Surrey Heights

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. The service was in breach of legal regulation relating to consent.
 

This service scored 46 (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 always make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
Some people’s needs were assessed; however, these were not always reviewed in a timely way. It was not always evident a person’s needs were reviewed following an incident. We found one person’s pre-admission assessment did not ensure their needs were fully explored and identified before creating a care plan and risk assessments. This did not ensure staff were guided to safely support this person to mitigate the risk of harm to this person, other residents and staff. One resident’s pre-assessment highlighted their distressed behaviour which could present as physical towards others. The provider was aware of the risk of incidents. However, we noted limited guidance was provided to staff in relation to this in the person’s care plan and risk assessments.
We found people’s mental capacity assessments were completed late at night. The registered manager confirmed night staff would complete people’s assessments. The provider did not evidence this was the most effective time of the day to assess people’s capacity and needs. The registered manager told us, “Once [people] come into the home, as time goes on, we get more information, involving them if we have any concerns, getting their feedback into the care plan”

The provider did not plan and deliver people’s care and treatment with them, including what was important and mattered to them.
People did not receive care, treatment and support that was evidence-based and in line with good practice standards. We found one person requested two paracetamols. However, staff were breaking one soluble paracetamol before dissolving into the water so the person would think there were two tablets. The provider did not evidence this treatment was delivered in line with their own policy, or under healthcare professionals’ guidance. This did not demonstrate the provider planned people’s care and treatment with them.
The provider used MUST and Waterlow assessments in line with best practice. ‘MUST’ is an assessment tool to identify people who are, or at risk of malnutrition. This tool supports care planning for people using the service. Waterlow assesses people’s risk of developing pressure ulcer or sores based on person's characteristics, medication or special risks. Necessary referrals were made should anyone need clinical support. We saw an example of speech and language therapist involvement where the person needed support with their nutrition, hydration and swallowing. The registered manager told us they “if the needs do change, we make sure they’re met as best as we can.” However, we identified occasions when this guidance was not followed.
For example, the provider did not evidence how hydration needs were regularly reviewed during the course of care and treatment to ensure any changes in people's needs would be responded to in good time. Staff reported that people’s fluid charts were accessible on the system and reviewed by night staff; however, they expressed uncertainty about whether anyone was actively overseeing the charts to ensure individuals were drinking enough. One person’s care plan stated, “suffered from severe weight loss…is on strict food and fluid chart to monitor her intake”. This person’s daily notes monitored fluid intake; however, we did not see evidence how this was regularly reviewed to ensure their hydration needs were always met. From the fluid charts we observed; people were not drinking the full amount of fluid offered. No fluid target was noted in their care plans; this did not ensure staff had guidance to support people to meet their target and what to do if people did not meet their target.
Guidance had been provided for staff to support people some people with their fluid and nutrition needs; however, we observed this was not always followed. For example, one person required level 1 thickened fluid. We reviewed the daily notes and on multiple occasions this person was given ‘thin’ fluid consistency. This did not reflect staff followed best practice, guidance and care plans to support this person to remain safe, and to reduce the risk of avoidable harm. Staff’s lack of knowledge regarding people's fluid and nutrition needs put them at risk of choking and avoidable harm.
People were positive about the food choices available, and the service offered smaller portion sizes for people according to their individual preferences. Relatives were positive with feedback and told us “Staff seem to know what my loved one needs”. People’s dietary requirements were recorded in their care plans and risk assessments, and the kitchen staff were aware of people’s preferences.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them.
The registered manager told us they felt there was “great communication” and operated an open-door policy to support staff; “So, they feel they can say something if they don’t feel something is right”. The activities co-ordinator said they had monthly meetings with other activities co-ordinators, and it was “quite nice as [they] can all work together to come up with ideas and work as a team.”
We observed there was good communication between staff regarding who was doing what. Staff ensured there was always someone available in the lounge area by alerting another staff member when they were leaving the room.
The manager said team leaders reported concerns to the GP either when they arose or during the regular ward round visit. The team leaders monitored people for clinical concerns and completed wellbeing checks throughout the night.

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.
We reviewed people’s care plans and noted information about encouraging people to live a healthy lifestyle. However, this information did not demonstrate person centred care, and evidence people’s independence, choice and control were maximised and supported when managing their health and wellbeing. For example, we noted one person with diabetes had information in their care plan stating they were “able to make out choices for [themselves] according to [their] wishes and desires to eat food. Staff should make sure that [person] should not have any food and drinks which can [elevate] sugar levels. Staff should keep such food out of [their] reach or sight so that [they] will not be tempted to have”. This did not evidence people’s independence, choice and control were maximised. Furthermore, this did not demonstrate how people were empowered and involved in planning their own care to ensure they maintained choice, control and independence to manage their conditions and needs. Furthermore, this care plan did not demonstrate staff would promote the person to add healthy options to maintain a healthy diet, rather than restricting their access to food choices.
We noted another person’s GP referral had an absence of information which meant their medical investigation was not done. The provider did not evidence this was followed up to ensure the person was able to complete their scan and access any further treatment as necessary.
People’s care records showed there was access to healthcare professionals. However, health related risks did not always have guidance for staff to support them in identifying concerns and the actions to take.

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.
People’s care plans were reviewed, though this did not always effectively identify the inconsistencies we identified during our assessment. Care plans noted staff needed to monitor for skin integrity and complete repositioning at specific intervals during the night. However, we found evidence in people’s daily notes this was not always completed, and where concerns were noted regarding people’s skin; staff did not evidence this was followed up with a healthcare professional to ensure positive outcomes for people.
One person was prescribed Fortisip; a food for special medical purposes for use under medical supervision. However, no monitoring or outcome information was noted in this person’s daily notes or care plan to assess if clinical expectations were met with this treatment. This did not demonstrate effective approaches to monitor people’s care, treatment, and their outcomes to ensure continuous improvements to people’s health and wellbeing.
Records of PRN medicine administration did not evidence rationale or outcome of administration. For one person, their ibuprofen gel was administered 5 times a day, for 27 consecutive days. The prescribed instructions were to apply only 4 times daily as PRN. The provider did not evidence how this person’s treatment was monitored to ensure this was delivered in line with prescriber’s guidelines and evidenced continuous improvements for people. There was no evidence in this person’s care plan or the weekly clinical meeting minutes their treatment was reviewed with the GP.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.
Several service users were receiving covert administration of medicine. However, there were no detailed or individualised care plans in place to ensure the safe, and lawful implementation of this practice. The care plans did not clearly outline the clinical rationale for covert administration of each specific medication, the intended duration, or the measures taken to ensure this was the least restrictive and most appropriate course of action in line with best practice guidance. There was also no evidence the community mental health team had been consulted regarding this decision, despite the nature of the medicine involved. The provider did not evidence covert administration was used only as a last resort, after all other options had been explored. This fell short of the requirements under the Mental Capacity Act 2005, including the principles of necessity, proportionality, and best interest. As a result, service users were placed at risk of receiving treatment that was not in their best interests, monitored, or authorised.
Some people did not have capacity assessments completed for medicine management. For example, we found some people’s PRN protocols said they did not have capacity to consent or request PRN medicine. However, we reviewed their care plans and did not see evidence people’s capacity was assessed and reviewed in line with the Mental Capacity Act 2005. Staff did not demonstrate they followed best practice and knowledge around assessing mental capacity, to support decision making and best interest decision making. Records did not evidence that staff completing mental capacity assessments had tried to seek the person's thoughts or wishes.
Information in people’s care plans was contradictory. We found people had mental capacity assessments for administration of medicine to be covertly. One person’s care plan stated, “is compliant with taking [their] medication and will very rarely refuse medications”. This did not ensure people’s needs were accurate and reflective for staff to administer medicine safely and effectively. This also did not provide clarity on people’s ability to consent to administration of medicine.