Rowan Garth Care Home

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 requires improvement. At this assessment the rating has changed to inadequate. This meant the effectiveness of people’s care, treatment and support did not achieve good outcomes or was inconsistent. The provider was in breach of the legal regulations of safe care and treatment and the need for consent.

This service scored 38 (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 adequately assess, check and discuss people’s health, needs and care, with them on a regular basis.

People’s needs were not appropriately assessed prior to or on admission to the home to ensure the care planned was effective. Ongoing care records in relation people’s care were not accurate or up to date. When people’s needs changed, their care was not always reviewed to ensure it remained fit for purpose. This meant staff lacked critical up to date information on people’s needs, risks and the care they required

Monthly care plan reviews were meaningless and contained repetitive information from one month to the next. They did not show a people’s progress was reviewed appropriately each month to check for any changes in their health, care and so care plans could be updated accordingly. There was little evidence people’s health, needs and care were discussed with them and/or their loved ones on a regular basis.

Record keeping in relation to monitoring people’s needs and care was not properly maintained to enable the provider to adequately check and assess if people’s care and treatment was effective.

These shortfalls placed people at risk of ineffective and inappropriate care which did not meet their needs, wishes or preferences.

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.

Most people and their relatives felt the care they received met their needs. We found however serious shortfalls in the delivery of people’s care with regards to the assessment, monitoring and management of people’s needs and risks.

The management and delivery of medicines did not adhere to best practice guidance published by CQC and the Royal Pharmaceutical Society in respect of medicines. People did not always receive the medicines they needed as prescribed or when needed. The systems in place to ensure medicines were managed safely were not robust.

Continence care and bowel management did not adhere to guidance issued by CQC and the National Institute of Health and Social Care Excellence (NICE). People’s continence care was not regular enough to protect their skin integrity or dignity. People’s bowels were not monitored consistently with clear information on regular bowel patterns to mitigate risks to bowel health and prevent discomfort.

Wound assessment and management, diabetes and epilepsy care did not adhere to guidance issued by NICE or the Royal Council of Nursing Council or specific bodies such as Diabetes UK. Wounds were not always properly assessed with a clear plan of care. Staff lacked clear and safe clinical guidance on how to identify, monitor and mitigate the risk of diabetes and epilepsy. Blood sugar monitoring in respect of diabetes was ad hoc and not completed at the recommended intervals. Guidance to staff on when to seek medical advice was not always safe.

Dementia care did not follow the recommendations of NICE, NHS England, the Alzheimer’s Society or the Kings Fund in respect of the care environment. People did not have personalised or individual dementia care adaptable to their changing needs. The environment in which people lived did not fully promote their independence or their ability to engage in meaningful activities.

The Mental Capacity Act 2005 (MCA), legislation designed to protect people’s legal right to consent was not always properly followed, which meant legal consent to some specific decisions had not been obtained appropriately. Support for people living with anxiety, distress and behaviours of concerns was not provided in accordance with guidance issued by CQC, Skills for Health or the Department of Health. This resulted in a cycle of repetitive behaviours that caused the person or others distress.

The provider did not always work well across teams and services to support people. They did not have accurate records in place to share the right information about people’s needs and risks when people moved between different services.

Records in relation to people’s needs, risks and care were not always accurate or up to date to ensure people’s care and support was planned and co-ordinated appropriately across staff teams or other professionals. The lack of accurate and clear information increased the risk of inaccurate or out of date information being shared with other services and professionals when additional support was needed.

Staffing levels were not always sufficient which hindered the ability of staff to work well in teams to ensure people received the support they needed when they needed it.

There was a handover process from shift to shift to share information about people’s needs and care between morning and evening staff. Staff members told us they could access handover records for each individual person on the home’s electronic care planning system. Staff told us however they did not always have time to read people’s care plans or records which increased the risk of them not fully understanding people’s needs.

Staff told us the unit manager was approachable and supportive. Staff felt teamwork was good.

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.

People’s health needs were not adequately assessed or described in people’s assessment and care plan information for staff to be aware of. This increased the risk staff would not recognise or respond to signs of ill-health in a timely manner. The medicines some people were prescribed also indicated they lived with health conditions not identified in their care plan for staff to be aware of. For example, heart failure, enlarged prostrate, constipation, skin conditions and mental health conditions. This placed people’s health needs at risk of being missed.

People told us they got enough to eat and drink and had a choice. People had mixed opinions over the quality of the food provided. People told us they could access the doctor if they felt unwell and felt staff looked after them.

A multi-disciplinary meeting took place at the home each week, with other health and social care professionals including the home’s registered GP and the community matron to discuss any concerns or changes in people’s care. Some people’s care records showed referrals to other professionals such as the dietician, speech and language therapy team, chiropody and mental health services had been made when required.

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

People’s risks were not properly assessed, and staff did not have sufficient information to monitor and mitigate risks to ensure people’s outcomes were positive and consistent. There was limited evidence people’s care was adequately monitored to ensure their support was safe and effective in promoting positive outcomes. There was also lack of effective oversight by the senior management team, registered manager and unit managers on the quality of care people received and whether this met clinical expectations and the expectation of people and their relatives.

For example, some people required their food and drink intake to be monitored to ensure it was sufficient to mitigate risks to their health and wellbeing. Records in relation to this were not adequately maintained. Some people needed their bowel health to be monitored via stool charts. Staff lacked information on what people’s regular bowel habits were, to monitor for change, some stool charts had not been fully completed, and staff had not always recognised when medical advice needed to be sought.

Some people experienced behaviours of concern which were repetitive in nature. There was a lack of effective monitoring, learning and analysis of this behaviour to identify people’s potential triggers, early warning signs and strategies successful in reducing their occurrence and impact.This meant opportunities to adapt and continuously improve people’s psychological care and outcomes were missed.

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

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make specific decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

The provider had not always followed the MCA to ensure people’s consent was legally obtained. For example, decisions in respect of whether the person consented to the provider taking photographs of them and sharing their information with other parties, had not been subject to the MCA legislation. Staff members had signed to consent to these decisions on people’s behalf when they did not have the legal authority to do so.

Some decisions made to restrict people’s freedom or choice had been made without due regard for the MCA or DoLs legislation. For example, decisions to move people to different bedrooms or segregation from others living in the home.

Some of the capacity assessments undertaken did not always relate to the decision for which consent was sought. For example, one person’s assessment stated it was related to seeking consent to key coded doors within the home which prevented them from leaving of their own accord, yet the content of the capacity assessment focused on the use of bedrails.

Some capacity assessments also assumed by the consequence of a diagnosis of dementia or other brain impairment, the person automatically lacked capacity to make decisions. This was not in accordance with the principles of the MCA. Information about people’s ability to consent and their cognitive abilities was contradictory. This increased the risk of inappropriate or unsafe decisions being made.

Some people, but not all, told us staff respected their choices in day to day care, for example whether they wanted a bath or shower, the time they wanted to get up and go to bed and said they were able to choose how they wanted to spend their time.

Some capacity assessments had been completed appropriately, for example, for the staff administration of medicines, bed rails and do not resuscitate decisions.