Trafalgar 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 requires improvement. At this assessment the rating has remained 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 regulation in relation to people’s involvement in the assessment of needs and person-centred care.

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 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.

Assessments of people’s needs were not always comprehensive, and people’s care plans had not always considered the full range of their diverse needs, including psychological and emotional well-being. Some people did not have all parts of their care plans fully completed. The manager took immediate action to address this. The manager told us they were aware of this however it continued to be a work in progress.

People’s care plans outlined guidance on how to support people with specific health conditions such as epilepsy or diabetes. However, different parts of people’s care and treatment were not efficiently coordinated to ensure all their needs were consistently monitored and met. For example, we reviewed care plans of 2 people with diagnosis of diabetes, a condition affecting every part of the body, including the skin. Their care plans ‘Tissue Viability’ section did not reference diagnosis of diabetes and did not include relevant risk assessment with clear guidance for staff to recognise early signs of complication. This meant people were at risk of developing complications of diabetes not recognised or escalated by staff which can potentially lead to delay in appropriate referral to healthcare professional and further health deterioration.

People and their representatives told us they were not always involved as fully as possible in their needs assessments to ensure all needs were captured and understood. A relative told us, “I asked for a copy of her care plan, but I never received it, and I have never seen it.” We reviewed their loved one’s care plan, and it stated they lacked capacity to make all decisions pertaining to their care and support. However, they expressed a wish for their relative to be involved in decision making. This meant people’s wishes and preferences were not always taken into consideration and people were not always consulted and involved in planning their own care.

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

Care and support were planned and delivered in line with current evidence-based guidance, standards, best practice, legislation and best use of technology. However, this was not always effectively monitored to ensure consistency of practice and to ensure it was fully embedded in the service. Assessments of people’s needs were not always comprehensive and expected outcomes were not always identified or met. Care and support plans were regularly reviewed however they were not always updated accordingly to people’s changing needs. Appropriate referrals to external services were not always made to ensure people’s needs were met. For example, we reviewed 1 person’s care plan which stated they were seen by optician in October 2024 and needed to wear glasses due to poor vision, however they couldn’t afford the glasses they received a quote for at that time. We found no evidence the person had been supported to get another quote for the glasses they needed or that their legal financial appointee had been contacted to resolve this.

We reviewed another person’s care plan which included conflicting information. Their ‘Care Plan Summary’ stated they didn’t need glasses, and their eyesight was good however the ‘Communication’ part of their care plan read they needed to wear glasses and may require help with cleaning them. One relative told us, “[My loved one] has hearing aids but lots of the time the batteries are run down or there are no batteries.” This meant people were at risk of not having their needs fully met in accordance with their wishes and preferences.

Most people's care plans outlined their food and drink preferences. Their care plans identified the level of support people needed from staff to prevent malnutrition and dehydration, and this information was available to the staff working in the kitchen. However, some people’s care plans contained conflicting information about the level of risk identified through regular malnutrition screening. Some people identified to be at high risk of malnutrition did not have malnutrition risk assessments in place. This meant people were at risk of not having their nutritional needs met and health deterioration.

Most relatives told us people enjoyed their food. Comments included, “[My loved one] enjoys the food and has gained an enormous amount of weight” and “[Staff] put food out in front of [my loved one] and leave [them] to eat it on [their] own. I have had to raise the issue of support for [my loved one] to eat and drink. I think it’s better now."

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.

Staff did not always work collaboratively across services to understand and meet people’s needs. Information was not always effectively shared between teams and services when they worked together to deliver a person’s care. Not all relevant staff understood people’s needs, how they should be met and by whom. For example, when people were referred between services. This meant people’s care was not always effectively coordinated, to ensure they received support and treatment they needed timely and consistent way.

We received mixed feedback from 4 visiting health and care professionals about collaborative working. They told us that some staff didn’t know people they support well and didn’t fully understand their health and care needs. This meant professionals had not always been provided with the information they needed to be assured people were receiving the care they required.

Professionals told us they experienced difficulties in effectively communicating with the home. They told us: “The care home management team are at times difficult to get hold of and response to phone calls / emails are delayed and require chasing several times.”

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

Processes for monitoring the effectiveness of people’s care, treatment and support were not effective in ensuring actions were always taken to continuously improve the service. The provider did not always understand what expectations and positive outcomes look like according to legislation, national standards and evidence-based good practice guidance relevant to their service. Assessments of people’s needs were not always comprehensive and expected outcomes were not always identified. For example, we found people’s cultural and support needs were not always considered when the premises were adapted or decorated. The physical environment was not decorated or adapted to a consistent standard to meet needs of people living with dementia. Premises and facilities were not designed in an accessible way to promote people’s independence and wellbeing. The provider had not followed good practice guidance to assess how each person living with dementia could orientate themselves in their surroundings. Contrasting colours had not been used and people did not have photos or personalised items in memory cabinets to easily identify which room was theirs. All bedrooms had only numbers on the doors. There was no clear signage with both words and pictures around the home to show directions. No designated easily accessible quiet spaces for residents who may feel overwhelmed or anxious. This meant people could not orientate in their environment independently and had to rely on staff assistance.

The provider sought feedback from people and their relatives. There was a tablet kiosk located in the entry hall available for all residents and visitors providing opportunity to submit feedback digitally. There were regular residents’ and relatives’ meetings where people had been given opportunity to express their opinions, wishes and preferences.However, feedback from people and their relatives was not always actively used to understand the expectations people had about the care they receive and what positive outcomes look like for them.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.