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

This service scored 54 (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 were effective. People’s needs were assessed; however, care plans and risk assessments did not always provide clear guidance for staff to support individuals safely. Some care plans contained conflicting or unclear information about health and support needs. For example: a communication care plan stated that a person could not use the call bell system, while the related risk assessment indicated the call bell was appropriate for seeking support. A mobility care plan noted that one staff member was required for transfers, whereas the continence care plan stated that one or two staff may be needed, without specifying which.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not follow legislation and current evidence-based good practice and standards. A person’s care plan referred to them having “good and bad days”. There was no information available to guide staff on their presentation on these occasions, or how to provide effective support. Some people were at increased risk of choking and aspiration. We saw a jug of pre-thickened fluids in a person's bedroom. Over time, thickened fluids continue to change consistency which meant there was increased risk the person could consume fluids of an incorrect thickness. Another person's care plan gave conflicting information regarding the texture of food they required. These issues increased people’s risk of choking or aspiration. These findings highlight a lack of clear documentation and oversight in managing safe care.

The provider did not always work well across teams and services to support people. The provider worked with health professionals who provided guidance regarding people’s care and support . For example, District Nurses visited to monitor skin condition, update information regarding repositioning frequency and equipment required. However, this information was not easily accessible within care plans and notes, meaning that staff did not always follow their guidance. We raised this with the manager, who took action to ensure the information was correctly recorded and more easily accessible. Healthcare professionals told us, "The advice we give is not being listened to" and "Communication with staff is difficult. We ask for things to happen, but they don't always. There seems to be a lack of understanding."

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. For example, a person had been identified as being at risk of self-harm. The care plan in place lacked specific guidance for staff on how the individual may present, how to monitor the risk, and what actions to take to reduce it. There were no associated risk assessments or evidence that concerns had been shared with relevant healthcare professionals. Although the care plan referenced a referral to mental health services, there was no evidence this had been completed or followed up.

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 health needs were monitored. However, timely action was not always taken to ensure people’s health was maintained. For example, a person had required blood tests, but staff were unable to tell us why or provide any results. This information was obtained following our request. People’s care plans contained information on their care needs and actions required to provide care but lacked detail to support effective monitoring. For example, there were no directions for staff to ensure that mattresses used to relieve pressure were set and working correctly.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. People were supported to make their own decisions where this was safe and practical. They were given appropriate information and the time they needed to make an informed decision. A relative told us,"[Name] is always asked if care can start."