Lyndon Croft

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

Systems to monitor and assess the effectiveness of peoples’ care and support were not always robust and did not always ensure the best outcomes for people were supported and achieved. The service worked with other agencies to provide a person centred approach to their care and support to maintain good physical, mental and emotional support. Managers were working to instil a culture of improvement to improve outcomes for people. People were supported to maintain family links. People were not always supported with continuing to participate in or explore new skills, interests, hobbies and work based activities. This meant at times activities were not effective in meeting the needs of people and were not meaningful, resulting in lack of stimulation and engagement.

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.

Many people and relatives told us they were not consulted in relation to their care needs and wishes and had not been involved in developing their support plans. People and relatives told us they had timely access to appropriate health care professionals, and we saw evidence of this taking place as people’s needs changed.

Whilst staff and the registered manager told us they monitored the effectiveness of peoples support needs this was not always reflected by what staff told us. For example, many staff felt there was a shortfall in the meaningful activities for people to participate in and lack of trips into the community. We saw evidence and were told by staff that they worked with other agencies to improve the effectiveness of peoples care and support.

We saw evidence that pre-assessments of people's needs were carried out prior to a person moving into the service to ensure they were able to meet their needs effectively. We did not see evidence of on-going assessments or service user involvement during the care review process to ensure this was a collaborative and inclusive approach. Audits were not always effective in identifying where shortfalls in people’s care and support were occurring.

Many people and relatives told us they had not been involved in any recent care reviews and had not seen their care plans. This meant they had not been involved in creating personal centred care plans to meet their needs and wishes. We saw that 2 options were made available for people who required a standard diet but for those who required a modified diet there were no alternatives made available. Snacks provided were very limited for those requiring modified diets and were usually offered yoghurt. Desserts and meals were different for those requiring a modified diet to those who did not. This meant people’s choice was limited in relation to their meal choices. We found the presentation of 'pureed' meals was poor and did not promote a varied and dignified meal experience.

The registered manager told us how they had a process of reviewing support plans based on feedback and daily notes of people using the service to update support plans to reflect appropriate support. However, we found this was not always effective. Staff told us they were confident people received safe care and that the information available to them was reflective of those they supported. The provider told us they had planned for additional training to improve the mealtime experience for people who require a modified diet.

There was a process to ensure working with other health professionals was managed effectively. However, we found processes were not used effectively to ensure people were robustly involved in their care planning. The providers processes had failed to identify these shortfalls in people’s care and support needs. We saw that menus were not displayed for the week and people told us they were not always aware of what the meal of the day was until they were sat at the dining table, or it was taken to their room. We saw menus were printed off and brought to the table as the meal service was taking place. Displaying and sharing of menus in advance would improve the mealtime experience for people.

There was positive feedback from people and relatives about the culture in the service, particularly in recent months. People overall, felt the team worked well together and it was an inviting atmosphere. One relative told us, "The staff seem a lot better now. It seems like a lot of the bad ones have gone. This manager seems better and more on top of things." We saw evidence that health professionals were involved in providing advice and guidance and this was working well.

Staff told us they received an induction and had opportunities to shadow experienced staff to ensure they knew how the service worked and understand people's needs. We were told and induction saw evidence of team meetings taking place together with daily handovers and ‘10 at 10’ meetings where areas of concern or positive feedback were discussed.

The health professional we spoke with felt there was a good working relationship with the service and any guidance was actioned. They also told us, "Care has improved since the Support for Care Home from the local authority have been involved. They visit weekly and do staff training sessions. Staff know residents well.”

Staff competency assessments were completed to ensure staff had the skills and knowledge to safely and effectively carry out their roles in areas such as medicines and manual handling. There was an induction process in place. The provider has just changed the format of how indications were recorded to ensure it is more robust. This now clearly captured what happened on each day. This was not the case in the records we reviewed but we saw evidence of the new format to be implemented. Handover took place each shift changeover and there was an option on the provider’s newly-introduced electronic care planning system to generate an electronic handover to review any significant support needs, changes or incidents and accidents. This enabled a quick overview and effective handover.

People and relatives told us that when they needed to see a GP, dentist, optician or chiropodist, these appointments were arranged on their behalf. People told us they were able to make choices and decisions but not all people were involved in reviewing or consulted about their health and well-being needs.

Staff could tell us how they would access additional support services, should they be required. Records demonstrated and staff told us that staff had received training to support people with specific health conditions. The registered manager told us they had arranged additional staff training to improve their knowledge and skills in relation to many health needs such as dementia awareness.

The system and processes to ensure care records and risk assessments were updated were not robust. This meant staff did not always have the correct guidance on how to support people appropriately, whilst encouraging independence. We saw evidence of meetings with health professionals to discuss people’s health and wellbeing, as required. This included a system for making applications for DoLS authorisations to ensure people were not unlawfully prevented from maintaining independence, choice and control of their lives.

People and relatives told us how they felt the standard of care in the service had improved since the new manager has been in post. People felt listened to and that their concerns would be actioned.

Supervisions and appraisals took place and staff felt these were beneficial and provided them with an opportunity to discuss any concerns they may have. However, the format of supervisions we saw did not demonstrate these were used as a supportive process for staff and their development. The provider told us they had now implemented a new format to capture this information. One staff member told us how they have been supported to undertake a qualification in health and social care by the registered manager. The registered manager told us that staff investigations were carried out as necessary. These were used to ensure people using the service were safe and received appropriate care and support. Lessons learnt from such investigations were then cascaded to the wider team. Champions had been introduced in some areas of the service to help increase awareness and monitor performance. This required some development to ensure these roles were effective in driving standards and improvement.

Audits were in place to monitor many areas of the service. A ‘resident of the day’ approach has been introduced which staff told us was a good opportunity to review care plans. However, this process of reviewing care plans does not include people or relatives currently. The robustness of these reviews needed to be improved as we identified areas where changes had not been made. The outcomes of audits on the service were analysed and actions identified. We saw these actions were completed by the registered manager or wider team to improve outcomes for people using the service. Compliments and complaints were used to help drive improvement. For example, where people had raised concerns, in some cases these had led to positive outcomes. However, some relatives felt there was an on-going issue with missing laundry and people wearing other people's clothes. Lessons learnt were taken from events and incidents and accidents which occurred and where possible, changes were implemented to improve outcomes for people.

People and relatives did not always feel they were involved in their care and treatment. However, people were happy with the support they received overall and gave positive feedback. People told us that staff respected their right to refuse care and support and we saw evidence of this in daily records. We observed staff knocking doors and asking if people would like support and people confirmed this took place.

Staff had received training in relation to consent, MCA and DoLS. Although there were some shortfalls in this training staff were able to tell us what this meant for people living in the service. The registered manager demonstrated they had a good understanding of the MCA and application of best-interests and DoLS.

There was a matrix in place to monitor the application and authorisation of DoLS. Where conditions had been applied, we saw that these had been actioned. There were policies in place in relation to MCA, DoLS and best interest decisions.