Surrey Heights

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 ‘Requires Improvement’. This meant people’s needs were not always met.
 

This service scored 61 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. We found the provider did not evidence people who used the service and those close to them (including carers and dependants), were regularly involved in planning and making shared decisions about their care and treatment, so it was centred around them and their needs.
Care plans did not always ensure there was sufficient information to allow for truly person-centred care. While people’s needs had been identified in different areas of care needs, there was not always detailed guidance for staff on how to meet those needs. For example, one person’s care plan noted their dementia diagnosis. However, the information regarding their individual needs was limited. This did not ensure care was person-centred to meet this person’s needs. We also found people’s care plans required updating to ensure they accurately reflected their current needs.
We reviewed people’s Positive Behaviour Support plans (PBS). We found this information was not always accurate and reflective of information in people’s care plans. For example, one person’s PBS plan indicated they had PRN sedative medicine for distress, and they may be presenting with similar signs of distress due to pain. This did not clearly indicate which form of support or medicine should be used to ensure people received care and treatment according to their individual needs. Moreover, the PBS plans were stored within people’s MAR charts in the locked clinical room. Only team leaders would have access to this room; therefore, all care staff would not be able to access these plans to support people according to their individual needs.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.
The registered manager told us the service provided familiarity and continuity for residents. The registered manager told us they participated in mental health and continuing health meetings to ensure they worked together for the resident. We found examples where referrals were made to ensure support people to receive the right support and treatment, although as described earlier in this report, this did not always happen.
We observed the service provided activities in line with people’s choices and needs. For example, we observed art activities, and music from relevant periods.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.
The registered manager told us how they supported people to ensure they could access supporting aids such as glasses and hearing aids, as well as organising the optician and dentist to visit the service yearly. The registered manager said the service used pain scales as part of accessible standards to communicate with people regarding their levels of pain. However, the provider did not evidence this was always used when administering people’s PRN pain relief medicine.
People’s care plans contained information detailing their individual communication needs and requirements. People told us if they had a worry they would speak with staff, however they felt their needs were met.

The provider does provide opportunities for people to share feedback; however, they do not consistently involve individuals in decisions about their care or keep them informed about changes resulting from those decisions.
We found that staff did not always make it easy for people to share feedback, ideas, or raise complaints about their care, treatment, and support. For example, staff stopped one person’s Lorazepam medication without advice or authorization from a healthcare professional. This person went without their medication for two weeks, and the service did not provide evidence that this issue had been discussed with the GP, the person, or their representatives. This situation highlights that people were not always fully involved in decisions about their care or informed of changes following those decisions.

The provider had implemented a ‘You Said, We Did’ initiative for family feedback. Responses addressed topics such as menu options, building refurbishments, and access to community support, including suggestions for a dementia café support group. Relatives expressed that they felt involved and were satisfied with the care provided.
While the provider had a complaints policy, the registered manager reported that no formal complaints had been received and, therefore, no complaints log was maintained. Instead, concerns were discussed verbally with advocates and family members, and the home adopted a relaxed approach to families contacting staff by phone or email for updates or reviews.
Information about how to make complaints was visibly displayed in the home. One relative told us they had no complaints but would feel comfortable speaking to staff if needed.

The provider made sure that people could access the care, support and treatment they needed when they needed it. Staff we spoke with felt that people received the care they needed. The service had lifts in place to support accessibility in the home. People could access care and support when needed. We noted the GP completed visits to the service and clinical meeting minutes were recorded.

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.
The registered manager told us they completed ‘resident of the day’ reviews, and assessments were completed by night staff. However, completing the assessments at this time of night did not ensure people were involved and at the centre of their care and treatment choices. For example, we noted one person’s assessments, such as Malnutrition Universal Screening Tool (MUST) were completed at night time. Daily note entries confirmed this person was asleep at this time. Staff noted in the assessment form they were unable to take the person’s weight. Staff did not update this person’s weight for 7 weeks. The provider could not evidence the BMI and weight entered was accurate and reflective of this person’s most current needs and health. This did not demonstrate the provider worked in partnership with people and ensured equity in outcomes.
Staff told us about the specific support accessible for younger people living with dementia. The activities co-ordinator told us they also took part in assessments to ensure plans were in place with any different needs. The activities team told us how the building was being refurbished to provide more flexibility for people living with dementia, such as having an area with additional facilities where they can work on specific projects and maintain skills such as cooking, household chores and washing clothes.

People were not always 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.
The registered manager told us they completed needs assessments, including end of life care plans. Staff told us how they supported people and their families in relation to end of life care. The registered manager said, “If the health declined, the GP would generally have the discussion with family about end-of-life planning, anticipatory medicines in place if needed. Then the discussion would be held with us.” However, this did not ensure end of life needs assessments were person centred, and people were supported to plan to ensure informed decisions could be made. This meant some people’s wishes may not have been gathered whilst they were able to effectively communicate this information.
We reviewed people’s care plans and found some people were not supported to plan for important life changes, including decisions about the end of their life. One person’s care plan stated palliative medicine was now in place and the clinical meeting minutes stated, ‘expected death’. However, no end-of-life discussions were evidenced in this person’s care plan. The provider noted “that will be discussed should [person’s] health start to deteriorate.” The provider did not demonstrate people’s decisions and what mattered to them was delivered through personalised care plans that could be shared with others who may need to be informed. Furthermore, this did not evidence people were supported to be in control of planning their care and support.