Yarborough House RCH

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 remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulations in relation to meeting people’s nutrition and hydration needs and good governance.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were not always appropriately assessed, and care plans were not always reflective of people’s needs or associated risks. For example, one person had recently started using the service and had a catheter in place. However, this was not documented in their care plan and there was no guidance for staff on how to meet their catheter care needs. This meant staff did not always have access to the information required to provide safe and effective care.

People were not always cared for in line with best practice and current legislation. Evidence based tools were used to assess areas of risk, such as pressure damage and falls. However, care was not always delivered in line with people’s assessed needs. Referrals had not been made for some people to relevant professionals and where professional advice was given, it was not always followed which meant people continued to be at risk of harm.

Staff raised concerns about the quantity and variety of food available at some mealtimes. Concerns were also raised that people requiring texture-modified diets did not receive the same range of meal choices as other people and were frequently offered soup as an alternative evening meal.

Records relating to food and drink were not always completed consistently and did not always clearly record what meals had been served or the consistency of food provided.

People did not always receive food and drinks in line with advice from Speech and Language Therapy (SALT) professionals. Records showed occasions where food and drink were provided at a different consistency to that specified in people's care plans. This increased the risk that people would not receive care and treatment in line with their assessed needs and professional guidance.

Staff did not always work effectively with other services or each other. We found referrals to health care professionals were not always made in a timely manner and records were not always completed making it more difficult for health care professionals to effectively assess people’s needs.

Information was not always shared effectively amongst the staff team. For example, one staff member told us concerns of an infection outbreak had not been passed onto the registered manager and another told us handover processes were poor as changes to a person’s textured diet had not been communicated to all staff. This placed people at risk of harm.

People were not supported to manage their health and wellbeing to maximise their independence and lead healthier lives. Records showed several people had experienced unintentional weight loss and were at risk of malnutrition. Concerns relating to people's nutritional needs had not always been recognised or acted upon. In addition, referrals to relevant healthcare professionals had not been made in a timely way. This placed people at risk of deteriorating health outcomes.

Referrals to healthcare professionals had not always been made. Where referrals had been made, professional advice was not always followed. For example, some people had not been referred to the dietician and professional advice from Speech and Language Therapists was not consistently followed. This meant people were at continued risk of malnutrition, aspiration and choking.

Despite these concerns, people and relatives were generally positive about the care and support provided by staff. A relative told us, “They would recognise if my [relative] was unwell, they would contact family and ask for arrangements to be made, the [GP] did visits and check ups as routine and staff would raise any concerns with them.”

The provider failed to ensure appropriate systems were in place and effectively operated to monitor people’s health and wellbeing. For example, one person was not weighed regularly. This meant the provider was unable to effectively monitor the person’s weight for signs of unintentional weight loss. Where regular weight monitoring was undertaken, unintentional weight loss was not always identified or acted upon impacting upon people’s health and wellbeing.

We also identified concerns in relation to the monitoring and delivery of pressure area care and positional changes, medicines management and aspects of personal care. These issues meant the provider could not always demonstrate people's health needs, risks and care requirements were being consistently monitored, reviewed and responded to in a timely way.

Despite these shortfalls, people and relatives generally spoke positively about the care they received.

Staff sought people’s consent before providing support Staff had received training in the Mental Capacity Act 2005 and DoLS. Records showed people's mental capacity had been assessed where appropriate, and decisions made on their behalf had been taken in their best interests. Staff were trained in mental capacity and DoLS and records showed people’s capacity was assessed and decisions had been made. In people’s best interests.