Clement Court

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 58 (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.

One person was prescribed a medicine for use only in an emergency. However, their care plan differed from the ‘when required’ guidance which was put in place following our request to see this document. This meant, staff did not have access to consistent or clear guidance on how to administer the medicine in an emergency which placed the person at risk. As the provider did not consistently review people’s daily care records, we were not assured that there was learning and reassessments of people’s needs to ensure their care and support remained in line with their changing needs.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

A person had a specialist way of being supported to maintain their nutritional intake. We asked to see evidence the person was having this specialist way appropriately cleaned and maintained. We were told, “Currently there is a note on the medication system at 9am each day to remind staff to do this, however, it's not recorded specifically that it is done. As an action, the [maintenance of the specialist way of supporting the person to eat] has now been added to [the electronic system] to ensure its recorded appropriately.”

People were observed having diet and fluids in line with their dietary needs. A relative said, “I know people get a choice [of food].” Food was appetisingly presented, including for those with modified diet to encourage people to eat their meals. People had a choice of food and could have alternatives but people on the ground floor were not always encouraged to eat in a timely manner. A staff member said, “We can go ask kitchen for sandwiches. There is plenty [of food]. They are not starving. We can go and get more food like biscuits.”

Another professional said, “Staff have sometimes made decisions to modify a person’s support whilst they are waiting for an assessment, these have all been appropriate and have helped to mitigate risks whilst waiting.”

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The provider had a system in place to handover between staff and shifts. However, how staff worked together was not always effective. One staff member said, “We [staff] should all come together, there’s room for improvement, as a whole home.”

Two different professionals have described the service using the term ‘chaos/chaotic’ in relation to staffing and getting input when they visit. A professional said, “There has been times when it has felt a bit like organised chaos, but not to the extent to raise any concerns.” Another professional said, “We can sometimes wait over an hour for support, and things can feel a bit chaotic.” The same professional said when the clinical lead was working, things worked better and they dealt with things, but when the clinical lead was not present, this was when things were not as good. They said, “[The clinical lead] is very good and knows the residents well. When they aren’t here, the service doesn’t run as smoothly.” This meant, we could not be assured the provider had established an effective process to ensure the home operated effectively, regardless of which staff were on duty.

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 needs for care and support.

A relative told us, “My relative is on a weekly weigh and has been referred to dietetics and got a target.”

Professionals told us referrals tended to be timely. Staff were able to share information about people’s need to support professionals. One professional said, “The referrals are mainly appropriate.” They went on to say, “The nurses and carers have always been open and friendly when we have visited and able to provide any information we request.”

A professional told us, “Staff when we have met in person or over the phone have always been polite, approachable and take part in the discussion regarding the person they have referred.” People’s health was being regularly monitored, with weights and bowel movements being checked. Where concerns were identified this was reviewed with health professionals, to help support people to remain well.

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.

There were gaps in some records such as repositioning, oral care, mattress checks, for example. However, this seemed to be a recording issue, as there were not widespread wounds within the service. People had their bowel movements monitored when needed, to ensure they did not become unwell due to constipation. This was being regularly recorded. However, as some people’s medicines to relieve constipation was not being administered consistently, we could not be sure this risk was always being effectively managed. The provider told us they would review this to ensure it was addressed.

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 MCA 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 take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

A staff member told us, “Always assume people have capacity, can retain and make important decisions. We do things in their best interest. We explain to them.” Another staff member said, “It’s if someone is capable of making decisions. We keep asking them, for instance mealtimes we offer a selection, today was steak and kidney pie. They didn’t eat it, so we tried fish.”

Mental capacity assessments were not always detailed and did not always evidence how people were supported to make their own decisions. Some capacity assessments were reviewed following our initial feedback about them lacking detail, but these reviewed versions also continued to lack detail. As a result, we could not be sure people were being appropriately supported in line with the Mental Capacity Act.

As we received differing responses from staff as to why some people were in bed, we could not be sure people were supported in the least restrictive way. We asked to see the best interest decision regarding 1 person who was in bed and this was not in place, so they were not being protected by the provider.