Drovers House

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 inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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’s needs were assessed prior to their admission to the home to ensure these could be met. Information from assessments was used to generate initial care plans as part of the admission process. Care plans were created using standardised templates. The provider’s expectation was that these would be personalised as required. Records showed this had not always happened in a timely way, and information was not consistently person‑centred or reflective of assessed needs.

Care records were not consistently reviewed and updated to ensure they reflected people’s current needs and supported safe care practices. During the inspection we reviewed the provider’s electronic care records with the registered manager. This confirmed 21 people’s care records had not been reviewed in line with the provider’s expectations or were not fully up to date. This meant care was not always based on up-to-date information, increasing the risk that people’s needs were not appropriately met.

People and their relatives were not routinely involved in reviews of assessed needs. Most people were not aware of what information their care records contained or how these records guided the care they received. The provider told us their expectation was that people should be involved in reviews of their assessed needs and confirmed they would ensure this was encouraged going forward.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. The provider did not consistently ensure that people received care and treatment in line with evidence based guidance.

Records showed that referrals had been made to specialist health care professionals for advice and guidance, including Speech and Language Therapists and district nurses. However, some people's care records did not accurately reflect professional's recommendations to support the safe delivery of care. This meant staff did not have clear, evidence-based guidance to follow, increasing the risk of unsafe care.

One person was assessed as being at very high risk of skin damage and had an existing wound to their heel. To support healing and prevent further deterioration, the district nursing service had provided the person with pressure‑relieving boots. The district nurse told us they had advised staff when the boots should be worn or not worn, including during transfers due to the risk of slipping. This information was not detailed in the person’s care records, meaning staff did not have the evidenced based instructions needed to support the person safely. In addition, the person’s skin care plan did not inform staff about the wound on the person’s heel, despite the wound being cared for by district nurses and staff completing wound records.

The kitchen team retained a board in the kitchen which advised which people required specialised diets We identified not all people who required modified consistency or specially prepared meals were recorded on this board. The provider took immediate action to update this following our feedback.

People received a choice of meals and alternatives were made available when requested or required. People were generally happy with the food and told us they were regularly offered drinks. Comments included,“The food is very good,” and “They will do me what I want if I want something different from the menu. I only need to ask.”

Despite the concerns we identified around records, staff had received training from dieticians on fortifying foods and preparing foods and drinks to the right consistency and were able to demonstrate their knowledge in this area. Where people needed to have thickening agents added to their drinks due to their risk of choking, we found these were stored securely in locked cupboards but were available to staff when they needed them.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There was evidence of effective communication between teams. Despite records not always demonstrating risks to people and changes in their needs, staff told us this information was made known to them and shared through handovers. This was evidenced by them knowing people and their needs well.

Senior staff met with GPs through a weekly ward round, and GPs visited the service to assess people when needed. Senior care staff administered insulin to those that required and were supported by district nurses to ensure this remained a safe practice. A visiting healthcare professional told us, “I feel assured that that is happening as it should. They are very good at giving the insulin as prescribed. They are also very good if I ask for a GP to be called, they are responsive.”

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.

People told us they had access to healthcare professionals to maintain their health and sensory needs. One person told us staff were supporting them to complete exercises set by the physiotherapist. The local GP practice supported people in the home and people were supported to appointments with dentists, opticians and chiropodists when needed.

Gentle exercise classes were planned weekly, and people were encouraged to spend time outside. A side-by-side bike encouraged people to get active outdoors. Staff told us the registered manager oversaw that all people in the home, had regular opportunity to spend time outside and that this was meaningful for them.

One person had chosen to reduce their weight, and the kitchen team prepared personalised meals for them, which were not fortified with additional calories, such as butter or cream.

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 was a lack of detail in the records maintained when people’s nutritional intake needed to be monitored because they were at risk of not eating and drinking enough to keep well. We saw documentation where staff had written ‘little or no meal taken,’ with no evidence of alternatives being offered or encouraged, or additional snacks provided throughout the day. Accurate recording helps determine if the person’s nutritional care plan needs reviewing to meet the person’s needs. It also helps other healthcare professionals make decisions relating to people’s treatment and identifies when people’s planned outcomes are not being met and they need to be encouraged to eat and drink more.

Duty managers monitored people’s supplementary records and shared information with staff during handover. For example, if a person’s fluid intake was low staff were informed to encourage the person to drink. Handover records confirmed this.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff sought people’s consent before care and support were provided. One person told us, “The staff listen to me when I ask for things, and they follow what I asked for.” Another person said, “They ask me before they do anything.”

Staff demonstrated a clear understanding of the principles of the Mental Capacity Act 2005 and explained how they supported people to make their own decisions wherever possible. They described how best interest decisions were made when people did not have capacity to provide consent.

Mental capacity assessments were completed when required, were decision specific and showed how people had been involved in decision making processes. The provider told us work was ongoing to further develop how people’s representatives were involved in decision making processes when they did not have capacity to do so for themselves.