The Devonshire Also known as 1- 3883899011

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 remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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.

People’s needs were assessed prior to moving into the home. The provider had a resident of the day process where people’s care planning documents were reviewed monthly. The resident of the day review involved staff from different teams within the home reviewing and updating people’s care plans and risk assessments. Staff knew people well and knew people’s current needs and preferences.

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

Where people had a daily fluid target, records did not always show people were offered enough fluids to reach their target. During this inspection, we observed people did not always have access to drinks. One person was consistently failing to consume fluids in line with their daily target. Staff had reported their concerns to the provider who failed to act without delay, taking 3 weeks to make a referral for specialist input. This meant the provider could not be assured people were safe from the risk of dehydration.

One person’s care plan contained clear guidance for staff on what to do if their blood sugar was too high or too low. However, on at least 4 occasions there was no evidence staff had followed the guidance and rechecked the person’s blood sugar when it was below their normal range. This meant the provider could not be assured staff were managing the person’s blood sugar in line with their assessed needs

People were weighed regularly, however care planning documents were not always updated with the most recent weight and documents contained conflicting weights. This meant risk assessments and tools used to identify people’s risk of malnutrition were not always accurate or up to date.

Staff told us the importance of not rushing people when supporting them with eating and drinking. During the inspection we saw staff supporting people to eat in a slow and relaxed way. We saw people were supported to eat modified diets in line with their assessed needs.

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.

People’s care plans included a comprehensive hospital pack. This meant if a person needed to go to hospital or receive support from another provider, staff who were unfamiliar with them could quickly access essential information. The hospital pack contained information such as the person’s medical history, prescribed medicines and any known allergies.

In addition to clinical information, the hospital pack included personalised details, such as people’s hot drink preference, preferred food choices and how best to provide support during times of distress.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The GP visited weekly to provide reviews and address any health issues for people. People were supported to access healthcare services and staff worked collaboratively with external professionals, supporting people to attend medical appointments.

The provider worked with a physiotherapist who visited the service weekly. The physiotherapist offered people the opportunity to participate in weekly exercises to help maintain and improve their fitness.

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.

The provider had systems in place to monitor people’s health, such as weight and skin integrity monitoring and fluid charts. The provider used a system that would show an alert if monitoring tools identified a person was at risk. These tools were mostly used effectively, however not all records were kept up to date with accurate information.

Care records showed some gaps in the care people received. For example, 1 person was assessed as requiring personal care 4 hourly, however records showed personal care was consistently not provided every 4 hours. Another person was assessed as requiring repositioning every 4 hours, care records showed this had frequently not taken place. This meant the provider could not be assured staff were delivering care in line with people’s assessed needs and effectively mitigating the risk of skin damage.

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

The provider worked within the principles of the Mental Capacity Act 2005 (MCA). The 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 Mental Capacity Act (MCA).

Where people required assistive technology to maintain their safety, we found best interest meetings had been recorded to demonstrate decision making. For example, some people required falls sensors if they were assessed as high risk of having a fall. Mental capacity assessments and best interest decisions had been completed.

Staff told us the importance of gaining consent when supporting people, 1 staff member told us, “When you give people a wash you have to seek consent, you have to let them know why you are there.”