Fort Horsted Care Home Ltd

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 58 (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 had not always assessed people’s health or care needs in a timely manner. For example, a recent admission did not have all essential assessments and care plans in place to ensure their care would be delivered safely and effectively. Despite regular monthly reviews of people’s care records, we found some assessments and care plans were incomplete or inaccurate. Important risks such as diabetes management, constipation, repositioning, continence or nutrition and hydration were not always clearly assessed or reflected in care plans. Some plans contained generic information or errors, which meant staff did not always have clear guidance to meet people’s needs consistently. Leaders were aware of these issues and had plans to improve care planning quality, but these were not fully embedded at the time of inspection.

The provider did not always plan and deliver people’s care and treatment with them. They did not always deliver care and treatment in line with evidence‑based guidance and agreed care was not always followed by staff in practice. For example, people who were at risk of dehydration were frequently not offered enough fluid to meet their individual’s fluid targets to help reduce this risk or in line with good practice guidelines for healthy hydration.

Where people required support with their nutrition in relation to their health or to mitigate risk of choking this had not always been effective. For example, a person required some nutritional support in relation to managing their blood sugar levels. Staff were not always following the planned care in relation to the food to offer if the person’s blood sugars were running low. Another person had a food intolerance. They sometimes made choices to eat what they wanted despite their intolerance, however it was not always clear that they were offered alternatives. For another person who required a modified diet due to risk of choking there were discrepancies in their care plan around what the level should be. However, the kitchen staff were aware of the correct level recommended by Speech and Language Therapy and told us they checked staff supported the person safely in line with their recommendation at mealtimes.

People gave positive feedback about their food. People had certain meal and dining preferences which they felt staff supported. A person told us, “Food is fine. I have never not been able to eat; there are always other options."

The provider generally worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. For example, people’s care records included hospital packs so important information about people could be shared between services when required.

The provider made sure staff, teams and services usually worked together to deliver effective care. Staff worked with a range of external professionals, including GPs, district nurses, and specialist services, to support people’s health needs. A person told us that health care professionals was coming to the service to review their particular health need. Relatives told us staff kept them informed and involved in discussions about care and health changes. A relative said, “They often update me with what the hospital says.” We saw evidence of referrals and follow‑up with professionals, supporting continuity of care and positive outcomes for people.

Staff told us, “We work as a team to make sure each resident needs are met by following the care plan, we discuss during handover and throughout the shift.” A healthcare professional told us, “Interactions with the service are positive, with staff generally approachable and responsive."

The provider did not always support people to manage their health. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People living at the service had access to onsite nurses and staff generally supported access to other external health care professionals, for example, the GP, community mental health team, and Speech and language therapists.A relative told us, “My [relative] had a bug a few weeks ago they contacted me and advised what they have…They contacted the GP and kept me advised about all steps of the way. They are good at keeping in contact.”

However, people had not always received care from staff to maintain their physical health for example around repositioning to promote skin integrity or constipation management to minimise possible discomfort. These shortfalls meant the provider did not consistently support people to maintain or improve their health and wellbeing.

We found some examples of when timely management had not taken place for some individuals changing health needs. For example, a person who had experienced weight loss had not been effectively supported to monitor or manage this. There was a plan to offer fortified foods and supplements which had taken place however there were not always records of meals being offered at supper or teatime. This meant the provider could not be assured they had maximised opportunities to increase the person’s calorie intake and weight. In addition, part of the plan was to complete weekly weight monitoring which had also not taken place for 8 weeks. This meant the provider had not effectively monitored the risk for the person to ensure their health did not deteriorate further. The provider could not be assured that systems were being operated effectively or robustly to monitor and manage concerns with people’s health in a timely manner. Despite this, when the person was weighed 9 weeks later, they had gained some of their weight loss back.

A healthcare professional told us, “Referrals to our service have generally been appropriate and made in a timely manner. On occasion, there may be some delays.”

The provider did support people’s well-being by supporting people to remain active. For example, external professionals came to the service to provide exercise activities. We observed some people were engaged in their own activities in their room such as watching television or completing word puzzles. There was an activities co-ordinator to help people engage and we observed people happily engaged in activities such as having their nails painted. A person told us, “There is enough to keep me occupied, I like physical activities, making up items or repairing, DIY type things.” A relative said, “They do provide good activities.”

Visitors were welcomed into the service to spend time with people. Some relatives told us people’s wellbeing had improved since moving to the service.

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.

Although the provider had systems and processes in place to support the service to monitor and improve outcomes for people these had not always been operated robustly to ensure effective outcomes. Systems in place to record and review incidents, accidents, medicines errors and other risks had taken place regularly. However, these had not always identified where people were not receiving effective care or positive outcomes. There was not always evidence to demonstrate that actions had been taken to improve people’s care or outcomes or that when actions were taken that these were embedded. For example, prior to our inspection we had fedback to the registered manager about gaps in a person’s repositioning records, however during the inspection we found the same issue for other people living at the service. For a person their care plan stated they should be repositioned every 4 hours overnight, but records did not show any repositioning had taken place over night. This increased possible risk to people and demonstrates monitoring and improving outcomes for people was not consistent or robust.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The provider made sure people’s consent to care and treatment was sought and respected. The provider had recently completed an audit and was in the process of improving staff practice around the Mental Capacity Act 2005 (MCA). Staff had requested and attended a workshop on the MCA. A staff member told us, “It is about communicating information to people at the time. If they are unable to understand information, if they do not have capacity for example we need to speak with [relevant others about decisions] and ensure they are involved before taking decision on the person’s behalf.”

People, relatives, and staff told us the staff routinely asked people for consent before providing care and respected their choices in day‑to‑day practice. A person told us, “[Staff] knock on the door.” Relative told us, “They always ask for permission.”

Where people lacked capacity, mental capacity assessments and best‑interest decisions were in place, and applications had been made to ensure care was provided lawfully. However, some mental capacity assessments were recorded in quick succession and were not contemporaneous.

We observed staff supporting people’s rights, dignity, and involvement in decisions about their care throughout the inspection.