Archived: Kettlewell House 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 good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
 

This service scored 54 (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.
We found some people had additional communication tools in place to support their individual needs and requirements. We noted staff used these tools to communicate information such as mealtimes. We found evidence of assessed needs and input from external services such as speech and language therapists. We also saw evidence one person with multiple pressure areas was supported by the service in conjunction with a tissue viability nurse to support this person’s individual needs.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.
We found personal behaviour support plans did not always give substantial detail regarding the risks or mitigation of risks for people. For some people, their plans of support were generic and did not include information around them receiving one-to-one support and how this should be managed.
Some staff expressed concerns around lack of support during mealtimes due to high levels of people’s needs and staffing levels. The interim manager expressed greater input and support from their GP partnership was needed. They said, “They do not currently come out to us and there is no weekly ward round.” One relative also told us they spoke to the GP regarding the deterioration of their relative but did not think their relative was seen in person until a significant time later. This meant people were at risk of not receiving safe and effective care due to a lack of systems and processes in place to support this.
 

Staff and teams did not work together with people to safely and effectively deliver coordinated, person-centred care, support and treatment. We reviewed staff statements which demonstrated a culture of normalising rough and unsafe care, including lifting people without hoists, restraining people with tables and rough handling. We found staff statements included comments such as, “I am worried about the new [staff]…they are learning from [staff] and the rest, I am worried they are learning to give this kind of care.” Another staff member said “[staff] are roughing [people] up. This makes new staff think it is normal.”

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.
Staff did not always feel like they were enabled to support people to be as independent as possible. For example, staff told us staffing levels impacted the quality-of-care delivery. One staff told us, “We have so many people who need two to hoist and to feed. There are times when we are too rushed.”
Another staff told us, “The last manager didn’t address the issues with one [person’s] behaviour to me.” The high turnover of management meant appropriate preventative action to help people lead healthier lives was not always implemented and maintained.
 

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.
We found one person living with diabetes did not have glucose parameters on their risk assessment, yet they were prone to hypoglycaemia . Hypoglycaemia is a condition of having dangerously low blood sugar (glucose) levels. This person’s care record failed to evidence glucose was regularly checked, and the record did not maintain sufficient information regarding how regular this should be checked to monitor and improve clinical outcomes. This person’s care record also failed to evidence a risk assessment for moving and handling was in place. This meant the provider lacked robust systems and processes to monitor the effectiveness of people’s care, treatment and support to ensure and action was always taken to continuously improve it.
The provider did not demonstrate they maintained effective communication with families to support people’s care and treatment. For example, one relative told us, “We used to get newsletters, but communication has changed since [Manager] left. There’s not been much information in the last year. We were supposed to have a relatives meeting last week, but it was cancelled.” Another relative told us, “How are you supposed to know who to go to when there are so many changes.” The service did not demonstrate they sought and considered feedback from people, their families, carers, professionals and stakeholders as appropriate when monitoring individual outcomes.
 

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.
However, we found some staff reviewing people’s capacity were not up to date with their Mental Capacity Act training. This meant people were at risk of being supported by unsuitable staff. We reviewed the training matrix and found some staff had not undertaken the relevant training to ensure consent and decision-making requirements of legislation and guidance were met, this includes the Mental Capacity Act 2005 and other relevant national guidance.