Kilburn Care Centre

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 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 because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People, and their families where appropriate, were involved in their initial care plan assessment when they moved into the service. However, ongoing care plan reviews were not always carried out in partnership with people or their relatives.

The provider had an electronic care record system and appropriate assessment tools guided staff to ensure individual needs were understood. People’s care plans also included details of any communication needs. Assessments were regularly reviewed and updated by the provider’s senior staff but not always with the person or their relative’s involvement. This increased the potential for people not to receive care and support in the way they preferred.

The provider planned people’s care and treatment with them, including what was important and mattered to them. They did this planning in line with legislation and current evidence-based good practice and standards. However, the delivery of that care was not always in line with people’s preferences.

People’s care needs were detailed in their electronic care plans, including guidance on how their specific needs were to be met. For example, some people had detailed care plan sections in relation to nutrition, hydration or modified diets, where they were relevant needs for them.

People, and their relatives, gave mixed feedback on the food and drinks available to them. People mostly told us they enjoyed the food, but that the quality varied. For example, a person told us, “The food is good, you have choices, and the menu is up on the board there. I normally eat in my room. You can have tea and coffee when you like.” In contrast, another person told us that, while the care home made their favourite dish, they struggled to eat it. We observed that was because the meat in the dish was too tough for them to chew.

Some relatives told us they were concerned people may not always get the necessary support they needed from staff. A relative told us, “I am not sure [my family member] can get enough food or fluid as they cannot feed themselves.” Another relative told us, “[Relative] has very few fluids as they need help to drink. I filled their drink container up yesterday and you can see they haven’t had any of it to drink. It’s dependant on them having enough staff to help [relative] to have a drink and eat their food.”

We found no specific evidence that anyone had come to harm, or that anyone had not received sufficient food and drink. However, not supporting people with their nutrition and fluids, in line with their preferences, could increase their potential to receive poor care.

The provider did not always work well across external teams and services to support people. They did not always communicate effectively with external health care agencies when people were being supported by different services.

For example, an external health care professional told us they were concerned about, “Things from ward rounds not being actioned or communicated to the wider team.” Additionally, that contacting the service was often difficult due to, “Not being able to get through to the home by phone when urgent reviews have been requested.” After finding similar difficulties in contacting the service by telephone, the inspector raised the issue with the provider who took action to improve their phone system at the service.

An emergency healthcare professional told us it was sometimes difficult to obtain the necessary information relating to a person, when agency staff were at the service, as they would often not know the background of the person or be able to handover the necessary information in a timely way. These barriers to effective communication between the service and external teams increased the potential for people to receive poor care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future need for more intensive support.

People were encouraged and supported to manage their care needs, where they were able to, by staff who understood their needs and preferences. Staff encouraged and supported people to make healthier choices to help promote and maintain their health and wellbeing.

The provider’s staff regularly monitored people’s health and supported people to access external primary healthcare support from GPs etc, as well as specialist hospital support when needed. A person told us, “Yes, the doctor comes here every week usually.

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.

The provider had the systems in place to routinely monitor the care provided, by checking their electronic care record system and carrying out spot checks. However, this was not always being carried out in a consistent way. For example, people’s incident and accident records were not always being reviewed by a manager and appropriate action taken to reduce the chance of recurrence.

The provider had been without a permanent manager at the service for several months, and did not have an identified clinical lead nurse at the service. That, combined with the high usage of agency nurses and care staff, meant there was an increased risk that opportunities were missed to make continuous improvements to people’s care and treatment.

The provider told people about their rights around consent, but in practice people could not always exercise their right to make choices when receiving care and treatment.

Staff understood how to assess people’s mental capacity, but their ability to offer people meaningful choices about their care was hampered by the provider’s staffing arrangements. People and staff told us that care tasks often appeared to be rushed because the staff were busy.

There were systems in place to evidence people had consented to receive care at the nursing home, if they had capacity to do so, and to ensure the principles of the Mental Capacity Act 2005 (MCA) were followed when people lacked capacity to make decisions about their care.