “Had involvement with the care plan at the beginning but not sure I have been involved since.”

People had health and care plans in place, and staff demonstrated good knowledge of individuals’ needs. Improvements had been made since previous inspections, including clearer information in some plans and better evidence of involvement from health professionals despite this, gaps remained.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service did not always deliver care and treatment in line with current best practice. While some improvements were evident, care was not reliably based on national guidance. Staff delivered some good day‑to‑day care and knew people well, but records and practice did not consistently reflect evidence‑based standards. For example, we saw gaps in administration of creams. People’s nutrition and hydration needs were not always monitored effectively, with prolonged gaps in fluid chart entries for those at risk of dehydration. Repositioning schedules were not always followed, despite people being assessed as high risk of skin damage. A person at high risk of skin breakdown was not being supported in line with assessed needs.

Staff sometimes followed best practice, such as using thickener in line with a person’s SALT (Speech and Language Therapy) assessment, and some people had clinically recognised tools for assessing their needs and monitoring outcomes, such as Waterlow and MUST (Malnutrition Universal Screening Tool) charts.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We found some gaps in how clinical decisions were reflected in people’s care plans and risk assessments. The registered manager had not always ensured specialist guidance, such as SALT input, was documented and available to staff. Despite this, staff demonstrated good teamworking in practice, showing kindness, compassion and effective communication when responding to people’s immediate needs.

The service worked collaboratively to support people, although further improvements were still needed. Staff told us communication had improved and the management team were now more approachable and responsive. People had healthcare passports, and we saw timely referrals and regular GP involvement to support joined‑up care. Staff shared verbal handovers, and there was evidence of multidisciplinary input where required, including SALT, district nurses and GPs.

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. The service did not always support people to maintain or improve their health and wellbeing.

Although referrals to health professionals were made, information about how to support people to remain healthy was not always available or embedded in practice. People were not always offered opportunities for movement or physical activity, and there were no structured options for accessing fresh air or spending time outdoors.

Care plans for people with diabetes or swallowing needs lacked personalised detail despite this being identified at our last assessment, and some care plans required updates to ensure staff could follow best‑practice guidance. Fluid and repositioning charts showed prolonged gaps in supporting people to stay hydrated and maintain their skin integrity.

While staff were compassionate and responsive when immediate needs arose, people were not consistently supported to take control of their own health or make choices which supported healthier lifestyles. Staff escalated health concerns, for example one staff member said, “We did notice a little mark on her heel so wereportedthis and she was found to have an infection and so she wasprescribedantibiotics, anychangeisreportedimmediately.”

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

Although audits were in place, many had not been completed, including mattress checks, fire door tests and care plan audits. These audits not being completed were opportunities missed to improve health and wellbeing outcomes for people.

Medication audits had not identified issues found during this assessment, such as gaps in topical medicine applications or missing information about ‘when required’ medicines. Incident and accident reviews did not demonstrate learning, and lessons‑learned sections were routinely left blank.

Where improvements had occurred, such as cleaner premises, these were not supported by consistent monitoring. Overall, the provider and registered manager did not always use available information to improve outcomes for people.

Where improvements had occurred, such as cleaner premises, these were not supported by consistent monitoring. Overall, the provider and registered manager did not always use available information to improve outcomes for people.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The service did not always ensure consent to care and treatment was clearly assessed and recorded. Mental capacity assessments were in place, however, some key decisions, such as the use of bedrails, did not have an associated assessment.

We saw examples of appropriate use of power of attorney documents and staff understanding aspects of consent.

Staff generally supported people in a kind and respectful manner, and we saw good interactions which respected people’s preferences. However, inconsistent documentation meant the provider could not assure themselves people’s rights under consent and mental capacity principles were always upheld.