Shirelodge Nursing 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 legal regulation in relation to consent.

This service scored 46 (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.

People had care plans in place which identified their care and support needs. However, we found care planning records were not always personalised, accurate or reflective of people's current circumstances.

Several care plans contained generic information and wording that had not been tailored to the individual. For example, a diabetes care plan included a list of blood glucose monitoring frequencies, such as, "Twice daily, daily, weekly, when necessary," without clearly identifying the frequency applicable to the person.

We also found examples of inaccurate information within care records. Some care plans referred to people using incorrect pronouns and we found records were not always updated following changes in people's needs, referrals, or changes to medicines.

Not all relatives we spoke with had seen or contributed to care plan reviews. One relative told us, "I've not been through a 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 used nationally recognised assessment tools to identify and monitor risks to people's health and wellbeing. These included the MUST (Malnutrition Universal Screening Tool) to assess the risk of malnutrition, Waterlow assessments to identify the risk of pressure ulcer development, and BMI (Body Mass Index) measurements to monitor whether a person's weight was healthy in relation to their height.

We generally found care plans were in place to support people who were identified as being nutritionally at risk. However, we were not assured that these plans were always reviewed and evaluated to determine whether they remained effective in meeting people's needs. For example, one person's records showed they were experiencing consistent month-on-month weight loss. There was no evidence that the ongoing weight loss had been assessed as a risk or that consideration had been given to whether additional interventions were required. Records indicated the person's BMI remained within the obese range, which may have contributed to the significance of the weight loss not being fully recognised.

While recognised assessment tools were in use, oversight was not always sufficient to ensure the information they provided informed ongoing care planning and risk management. This limited assurance that care was consistently delivered in line with evidence-based practice and people's changing needs.

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 interaction between each other that we observed was good. Feedback relating to handovers was mixed. Staff told us that colleagues were often late to handovers and did not actively participating in discussions. Staff also described a disconnect between day and night handover processes. For example, morning handovers involved all staff coming together to share information about people's needs and any changes in risk. Night handovers were conducted separately, with nursing staff receiving a nurse-to-nurse handover and care staff receiving a carer-to-carer handover. This approach increased the risk of important information not being shared consistently across staff groups.

We were told the home had previously held daily stand-up meetings, where representatives from different staff teams came together to share key information, discuss priorities, identify risks and concerns, and coordinate support for the day ahead. However, staff told us these meetings had become infrequent, and we did not see evidence that they had been taking place consistently. This reduced opportunities for effective communication and collaboration across teams.

The head of care recognised this shortfall and reintroduced the daily stand-up meetings on the final day of our assessment. While this was a positive step, we were unable to assess the effectiveness of this change during the assessment period.

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.

Feedback regarding the food provided was mixed. Some people spoke positively about the meals available. For example, positive feedback was received about a recently served freshly cooked Sunday roast. However, most of the feedback we received indicated improvements were needed to the food offered. People described the food as “nothing special” and “bland,” suggesting it did not always meet their preferences or expectations.

We observed the lunchtime experience and found it was not always conducive to promoting wellbeing and enjoyment. People sat and ate with little interaction, and the dining environment lacked a social atmosphere. In one lounge, music was being played at a volume that did not promote a calm or relaxing mealtime experience. The mealtime atmosphere was rushed and chaotic, which may have reduced opportunities for people to enjoy their meals and social engagement.

We were concerned that during the extreme heat drinking jugs were not routinely changed during the day after being refreshed by night staff before they left shift. We were told ice lollies had been available during the hot weather, which provided an additional source of hydration.

We also identified concerns regarding the management of modified diets. Catering staff told us meals were prepared as either, “Soft,” or “Normal,” diets, with no clear differentiation between specific International Dysphagia Diet Standardisation Initiative (IDDSI) levels. For example, one person's care plan stated they required a Level 6 diet; however, kitchen records described their dietary requirements as, “Soft meat but normal foods.” This created a risk that people may not consistently receive food prepared in accordance with their assessed swallowing needs.

We shared our concerns with the registered manager, who took immediate action to review the arrangements.

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.

The provider identified desired outcomes as part of the care planning process, covering both clinical and non-clinical aspects of people's care and support. For example, one person's care plan included outcomes such as maintaining their appetite, enjoyment of food and drink, hydration levels, and nutritional intake.

However, although goals and outcomes had been identified, we were not assured they were routinely evaluated to determine whether the care and support being provided was effective in achieving them. Records did not consistently demonstrate that progress against outcomes was reviewed, or that care plans were adapted in response to changing needs.

We also found limited evidence that people, their relatives, or other representatives had been involved in reviewing the achievement of identified outcomes. This reduced assurance that care planning remained person-centred and reflected people's views, experiences, and aspirations.

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

The provider had completed mental capacity assessments and best interest decision records for people who may have required support with decision-making. However, we were not assured these had always been completed in accordance with the principles of the Mental Capacity Act 2005.

For example, we found some mental capacity assessments were not decision-specific. Instead, multiple and unrelated decisions had been grouped together within a single assessment, including decisions relating to locked doors, CCTV monitoring, alert sensors, medicines management, and finances. This meant it was not always clear whether people's capacity had been assessed appropriately for each individual decision.

There was also limited evidence within mental capacity assessments and best interest decision records to demonstrate how people had been involved in the process. Where people lacked capacity, records did not consistently show how relatives, representatives, or other relevant parties had been consulted. Where people had communication needs, there was insufficient evidence to demonstrate how they had been supported to express their wishes, feelings, and preferences.

The provider had made available e-learning training on the Mental Capacity Act. However, staff feedback indicated they required further training and support in completing mental capacity assessments and best interest decision-making processes.