Cressington Court Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence the provider met people’s needs.At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 43 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Care plans were not person-centred, lacking details and being of general poor quality. For example, where people required support to manage identified needs, such as diabetes, their care plans and risk assessments did not always include information around risk management. Where information was documented, it did not always contain sufficient detail or guidance to ensure people’s individualised needs could be met.

Where blood sugar recordings were documented within the person-centered software system (PCS), there was no evidence of action being taken in response to high results. For example, we saw one person with a blood glucose level of 21.9 mmol/L and another had a reading of 25.5 mmol/L. There was no evidence of clinical follow-up with records only indicating blood sugar monitoring. In both cases, the only note entered was ‘blood sugar monitoring’, with no evidence of clinical follow-up. According to Diabetes UK, normal blood sugar levels are typically between 4–7 mmol/L, meaning the readings recorded for this person were significantly outside the safe range and required prompt intervention.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity. The provider could not be assured they had systems and processes to ensure people’s care was regularly reviewed, as detailed throughout this report, processes were not effective in ensuring people’s care records were accurate. This meant staff did not always have guidance relating to people’s needs to ensure they achieved positive outcomes. There were inconsistencies in people nutritional care records therefore, there was a risk people were not receiving their assessed dietary requirements. There was contradictory information within the International Dysphagia Diet Standardisation Initiative (IDDIS) levels recorded, dietary notifications within the kitchen and care plans. For example, we saw a person’s dietary notification within the kitchen stated Level 5 (mince and moist) however, eating and drinking care plan stated level 4 (Pureed). Another person’s kitchen notification stated level 5 as their eating and drinking care plan however, their choking risk assessment stated level 6 (soft and bitesize).

As people did not always have care plans and risk assessments in place regarding their specific needs it meant staff did not always have up to date guidance available about people, which left them at risk of receiving unsafe support and potential harm.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. People's communication needs were assessed and recorded within care plans. However, information recorded was brief or out of date and did not fully explore the impact of sensory loss, or difficulties in processing information, may have on people and how they could be better supported.

The provider did not make it clear what actions had been taken to address the feedback and comments provided. We did not see any meaningful actions where staff had involved people in decisions about their care or tell them what had changed as a result. People were provided opportunities to discuss their care and provide feedback. The provider had conducted surveys and reviews with people to discuss their opinions.

Most people could access the service and the support available within it. Relatives described staff as approachable and willing to help, and many said there were usually enough staff around during visits to assist with immediate needs. Although staff coordinated people’s health appointments, the provider could not be assured information was accurate due to the inaccurate information in people records as discussed throughout this report.

The managers did not always actively listen to information about people who were most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.As people’s care was not always tailored to their needs, the provider could not be assured people always received equitable experiences. For example, we found care plans were not reflective of people’s current needs. People who were anxious or had cognitive impairment sometimes received limited reassurance or inconsistent emotional support. We observed one person who wanted to leave the building not approached or reassured by staff for a sustained amount of time. People with sensory or communication needs did not always receive equitable support.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Whilst end of life care plans were in place there was not always evidence people were encouraged or involved in planning for their future. Therefore, the provider could not be assured people would receive end of life care tailored to their individual wishes.