Peregrine House

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 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Relatives confirmed initial discussions were held with the provider and with a representative from the Local Authority or hospital discharge team where appropriate. The provider completed an assessment of their family member’s care and support needs. Visits to Peregrine House were conducted to enable the prospective person and/or their relative to view the premises, to meet staff and others living at the service.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did not always do this in line with legislation and current evidence-based good practice and standards.

People’s and relatives’ comments about the quality of the meals provided were positive. Comments included, “[Family member] enjoys the food and they get a good choice”, “[Family member] likes the food” and “The food is quite good, I have no concerns.”

The dining experience was variable across the service on the first day of our assessment. Where appropriate, staff showcased food choices through ‘show plates’ by enabling people to choose their meals at the point of service. Meals were well presented, considering people’s individual food and dining preferences. For example, if they favoured a big or small plate of food, and specific favourite food items. People were not rushed to eat their meal and received verbal encouragement and prompting from staff where they experienced a reduced appetite.

Where people were at risk of poor nutrition, their weight was monitored at regular intervals and appropriate healthcare professionals, such as dietician and Speech and Language Therapy Team [SALT], were consulted for ongoing advice and support. However, as already cited within this assessment report, where people required their fluid intake to be monitored and recorded, records demonstrated their fluid targets were not always maintained and there was a lack of evidence to show what was being done to monitor and address this. Not all staff were observed to follow a person’s care plan relating to their choking and dysphagia risk.

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.

Information demonstrated the service worked with others, for example, the Local Authority, healthcare professionals and services to support people’s ongoing care provision. Staff told us they had the information they needed to support people. The registered manager and staff confirmed daily handovers took place. Effective staff handovers ensure continuity of care, facilitate the transfer of essential information, detail staff responsibilities and accountability between shifts, allowing staff to be well-informed about each person’s needs and any relevant updates.

Staff did not always support people to live healthier lives.

Not all people had access to healthcare services when needed. Relatives’ comments relating to supporting people to live healthier lives were variable. Where comments from people using the service and relatives were positive these included, “If I need a doctor, the staff deal with this”, “[Family member] had 1 fall and they [staff] called the ambulance. The care home liaises with healthcare professionals and with the family. They always let me know what is happening” and “[Staff member] makes sure [family member] gets all of their jabs and rings to let me know when it’s all done.” Concerns were expressed by a relative that information to accompany their family member to hospital was not sent, leaving them to provide an explanation to hospital staff, as the member of staff who had accompanied their family member to hospital, left when they arrived. Another relative implied their family member had missed a hospital appointment as staff had not been made aware of the impending appointment. However, the relative confirmed the latter had now been addressed and the person using the service had attended their hospital appointment at a later date.

The registered manager confirmed a weekly GP surgery was held and the community practitioner nurse regularly visited Peregrine House. Most relatives confirmed staff were responsive to people’s healthcare needs and were kept up to date about their family members needs and the outcome of health-related appointments. Comments included, “[Staff member] has a good relationship with the GP. I have been into the GP surgery with them and they [staff member] are really connected” and “If there are any healthcare issues arising for [family member], then the office phone me to let me know.”

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.

An electronic software system was being used for care planning. Staff used handheld devices to access people’s care records and record the day-to-day support people received. People’s care needs were reviewed regularly each month as a minimum and in between if a person’s needs had changed. However, not all relatives believed they were routinely kept up to date about their family member’s care needs or when a review of their care needs had been undertaken. A relative told us, “They [staff] should let me know if there is a review of [family member’s] care plan. Twice I have been there [Peregrine House]. I have only found out after that the review had taken place, and I haven’t got a copy. I have told them [Peregrine House] I need to be informed so I can be present at reviews.

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 make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards [DoLS].

Staff did not demonstrate sufficient knowledge and understanding of the key requirements of the MCA and how this affected people using the service. We found the service was not fully working within the principles of the MCA. Although staff understood the need to gain consent from people for care and to encourage people to make decisions for themselves wherever possible, this did not routinely happen in practice. People were not always given a choice of drinks or given the opportunity to participate in meaningful activities. This significantly improved on the second day of our assessment.

Assessments relating to people’s capacity were completed and recorded. Some MCA’s viewed recorded conflicting information to that recorded within the person’s care plan. For example, the care plan for 1 person recorded they could make day-to-day food and drink choices and inform staff if they were hungry and thirsty. The same person’s care plan recorded they could independently mobilise within the service. Another person’s MCA referred to them lacking the capacity to have their continence needs met. The latter was not accurate as during our assessment, we witnessed the person being able to verbally request to staff the need to have their comfort needs met. However, an MCA assessment had been completed despite both people’s care plan recording the person had capacity, therefore an MCA should not have been completed. Proper record-keeping for both the capacity assessment and the care plan is essential to demonstrate compliance with the principles of the MCA. Capacity assessments are important so as to understand a person’s ability to make decisions, whether these are day-to-day or more complex.

Legal authorisations were in place to deprive a person of their liberty and had been applied for in a timely manner. Where people had an authorised DoLS order in place with conditions imposed, there was evidence to demonstrate these had been reviewed and actioned to ensure compliance with the Mental Capacity Act.