Lavender Fields

On this page

• 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 that the provider met people’s needs.

At our last assessment we rated this key question good.

At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to providing person centred care.

This service scored 32 (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.

There were no effective systems in place to make sure people, and their relatives were involved in developing their care plans. Care plans did not provide the level of detail to ensure a person-centred approach to people’s care and support.

Assessments of people’s needs did not evidence a person-centred approach with the involvement of appropriate professionals when necessary to enable decisions about people’s care to be completed effectively.

People told us they were not always receiving person centred care as the number of staff vacancies, resulting in high agency use, meant not all staff knew them well. Care plans did not provide the individual information required to enable care that was personal, whichever staff were available.

Feedback from relatives included, “Well the carers are decent but there are some things that don’t make sense for example the medicines person will come round at breakfast and interrupt (loved one’s) breakfast to (give medicines). They get really upset and leave their breakfast. It’s not dignified and it’s not necessary, it’s not person centred they are just focussed on getting the job done”, and “I’ve not seen the care plans or sat down with staff to have a review".

There were some shortfalls in how the provider understood the diverse health and care needs

of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The provider had not ensured systems and processes had been implemented to enable people to receive appropriate and skilled joined up care, for example in relation to health care and mobility needs. This placed care staff at risk of not identifying problems when they arose or taking timely action to protect people from potential harm.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider did not always ensure important and critical information was provided to those who needed it. Relatives told us when people were taken to hospital, information such as family members who had lasting power of attorney to make decisions about people in their best interest was not handed over to the hospital or ambulance crews. A relative told us, “(Person) had a fall and the ambulance was called. The paperwork was not in order, there was no copy of the power of attorney, and the staff didn’t send any of the appropriate paperwork with her”.

People’s relatives told us that staff did not always tell them or keep them updated if there had been an incident or if their loved one was unwell. A relative said, “Agency staff called an ambulance, and I only knew 4 hours later.”

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

People and relatives fed back that they were not happy with the numbers of agency staff as this affected consistent care. The lack of management oversight meant vacancies had not been filled in a timely way to ensure a consistent staff team were providing people’s care.

A relative told us, “The regular care staff are good and know (my loved one) well – the agency staff come and go and have no commitment.”

Staff were making decisions about how to support people, and when things changed or there was an incident, they had informed people’s loved ones. However, there was no evidence different options were discussed with people or relatives, to enable a different approach, demonstrating people and relatives were informed but their viewpoint was not evident in care planning.

Relatives told us, “There was no meeting or any discussion about preferences, I don’t remember any care plan or discussion”, and “There have been many managers, I never know who to go to”.

The provider did not make sure that people could access the care, support and treatment they needed when they needed it.

People’s care plans were completed by staff in isolation. The review process did not evidence people or their relatives had been involved in the care plan review. As a result, decisions were made for people without consulting them and care became less person centred. During our inspection, we fed back our serious concerns to the provider that some people required an assessment by external healthcare professionals and had not been supported to access this. Action was not taken in a timely way and when referrals had been made, they were not made to the appropriate disciplines. People had not been given equal access to the specialist advice and guidance they needed.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People’s care plans had not always been developed to meet people’s desired outcomes. The provider did not always understand the importance for people and their well-being to achieve the outcome they wanted. Staff did not always work with people’s strengths to develop strategies to reach their goals such as improving their mobility or using a piece of equipment to be more independent when being assisted to move.

People’s care plans did not always contain information about people’s additional needs which may affect their experience and outcomes within care. There were not always effective processes in place to check people had access to appropriate health care provision and what may be needed to support people. People’s health conditions such as Parkinson's disease had not always been considered to make sure they had access to appropriate healthcare.

People were not 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.

People’s wishes at the end of their life were not always considered or recorded. People had ‘Advanced care planning’ included in their records, but these were not consistently detailed or completed.

A person’s advance care planning record documented they were at the ‘End of Life’ stage of their life. However no individual information or guidance for staff to follow relating to their wishes if they were to pass away was included. Multiple records stated, “Discussions still to be had to discuss advance care planning”.

People’s care records recorded if they had a ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) in place or not. However, guidance was not in place for staff to provide clarity when this would be appropriate and if there were circumstances when people should be resuscitated. A person’s record stated, ’For (person) not to be resuscitated when time comes’. During the inspection process we were made aware that DNACPR records were not readily accessible to emergency services when needed.