Creedy 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

People were involved in their assessments and care planning processes. Before people moved into the service their needs were assessed. Care plans were in place which detailed people’s care and support needs but these were missing essential information about their clinical needs in relation to health conditions. This evidenced that the legal requirement in relation to person centred care had not been met. The provider had systems and processes in place to meet people’s nutrition and hydration needs. People told us the service worked with GP’s and health professionals to meet their health needs. The provider had a clear process in place to escalate health concerns. Staff had a good understanding of meeting people’s changing needs.

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.

People did not always receive person centred care. For example, we observed a staff member not acknowledging a person’s choice which caused the person to become agitated. People told us they were involved in their assessments and care planning processes. A person said, “I had a meeting with them when I came here. About once a month they come. They have a chat and ask how things are you know with hygiene and incontinence.” Some relatives told us they had been involved in the assessment and care planning process when their family member first moved to the service. A relative said, “We had an interview with [registered manager] when we came here. She sat us down and told us about the home and we chatted all about [person].

People had face to face assessments once they had been referred to the service. These were usually done by the registered manager. Family members were contacted and encouraged to be involved in the initial assessment. Care plans were started, using the information gained at the assessment together with referral documents from the hospital or local authority. Care plans were further developed once the person moved into the service. On the day of our assessment a person moved into the service and we saw and heard staff speaking with them about their wishes and needs. Kitchen staff told us that the nursing team check about any food intolerances, allergies or preferences and complete a form for the kitchen. Staff told us they had access to the assessments and care plans on their hand-held devices and could read these at any time. Assessments and care plans were reviewed and updated regularly. Changes to people’s care needs were passed on at handover meetings and documented in handover notes. A staff member said, “We have a handover every morning, we write down notes, we get good communication about bowels, diabetes etc and then we share with care staff. Nurses use the [electronic] handover tool and we write it down.”

Some people had risks and needs that had not been fully assessed as detailed in the safe key question. People’s health needs had not been assessed. However, most people’s basic needs were assessed and documented, such as their personal care, continence, eating and drinking and communication. The provider used recognised tools for assessing some risks, such as nutrition and skin integrity. The provider had processes in place for updating care plans and risk assessments on a monthly basis. However, the process was not fully robust as it had not identified that assessments of people’s diagnosed health needs were missing. The electronic systems produced reminders and flags when reviews or important events were due, for example, when a review was due and when people were due to be weighed. People with learning disabilities living at the service did not have care plans which included their goals and aspirations, which meant they were not supported in line Right Support, Right Care, Right Culture good practice guidance.

We received mainly positive feedback from people about the food. Comments included, “The food is first class, you get a choice, you can have something else if you don't like it. I'm having a cheese omelette today. You get enough to eat, sometimes too much and you choose where to have it”; “I've not been eating much, sometimes not at all. They have learnt and only give me a small meal” and “They don't always have what I like. They do give a choice, sometimes it's hot and sometimes cold meals like a salad. If I ask for an omelette, they will make me one. I don't have any special diet though.” People had their meals in the dining room, lounge and in their bedrooms. The menu board in the dining area listed choices of food which reflected the food that was available and being served. Relatives told us, “She has liquidised as her swallowing is getting worse. Usually has soup”; “They do give [person] choice about food he can say to some extent but they know what he likes. He doesn't like too much meat. They do tell me he is eating well, and he is good at drinking” and “The food here is superb and it doesn't matter what they ask for they can have it. I can't fault it.”

Staff responsible for supporting people with their food and drinks had a good understanding of people’s assessed needs in relation to type and texture of food and level of thickness of fluids to aid swallowing. A staff member said, “We ensure 2 carers use a slide sheet to sit people up properly and talk with the resident to make sure they are ok before they eat. Some have minced and moist, some puree and some soft and bite sized which is easy to chew. We give drinks at the right thickness, thickener is kept in locked cupboard all carers have the keys to this. Each person has their own thickener with their own name on. Care plans are clear about what thickener levels to give.” Staff told us they helped people to make their meal choices if they needed it.

The provider had systems and processes in place to meet people’s nutrition and hydration needs. People’s care plans and risk assessments provided clear information about their choking and swallowing risks. Information was available in other care plans about what modified diets people were prescribed following the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. The IDDSI guidance was also available in the kitchen to staff responsible for preparing, cooking and serving meals. However, records fluid taken by people were not always complete and accurate. For example, a person had a very clear fluid target each day due to their complex health needs. The provider’s records did not always record that the person had met this target each day. We explored this with staff who we observed supporting the person with their nutrition and hydration. We found there were issues with the handheld devices staff used syncing with the computer system. This meant it was difficult for nursing staff and the management team to have oversight of safe levels of nutrition and hydration.

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.

People were supported with their healthcare. A person said, “I can see a doctor, if need be, the doctor comes in quite often but I haven't had to. The nurses help you a lot, they do all my medication on my behalf. I would only have to ask. The chiropodist comes in each month.” Another person told us, “I've had to see a doctor a few times. I have seen a psychiatrist. The staff will call the chiropodist. I'm supposed to be going to see a dentist as I have problems with my teeth, the staff are sorting it.” Relatives told us, “She sees a chiropodist; she won't see a dentist and we’ve called the optician. She had the doctor last week” and “She sees the chiropodist, goes to the [local hospital] for her eyes. The nurses sort all her medication. They did have to take a sample as they thought she had an infection and got her antibiotics.”

Staff had a good understanding of meeting people’s changing needs. Staff members told us, “I inform the nurse of any health concerns and they contact the GP, nurse or the NHS” and “We had a resident last year that suddenly started drinking excessively. We reported this to the nurses who took action and found the person had become type 2 diabetic. I would report any health concerns to the nurse straight away. They then check the blood sugars.”

People living at the service had access to onsite nurses employed by the provider and other health care professionals, for example, the GP, community mental health team, community learning disability team, home enteral feeding team, chiropody, dietician, dentists and SALT (Speech and language therapists). People’s care plans included hospital passports. A hospital passport gives hospital staff important information about people, their communication needs, care needs and their health when they go to hospital. Visiting was encouraged and people were supported to attend medical appointments.

People received support from staff when health clinicians assessed their health needs. A healthcare professional said, that staff supported people during assessments. They said staff provided, ‘Excellent communication and support’ and ‘I always have a positive experience with staff at Creedy House, particularly registered nurses who are my main interface, as they always fully support me on my visits. They take the time to ensure we can have a full pre-brief; moreover, assessments are optimised as most of the time they attend the face to face element of the assessment.’ Another healthcare professional told us, ‘There is always a nurse present to support with the home visits which will normally be the Nurse that has sent the request. Again, some nurses are more confident in recognising symptoms and can give clear and accurate information which is important when they are advocating for patients. The Nursing team are always advised of the treatment plan, especially if we are prescribing antibiotics and they know to collect the medication on the same day, which it is believed they do.’

Some staff told us they had not had all the training and support to meet people’s health needs. The registered manager told us that staff had not completed multiple sclerosis and mental health training because these were not mandatory courses. We reminded the registered manager that people living with those conditions lived at the service and therefore the staff needed to understand how to support them. After the visit to the service the registered manager added additional training to the staff training programme and this included epilepsy and diabetes training.

Care plans were in place which detailed people’s care and support needs. However, additional care plans were not in place in relation to people’s clinical health conditions. We raised this with the registered manager who arranged for these care plans to be put in place. They sent us updated copies of care plans to show this had been started, however further work was required to make the care plans person centred.

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