Alderlea 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 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 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.

The provider did not make sure people’s health, care and wellbeing needs were fully assessed, recorded and reviewed to ensure staff had accurate guidance to provide effective care. Care records contained gaps and inconsistencies, and some assessments did not clearly reflect people’s individual needs. For example, a person had been admitted to the service 5 days before our visit. We found there was no PEEPS (Personal Emergency Evacuation Plan) in place, and no documented assessment of risks or guidance for staff on how to meet the person's needs safely and consistently. The manager completed these after our feedback. Care records also lacked clear guidance in some areas, including how staff should support a person who could not use their call bell. Guidance for staff when supporting people requiring assistance to move around the service lacked sufficient detail to ensure this was always safe. The provider reviewed care plans and risk assessments in detail after our feedback to ensure people’s needs were accurately recorded. Although relatives told us staff understood people well and had been involved in care planning when people moved into the service, others said they had not been involved in care plan reviews despite holding Power of Attorney (PoA). One relative told us, “We were asked to contribute to the care plan when [Name] first moved in.” Another told us, “There’s never been a review of the care plan involving me, although I have PoA.”

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 did not always ensure care and treatment were delivered in line with current guidance and best practice. Care records showed concerns about hydration monitoring, with several people recorded as drinking less than 1000ml of fluid in a 24-hour period. There was no clear evidence that risks relating to dehydration or urinary tract infections (UTIs) were being assessed or managed appropriately. Antibiotic records showed a high number of UTIs, but there was no evidence that staff or managers had reviewed this to identify possible causes, such as poor fluid intake, or taken action to reduce the risk. Although people and their relatives’ generally felt staff were knowledgeable and competent, records and monitoring systems did not consistently demonstrate that clinical information and recognised assessment tools were being used effectively to guide care and treatment decisions.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. The provider made sure staff, teams and external professionals worked together to support people and promote continuity of care. Relatives described consistent support and continuity through designated carers who knew people well. Shift handovers supported staff teams to share information. The manager explained staff accompanied people to appointments to make sure important information was shared and understood. Healthcare professionals provided positive feedback about partnership working. They told us, “Staff are really good, and will raise a concern if they feel that there is any deterioration or change in a wound or skin condition.”

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. People had access to healthcare support including doctors, opticians, podiatrists and vaccination programmes. However, gaps in monitoring arrangements meant the provider could not demonstrate that all health risks were consistently identified, monitored and addressed. For example, records we reviewed identified concerns with hydration monitoring, with several people receiving less than their recommended fluid intake and no clear evidence to evidence how this was being monitored or addressed. Records for a person using the service showed they had not received support with oral hygiene for 21 days. Poor oral care can lead to pain, infection, a deterioration in oral health, and difficulties eating and drinking. The provider had failed to ensure the person's assessed health needs were consistently met and risks associated with poor oral health were managed appropriately. Relatives told us staff supported their loved one’s healthcare needs and independence. One relative told us, “[Name’s] quality of life has improved 100% there”.

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 did not always effectively monitor outcomes for people or use information to drive improvement. Governance systems had not consistently identified or addressed concerns relating to hydration, infections, accidents and incidents. Records showed incidents and accidents were reviewed individually, but there was no effective trend analysis to identify recurring themes or opportunities to reduce risk and improve outcomes. Quality assurance systems had not been completed consistently, and some audits had not been undertaken since leadership changes within the service. We identified a high number of urinary tract infections among people using the service, but there was limited evidence of action taken to understand causes or trends.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff demonstrated an understanding that people should make their own decisions where this was safe and practical. They encouraged people to make day-to-day decisions and promoted their independence by supporting people to maintain control over activities such as dressing, mobility and personal care. Relatives described staff as respecting people’s wishes and preferences. Relatives described staff working in ways that respected people’s independence and choice. One relative told us, “They seem to ask her to do things consensually.” However, we identified some concerns regarding the quality of recorded mental capacity assessments. Where a person is deemed to lack capacity, decisions must be made in accordance with the Mental Capacity Act 2005. We were not assured that the assessments accurately reflected the correct information. Despite this, staff understood the importance of obtaining consent and involving people in decisions about their care.