The Terrace

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 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 seeking and recording consent for people.

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 was effective by assessing and reviewing their health, care and communication needs with them.

People’s needs were initially assessed and reviews had been completed using appropriate nationally recognised tools. However, some care plans lacked detail and reviews of people’s care had not identified or addressed shortfalls. For example, 1 person’s care plan stated they required assistance to reposition every 2 hours. It was not clear how this was managed overnight and staff did not always follow the guidance detailed in the care plan.

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

The provider followed best practice guidance when assessing people’s needs and staff demonstrated a good understanding of the people they supported. Care records also showed active involvement from GPs, district nurses, occupational therapists, and other healthcare professionals in planning and reviewing people’s care.

People’s mealtime experience and quality of food provided needed improving to ensure people’s nutritional needs and preferences were met. People, relatives and staff told us that the quality of the food was poor, lacked variety and was not in line with people’s preferences. Menus were produced and put on tables but the food provided was not the food on the menu. People told us they were not always given a choice of meal. A relative told us how basic food preferences around sauces on sandwiches were not always met and so their relative was having cereal instead. People were seated for their evening meal but left waiting with no staff available to serve the meal and support people.

The service was in the process of recruiting a new chef which they felt would address the concerns raised at this assessment.

The provider 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.

Staff had a good working relationship with professionals supporting people such as district nurses and other visiting healthcare professionals. Staff told us they worked well as a team to ensure people’s needs were met.

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.

Staff had a good understanding of people’s needs, as many of the staff had worked at the home a long time. However, care records did not always reflect these needs, and there was no evidence of regular meetings to review people’s care needs.

People, relatives and staff told us activities did not promote and encourage well-being through movement and mental stimulation. One staff member told us, “There is so much that they could do, residents aren’t stimulated. They (management) don’t ask our opinion on how to improve it.”

People’s independence was not always maximised or encouraged due to environmental restrictions. There was no independent access to a safe outside space for people living with dementia and 1 independently mobile person could not freely access the communal areas.

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.

There was a lack of meaningful review with the person to ensure care and treatment provided was effective and meeting their assessed needs. Processes were not always effective in monitoring people’s weight and skin, so it was not always clear if action was taken and whether current measures were effective.

Guidance for staff was not always followed and in some cases, a generic approach was taken in the delivery of care. For example, hourly overnight welfare checks were done for all residents and there was no evidence that this was individually assessed and necessary. There was a risk of interrupting peoples’ sleep unnecessarily.

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

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA).

We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. People did not always have a DoLS authorisation in place where this was needed.

People’s consent was not always documented, so we could not be assured people had provided consent or that restrictions had been properly considered and discussed with them, in line with requirements under the MCA. For example, capacity and consent was not documented for the use of people’s images and videos of them on an open social media page. Families told us they had not been spoken to about this and were not aware it was a public facing, unrestricted page.

Staff had received training in MCA and DoLS, however they did not demonstrate an understanding of the basic principles and best practice. A staff member told us how they had observed staff completing moving and handling with a person without explaining what was happening or gaining consent which led to distress.

It was not always clear whether people had a Lasting Power of Attorney in place, as the service had not confirmed or documented this.