Arncliffe Court 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 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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes. The service was in breach of legal regulation in relation to consent.

This service scored 29 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. Assessments did not always consider people’s current health, care and wellbeing needs; there were concerns with the level of information and accuracy of several care plans we reviewed. For example, a person’s care plan stated they could mobilise with a mobility aid and in other sections of the care plan stated they required support from 2 staff to mobilise using a standing aid and a wheelchair. Staff did not always have access to detailed information about people’s specific needs. For example, there was no guidance for staff to support a person who experienced emotional distress which placed them at risk of their care needs not being met. People’s care and support plans were not always updated following a change of need. For example, a person’s care plan contained details of activities they no longer participated in due to their health deteriorating.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. Assessments related to skin integrity, diet and nutrition, and mobility were inconsistently completed. While some individuals had appropriate assessments in place reflecting their needs, others did not. For example, a person had been assessed as requiring specialist footwear prescribed by an external health professional to reduce the risk of falls. However, staff and leaders were unaware of this requirement, and the person had not been supported to wear the prescribed shoes. Another person's care plan referred to the use of covert medication, where medication is concealed in food or drink with proper authorisation. However, there was no supporting documentation to confirm this approach had been sanctioned by the GP or pharmacist. Additionally, there were no records indicating alternative options had been considered prior to making this decision. This lack of documentation was a breach of the requirements under the Mental Capacity Act 2005 (MCA), which mandates covert medication must be part of a best interests decision-making process, fully documented and legally justified.

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. Information was not always shared between teams and services to ensure continuity of care. A healthcare professional told us, “Some staff will alert us to issues even small as they need support, but when reviewing it with someone else or during discussions at our multi-disciplinary team meetings (MDT), they are not concerned.” Although contact with healthcare partners was recorded, management did not attend the MDT meetings to support staffs understanding of individuals’ health conditions. As a result, staff were left without key information needed to provide safe and effective care. We found information received from healthcare professionals was not followed up and was not consistently reflected in people’s care plans. This meant risks to people were not always identified or mitigated.

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 consistently support people to live healthier lives or, where possible, reduce their future care and support needs. The provider did not demonstrate a proactive approach to identifying health and wellbeing risks at an early stage, nor were there effective systems in place to prevent deterioration of people’s health conditions. Due to the lack of detailed records and poor monitoring processes, we found risks were not consistently identified or escalated in a timely manner. However, there was evidence of input from external healthcare professionals and people told us the provider was responsive when they felt unwell. One person told us, “They call the doctor for me if I am not feeling well.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves. There was a lack of provider oversight regarding people’s health outcomes. For example, the provider did not consistently review daily notes or care plans to ensure changes to people’s health and care needs were identified and assessment undertaken to establish if additional support was needed. For a person requiring input from external health professionals for the management of a skin injury, the provider failed to update their care plans or associated risk assessments. There was no routine monitoring of the wound’s healing or deterioration to ensure the treatment remained appropriate to the individual’s needs and information had not been obtained to guide staff on how to care for the wound. We shared our concerns with the registered manager who took action to obtain the necessary documentation and ensure the individual’s records were brought up to date.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. The provider had not completed some people’s formal assessment of decision making nor had they applied the deprivation of liberty safeguards (DoLS) effectively to safeguard people’s rights. Some people’s records to consent to receiving care and treatment, taking photographs, and sharing of their information was signed for by staff members. Having staff sign consent forms on behalf of people, without lawful authority or proper assessment of capacity, undermines the principles of the Mental Capacity Act 2005 (MCA). This practice contradicted the provider’s own MCA and DoLS policy about signing on behalf of people. This meant consent may not have been valid. The registered manager was unclear about which individuals had a Deprivation of Liberty Safeguards (DoLS) authorisation in place. This lack of oversight placed people at risk of not having their rights upheld and their liberty unlawfully restricted. Although most staff had received training on the Mental Capacity Act (MCA) and DoLS, our conversations with staff revealed gaps in their understanding of how these frameworks apply to supporting people in practice.