Shore Lodge - Care Home Learning Disabilities

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• 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

At this assessment we identified a breach of regulation relating to consent. However, although areas of concern were found until we have assessed more quality statements the rating for this key question remains the same. People were not supported following ‘Right support, right care, right culture’ guidance. Staff were not always following the principles of the Mental Capacity Act 2005. Staff did not always understand their role and recording how decisions were made when people did not have capacity to do so. People’s needs had not always been reviewed and their care plans updated.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff explained how they sought consent before supporting people with their needs. They could describe how they supported people to make choices, such as choosing their clothes.

The manager told us people’s needs were assessed and regularly reviewed. Staff told us they knew people well and knew when their needs were changing. We saw some staff engaging positively with people, making them smile. One staff member told us “Everyone has a care plan, the plans are similar though”. The information staff shared with us was not always in keeping with the information in people’s care plans. One person’s risk assessment recommended ‘regular 1:1 activity’ and one staff member told us “We cannot leave [the person] alone and we are mostly short of staff so nobody can be with [them] completely because of other work that needs to be done”.

The systems and processes in place did not always ensure people’s care plans and assessments were personalised. Assessments and care plans did not always link information or give clear guidance on how risks should be managed. The risk rating assigned by staff when assessing risks was not always accurate. One person was assessed as at risk of harm to themselves and others. However, staff had rated the risk as low in their assessment and the person’s behavioural support plan referred to on the document had not been completed so was missing from the care plan.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Some relatives were happy with the care and support their loved one received. One relative told us, “[the person is] clean and [their] clothes are always tidy, [the person] is looked after I am sure” another relative said, “I think [the person] is well cared for”. However, another relative was concerned about her relative and if staff were supporting them in the way they preferred and meeting their needs.

Staff explained how they sought consent before supporting people with their needs. They could describe how they supported people to make choices, such as choosing their clothes.

The principles and application of the Mental Capacity Act 2005 were not understood, and people’s rights were not upheld. Multiple decisions were assessed at the same time and within one assessment. The details within people’s records did not evidence individual decisions were fully explored. Mental capacity assessments in place did not refer to decisions that needed to be made, but referred to completing a care plan or risk assessment. A mental capacity assessment completed with one person detailed how staff had asked the person questions around the decision in question to determine their understanding. However, the person was non-verbal. There was no evidence any other more appropriate methods of communication were used to assess the person’s capacity in relation to the specific decisions. None of the documents were signed. Where people were deemed to be lacking capacity to make a particular decision, a best interest form had been completed. However, decisions were made between 2 staff only. The provider’s form stated, ‘It is a requirement that at least one person external to LCD be consulted e.g. Family member/ IMCA/ Other professionals’. No family members or external professionals had been included in any best interest decision.