Holcroft Grange Residential 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.

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.

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 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.

We could not be assured people’s care and treatment was effective as some people’ s care plans contained either inaccurate or inconsistent information.

People’s care plans did not always demonstrate people’s needs had been discussed with them. This is important as care plans should be developed collaboratively, focusing on what matters most to the person. As some care plans lacked sufficient detail, and some were inconsistent and contained incorrect information, we could not be assured care plans were regularly reviewed to ensure they remained effective and relevant to their needs.

However, people’s relatives told us they had been involved in the assessment process for their loved one. One relative confirmed, “The manager came to our home and assessed [Name] and asked a lot of things about them."

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

We were not always assured people had been fully consulted and involved with the planning of their care and support. For example, one person’s care plan contained information about a chronic medical condition which contained guidance for staff on how to manage this. However, when we asked questions about the management of this condition, we were informed the care plan was incorrect and the person did not in fact have this condition but had another condition (the information of which hadn’t been included.)

People were weighed regularly and medical advice sought if people’s dietary intake significantly reduced. However, people at risk of malnutrition/on a specialised diet and/or fluids, did not always have their dietary intake recorded on food and drink charts. This meant it was not possible to tell from records whether the person’s dietary and fluid intake was accurate or sufficient and in line with the standards specified in the Index of International Dysphagia Diet Standardisation Initiative (IDDIS). This aspect of dietary recording and monitoring required improvement.

Feedback from people and their relatives about the quality of food was mixed. Comments from people included, “The food is excellent. I get plenty to eat and drink” and “The food is just about okay I can eat it but there are a lot of chips and beans. They do a good Sunday roast though” and “The food is okay. It’s basic - not cordon bleu but it’s adequate.”

One relative told us, “I think [Name] enjoys the food here and they monitor what she is eating and drinking.”

People told us if they didn’t like what was being offered, they could ask for an alternative of their choosing. One person confirmed, “There are choices and if I don’t like what they have on offer they will give me something else."

Although we were assured the provider worked well across teams and services to support people, plans did not always reflect people’s needs accurately which meant other professionals or services would not always have an accurate understanding of people's needs.

However, during our inspection, we observed staff worked well together to help deliver people’s day to day support.

We received positive feedback from an external professional who worked closely with the home on a regular basis. They told us, “Staff take advice on board, and we have a good rapport, they email any concerns about people and are observant. Things are much better now - the manager is very approachable."

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.

Although people told us staff supported them well, we could not be assured people were supported as well as they could be to live healthier lives. For example, for some people who were on modified diets, food intake records were not maintained accurately, so it wasn’t always possible to properly assess their effectiveness on people’s health and well-being.

Some improvements were needed with regards to identification and management of risks and how to support people to prevent deterioration, as guidance for staff was not always clear. For example, for one person who had been identified as at risk of as UTI (Urinary Tract Infection) there was little guidance for staff on how to identify the symptoms of this.

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

As some people’s risks had not been assessed properly, and people’s daily records had not always been maintained, we could not be fully assured people’s care was monitored as effectively as it could be. For example, records in relation to the people’s dietary intake for those on a modified diet, did not reflect a diet in line with that had been prescribed by SALT. This meant opportunities may have been missed to identify areas where improvements or changes to people’s care and treatment could be made to help better their outcomes.

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

Some people’s care records did not always evidence people had consented to all aspects of their care and support. Where people were deemed to have capacity, care plans did not always record a capacity assessment. Therefore, we could not be assured the key requirements of the Mental Capacity Act 2005 were fully understood or practiced. The way in which mental capacity assessments were carried out required review, to ensure everyone had the support they required to be able to express their views and wishes and were actively supported in decision making at all times.

However, we observed staff asking for people’s consent prior to delivering care and support. This was also confirmed by people. One person told us, “I please myself what I do.”

We also saw evidence of people being supported by an external advocate. (An advocate is independent professional who helps people understand their rights, make decisions, and ensure their wishes are heard.)