ST ELIZABETH

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.

At our last assessment we found the provider was in breach of 2 legal regulations. We found leaders did not ensure care delivery was person centred and the failure to comply with the principals of the Mental Capacity Act 2005.

At this assessment we reviewed 6 quality statements for this key question. We found not enough improvement had been made and there were continued breaches of legal regulations. We identified ongoing concerns with person-centred care and the failure to comply with the principals of the Mental Capacity Act 2005.

This service scored 42 (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.

People’s needs had not always been fully assessed. Care plans and other guidance for staff was not always sufficient, clear or consistent to enable them to meet people’s needs. We found care records and pre-admission assessments did not provide a clear indication of people’s needs, lacked sufficient detail and guidance and were not always up to date to reflect significant changes in peoples care needs despite them being regularly reviewed by staff.

Staff told us that when people move into the home, they “read through their care plan to establish what their needs are and how to support them.” Another said, “I have a conversation with them as you only get a snippet when they come in the home.” However, we identified care records that contained incorrect information which meant staff would not have accurate information in relation to the person’s care needs. This included a person who was recently discharged from hospital with significant changes in their care needs.

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.

Assessment tools were not used effectively to minimise risk to people. For example, RESTORE2 is a tool used to detect early signs of deterioration in people. The provider had a risk assessment in place stating staff were using this tool and trained in its use. This was not being used correctly and when people scores were indicating they may be becoming unwell, their condition was not monitored appropriately. This increased the risk of significant harm to people through lack of appropriate, timely medical intervention.

There was no effective monitoring of people’s hydration needs, including actions to take when a person fluid intake in inadequate. People who had reduced fluid intakes did not have hydration risk assessments in place to provide guidance to staff about the risks of dehydration.

Recognised tools for assessing risk of malnutrition were not used effectively to identify and monitor risk. For example, a person identified as requiring weight monitoring weekly however, they were being weighed monthly. Another person had not been weighed for several months and there was no other monitoring completed to track any weight loss, such as mid upper arm circumference. This meant unexplained weight loss would go undetected causing delays in action or referrals to external professionals if required.

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.

There was a lack of evidence to demonstrate that people who were unable to attend external appointments accessed the services they required. There was limited information within records to demonstrate how services worked together. For example, care plans briefly refer to a chiropodist coming to the service, however, there was no information regarding the frequency of these visits especially when people had a health condition such as diabetes that could impact on their health and wellbeing.

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.

Most people felt their health needs were met and could see medical professionals if needed. Feedback received from peoples’ relatives was mixed and comments included, “[Loved one] has had visits from the optician to sort their glasses”, “they [staff] are working on getting a dentist in” and “My main concern is that nails on [persons] hands are always dirty.”

We saw some evidence which indicated people living in the service had access to other health care professionals, such as GPs, chiropodist and district nurses.

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 a care plan that had not been updated following a significant change in a person’s condition which then failed to give staff the clear and up to date information they needed to provide effective high-quality care. For another person, there was inconsistent information about how their condition was managed, including whether they were on medication.

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

The provider failed to ensure the correct procedure was followed in relation to the Mental Capacity Act 2005 (MCA). On reviewing people’s care records, we found examples where the provider had failed to ensure they acted in accordance with the legal requirements.

Mental capacity assessments had not been carried out, where indicated, when specific decisions needed to be made, such as decisions related to their accommodation for the purpose of 24-hour care and supervision, decisions related to how their care was planned for and delivered, receiving regular welfare checks and having photographs taken. Where capacity assessments had been carried out, records did not demonstrate these were in line with the MCA code of practice, and did not show the person was supported to be involved in making decisions.

Some best interest decision records did not include dates of conversations or elaboration of the action being taken and why it was deemed to be in the person’s best interest. There was evidence that some decisions were being made for people without consultation of other people who knew them. There was no evidence people were provided information to make informed decisions.

Decisions which involved restrictive measures, such as movement sensors and bed rails, had not prompted an assessment of people’s capacity, where appropriate, and there was no evidence of how a decision had been made, or whether the decision was in the person’s best interest.