Manordene

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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to leaders not following the principles of the Mental Capacity Act 2005.

This service scored 29 (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. There was a lack of evidence that people were involved in the planning and reviewing of their care. People’s communication methods were not always outlined within their care plans to enable them to receive care and treatment which worked for them. There was a lack of evidence that people’s wellbeing was reviewed. For example, 1 person had a history of poor mental health. There was a lack of detail around how to support the person despite the care notes frequently stating the person’s mood level was low.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. Staff did not always have a good understanding of good practice and guidance. There were some staff that were knowledgeable on how to support people living with dementia. However, other staff lacked knowledge of dementia and there was a lack of guidance in care plans on how a dementia diagnosis directly impacted people. Given the majority of people were living with dementia, this meant they were being supported by staff who did not fully understand their specific needs.

We saw there were some universally recognised tools to assess people’s health needs including for their skin integrity and falls. However, staff completing these, were not updating them when people’s needs had changed. Care plans did not contain information or guidance around to assess when a person was in pain. There were no Abbey Pain Scales (or an alternative tool) used (an instrument designed to assist in the assessment of pain in patients who are unable to clearly articulate their needs).” One member of staff told us of this tool, “That would be beneficial.” This meant that people may not be provided with pain relief medicine when needed.

The provider did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services. Staff were not always sharing information with each other when they came on shift. Staff told us that communication needed improvement between nurses and care staff. Comments included, “Sometimes you know the handover is not fully done. (Carers) are at times reporting at the end of the day” and “I feel the nurses could give better handovers to be honest.” We saw from the handover records there was very little information providing to oncoming staff.

The provider did not always support people to manage their health and wellbeing, so people could not 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.

There were at times, a delay in receiving support from external professionals in relation to people’s health. For example, there were 4 people that were sat in ‘bucket’ chairs that had not been assessed by the occupational therapist as suitable for them. The registered manager told us, “I haven’t referred them, and I have not known for any of them to be referred. I will look into it.” There was also a recent concern that staff were not following advice from an external professional around a person’s modified diet. This resulted in a safeguarding concern being raised.

However, we saw from care records people were able to access health appointments with an optician, GP, Speech and Language Therapist and hospital appointments. Health care professionals fed back that when they visited, they felt staff had a good understanding of people’s needs.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We saw from care records that fluid charts were used to monitor people’s hydration. However, we found there was a lack of oversight of these, or actions taken when people had not reached their target fluid amounts. The provider failed to ensure people’s high levels of anxiety were monitored, so they could look at ways of reducing these for better outcomes for people. We noted 1 person was being given regular ‘as and when’ medicine for severe agitation. No action had been taken to monitor this to determine why the person’s anxiety may be increasing.

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

Where decisions were being made for people around restrictions, there was no evidence that their capacity had been assessed. There was a blanket approach to everyone using bed rails. However, no capacity assessments had taken place or any best interest meetings to consider the least restrictive options. Capacity assessments and best interest meetings had also not taken place in relation to sensor mats, the ‘bucket’ chairs or around people on covert medicine. The registered manager told us they did not undertake these capacity assessments and relied on the GP to do this. They said, “I didn’t think that was something I needed to do.” We asked the registered manager for information of any Deprivation of Liberty Safeguards applications they had made to the local authority. They told us they were unable to provide this as they did not collate this information on a tracker.

Consent had also not been sought from people or their representatives in relation to CCTV being used in the communal spaces. We also found 1 person had been moved from their own room into a shared room with another person. There was no evidence their consent was sought before this was done. There was a lack of understanding by staff of the principles of the Mental Capacity Act 2005. We saw from the training matrix that 17 staff had not received training around this, and the remaining 6 staffs’ training was out of date