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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

Mental capacity assessments were not always completed when required. When they were, they lacked relevant information to enable the person to make the decision themselves, or for relevant people to make a best interest decision on their behalf. Best interest decisions had not always been recorded, and those that were lacked detail to ensure the least restrictive option was chosen” The provider was responsive to our feedback and improvements had been made. These need time to embed. The provider had processes in place to assess and monitor people care in line with a range of nationally recognised guidance and good practice. However, we found assessments were not always used to ensure people received care in line with their assessed needs. Pre-admission assessment processes had not always been robust and effective. Some people had no pre-admission assessment documentation, so important information was missing when they moved into the home. The provider was responsive to our feedback and had made improvements when we visited in June 2024.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives were mostly happy with the assessment process before moving into the home. One person told us, “Staff interviewed me in my own home.” A relative said they had discussed their family member’s mobility needs and equipment was in place when they moved in. Another relative said, “They did a thorough assessment before mum came in. They asked her what she wanted out of her new home.” One person said they did not have their wound assessed on the day of their arrival as expected, but this was done the next day.

Most staff felt they could meet people’s needs currently. Comments included, “I have no concerns” and “Seniors or team leaders will go [to complete assessments]. From there they will decide whether the person is suitable and then the [registered manager] has to agree.” Not all staff agreed. One staff member told us they felt peoples’ needs were too high for the home. They said, “Most of them should be in a different place. This is supposed to be residential. The level of dementia and nursing needs impacts on other residents.” Another comment from staff included, “We’re not told what to expect and what not to expect. We’re seeing more residents with complex needs. When we have a good staff ratio I feel that we can meet everyone’s needs.” At our site visit in June 2024 we found the assessment process had improved. Senior staff completed the assessment, and this now had to be agreed by the nominated individual before a placement was agreed. This empowered staff and also aided their learning.

Assessment processes had not always been robust and effective. For example, one person had records stating an assessment had been done before admission, but this could not be found so their baseline information was missing. Admission assessments did not always fully consider if the service could support people with all aspects of their care. The registered manager told us there were a number of concerns about the previous management and the lack of assessments, which she was now trying to address. The nominated individual sent us evidence that all assessment paperwork now went to them to review before making a decision. This gave them the opportunity to ask questions, clarify any concerns and be confident the person’s needs could be met before agreeing a placement.

Most people and relatives said they were very happy with their care and had no complaints. One person told us, “They have helped with my diabetes. The pastry chef does sugar free desserts. The chef is also aware I need a low potassium diet.” A relative told us, “I’m pleased they [staff] are meeting mum’s emotional needs as well as her physical needs.” Another relative explained staff helped with their family member’s meals, “They know mum needs semi-solid food, small portions, no meat.”

Most staff we spoke with did not know about or understand how to implement evidence based tools and national good practice guidance. Staff comments included, “I’m not sure what this means,” and “I’ve heard of it but not sure what it is,” and “I haven’t heard of that.” The nominated individual told us they had arranged additional training for staff in dementia care, stroke, catheter care and end of life which would help equip them with knowledge and skills based on current best practice. This training was on-going and had been provided by local care teams and other training providers. This knowledge needs to embed within staff care practices.

The provider had processes in place to assess and monitor people care in line with a range of nationally recognised guidance and good practice. However, we found these were not always used in practice. For example, staff not offering enough fluids each day to meet people’s assessed fluid targets. This showed staff had not recognised and monitored peoples’ fluids effectively. At our site visit in June 2024 there had been improvements made. A manager told us they had been working with staff to improve understanding and fluid charts were now automatically created when required. A specialist organisation in dementia care had carried out audits to assess how well the home was equipped to meet the needs of people with dementia. Actions from the first audit had been completed and the results of the second audit showed the home had improved their environment to be more dementia friendly.

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.

People and relatives consistently told us staff gained their verbal consent before providing any support. For example, one person told us, “They [staff] bring me my tablets. They always ask me where I want to take them.” Another person said staff always asked if they wanted to bath themselves or if they wanted support.

Staff told us they always asked people before providing any care or support. Comments included, “They [people] do have a right to decline support and make an unwise choice. I would offer a safe alternative” and “If I am going into someone’s room, I will knock on the door first and wait for them to respond before going in. ”We observed staff checking with people before providing any care and support, including knocking on doors and waiting to be invited in. However, staff did not always demonstrate an understanding of the MCA. They had not always followed guidance and had not always implemented the MCA appropriately, or at all. This had improved at our site visit in June 2024 and needed time to embed into practice.

The Mental Capacity Act had not been implemented appropriately and peoples’ rights had therefore not always been protected. For example, people had not been assessed to see if they had capacity to make decisions about drinking alcohol when they were on certain types of medicines. Following our feedback we received several MCA assessments. However, these had not been completed in line with the principles of the MCA. People had not been given the information they needed in a clear and simple way, and the assessor did not return at different times to check their understanding. The provider acted on our feedback and at our site visit on 27 June we found improvements had been made to ensure consent was gained appropriately. This will need to embed into care practice.