Lavender Fields

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 inadequate. 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.

The service was in breach of legal regulation in relation to the need for consent.
 

This service scored 62 (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.

At our previous assessment we found assessments and care planning did not always fully reflect people’s needs. During this assessment care records demonstrated clear improvement. People's health, wellbeing, communication, nutritional, skin integrity and mobility needs had been assessed and reviewed. Relatives told us they had been involved in reviewing the care plan. A relative said, “The care plan has been reviewed. They were very thorough; we were very impressed.” This led to improved care planning and guidance for staff to make sure people’s needs were fully met.
Assessments were undertaken with people if they had been out of the service, for instance in hospital, before they came back into the service to make sure their needs could still be met by staff.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

At our previous assessment we found people did not always receive care and treatment that was recognised good practice, placing their health and wellbeing at risk. During this assessment we found clear improvement. Care plans reflected recognised assessments and approaches, including managing falls, skin integrity, nutrition, hydration, continence and choking risks. This improved approach supported all aspects of people’s lives within the service. For example, more people were up and about, enjoying time in the lounges and eating meals together in the dining rooms.
 

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.

At our last assessment, staff were not engaging with healthcare professionals to gain appropriate advice and guidance in relation to people’s specific needs. Staff were making decisions without the appropriate skills and experience to do so. At this assessment, the culture had changed and staff now worked with a range of healthcare professionals to support people's health and wellbeing. Records demonstrated involvement from GPs, district nurses, dietitians, mental health professionals and other specialist services when required. Recommendations and advice from professionals were now followed and used to update care plans and risk assessments.
The staff team now worked well together, and across all floors, which had supported the change in culture. A staff member said, “Everybody as a whole is much more relaxed now. I do love working here, the last year has been really hard, but we’ve had team work and we’ve been supporting each other. It’s much nicer to have a manager, there were things that were overlooked. It’s nice to not worry about coming to work now.”

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.

Care plans generally included nutritional monitoring, hydration support, bowel management, skin integrity management and falls prevention. Care was now delivered consistently which meant people’s health concerns were identified quickly to ensure good maintenance. People were better supported to maintain a healthy lifestyle. More people were out of bed and socialising in communal spaces, preventing social isolation and improving outcomes. People were clear they had a choice and could stay in their room if and when they wished. Relatives also described people being supported with activities, access to outdoor spaces and opportunities which promoted wellbeing. Comments included, “The GP comes on a Thursday. They put people on the list to see the GP, there’s easy access” and “The activities have improved. There’s a lot going on. They’ve got more ideas of things to do. They mark important days. They have outings, that was lacking before.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The registered manager monitored people's care and treatment and had improved oversight since the previous assessment, although this continued to be a work in progress. Care plans and risk assessments were reviewed and incidents were investigated and signed off by managers. The registered manager was aware people’s experience of the service was not always positive at the time of the last assessment, before they commenced in post. However, they were passionate about ensuring the staff team understood their responsibility to improve people's experiences and outcomes.

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

At our previous assessment we identified concerns relating to the Mental Capacity Act 2005. During this assessment, we found some, but limited improvement in relation to decision-specific mental capacity assessments and supporting documentation. Records continued to contain inconsistencies regarding how people’s capacity to consent was assessed, and decisions made on people’s behalf around consent and best-interest decision making. Some assessments did not clearly demonstrate how conclusions around decision making had been reached and who had been involved in the decision. Recording of consent remained inconsistent. For example, a person had 2 mental capacity assessments, in relation to consent to live at Lavender Fields, and another relating to consent to staff administering their medicines. The person was deemed to lack the capacity to consent to both the decisions. There was no evidence that anyone other than 1 member of staff was involved in the decision making, or the decisions made in the person’s best interest. Evidence recorded was basic and did not show the appropriate process was followed to ensure the person’s rights were maintained and upheld.
The provider and registered manager accepted improvements were still needed to make sure people’s rights were protected.