Downshaw Lodge

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

We identified a breach of legal regulations. People’s individual needs were not fully assessed and planned for. Plans were not personalised or reviewed and updated to fully reflect people’s current and changing needs. There was little evidence to show people and those important to them had been involved in decisions about their care and treatment. Safeguards to uphold and protect people’s right needed improving. People’s relatives said staff monitored their family members health and sought advice when needed. The service worked in partnership with relevant agencies to ensure guidance and support was provided in specific areas of care and support, so people’s health and well-being was maintained. Areas of staff training was provided to help promote best practice. This included topics such as fluids and nutrition, dysphasia, pressure ulcer prevention and falls prevention. It was recognised that people’s records needed to be improved to better evidence clinical oversight by the nursing team. Relevant servicing and checks of the environment and equipment had been completed. Action was outstanding in relation to fire safety and further improvements were needed to enhance the standard of accommodation provided to people.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s relatives felt their family members was cared for in a way they wanted and needed. We were told they were kept informed about changes in their relatives care needs were discussed with them.

Nursing staff said assessments were completed of people prior to them moving into the home and when returning to the service following an admission to hospital. Nursing staff said this helped to determine if people’s needs could be met by the home. Nursing staff gave an example where a person’s discharge from hospital had been delayed due to the persons changing needs which required further assessment and need for equipment prior to them returning home. We were told new staff would have an opportunity to read people’s care and support plans. However, on a day to day basis staff would just refer to and complete the 7-day booklet which included the daily reports and monitoring sheets.

The assessment, planning and reviewing of people’s health, care, and wellbeing needed improving to ensure records were accurate and complete, providing clear direction for staff in the care and treatment people wanted and needed. Records did not evidence staff had worked collaboratively with people and those important to them, so assessments and plans were personalised and clearly reflected their needs, wishes and preferences. A review of records for 7 people showed information was not accurate or complete. We found a range of issues including out of date photos to help identify the person, records with no names or dates and dependency tools did not reflect current needs. Furthermore specific plans in relation to moving and handling, behavioural support, oral care, continence care, end of life were vague and did not fully reflect people’s support needs. Records were not consistently reviewed and updated on a monthly basis. Our findings demonstrated a breach of regulation 9 regarding person centred care.

People had access to the health care support they needed. Relatives said the GP and other healthcare services, such as speech and language therapists or dietician, were contacted where additional advice and support was needed. One relative said their family member had been losing weight, supplements had been provided and they were now gaining weight. People were encouraged to maintain good nutrition and hydration. A varied menu was provided offering a balanced diet. People and their relatives told us, “The food is good. We get three meals a day. I do like the meals here and I get plenty of drinks” and “The food always seems good, and they look after his dietary requirements.”

Care and nursing staff said they would make referrals to relevant health and social care agencies, such as occupational therapists, speech and language therapists and community nurses, so relevant guidance and support could be provided so people’s current and changing needs were met. We spoke with the chef about people’s dietary needs. They demonstrated a good understanding of best practice when supporting people with weight loss or difficulty with swallowing. This had been supported with the completion of relevant training in nutrition and hydration and International Dysphagia Diet Standardisation Initiative (IDDSI) Framework which explores modified foods and thickened liquids.

Relevant policies and procedures in place to promote areas of good practice. This was supported by a programme of staff training. The team also sought guidance from relevant healthcare professionals so best practice was followed. It was recognised that systems needed to be improved to better evidence clinical oversight by the nursing staff of people’s care and treatment. Risk assessments were completed helping to identify hazards and risks, suggest measures for controlling risks as well as communicating good practice guidance for staff to follow, so people were kept safe. This included nutritional risk which was monitored using the ‘Malnutrition Universal Screening Tool’. This included management guidelines which could be used to develop the person care plan. A review of people showed information was not always reviewed and updated.

People said they were supported by staff in meeting their needs. People’s relatives said they were kept informed and felt staff were responsive in monitoring and identifying people’s changing needs. They were confident staff would seek additional support from the GP if this was needed.

Staff spoken with gave good examples of how they worked worked together with other services to ensure people’s needs were met. Staff felt there was good support from the local GP who was responsive to requests for assistance. Staff also evidenced where regular communication had been made with the GP and other agencies when making or following up on referrals for people. Senior staff spoke about training in the administration of insulin for those people receiving residential care. Training and assessments of competency were to be carried out by the district nurses. Once signed off district nurses would then delegate the responsibility for insulin to senior care staff. One staff member was unhappy with this arrangement and felt the community nursing team should continue to have management and oversight.

We were aware the service was working closely with the Local Authority to monitor and review areas that required improvements to be made.

The service provides both residential and nursing care. People requiring nursing care lived on both the ground and 1st floors, however nursing staff were based on the 1st floor. It was recognised that systems needed to be improved to better evidence clinical oversight of people by the nurses. People’s records reflected where advice and support had been provided by other agencies. A hospital passport was seen on people’s records however these were incomplete and did not provide all relevant information about people when transferring between services.

The relative of one person said healthcare support was readily available. We were told, “A chiropodist comes in and doctors, he is always well looked after.” In addition to people’s health care needs consideration was also given to their social and emotional well-being. Feedback about activities and opportunities was mixed. Not everyone was able or wanted to join in the activities. We were told, “They have activities people who are very good, but some of the activities are a bit childish for me but I will help out occasionally” and “I’m not really one for joining in with them. I read my paper and watch the TV and that does me.” People’s relatives also commented adding, “Not a lot of activities take place up here (first floor). The girls will chat with him in his room though!” and “He watches the activities and is aware of what’s going on. The staff always talk to him, sing to him, and include him in everything they do.”

Staff said they had a good working relationships with the local GP, who was accessible and supportive of the team in helping to keep people well. Activity staff said they now had a budget available to fund activities. However, they acknowledged it was difficult to engage and stimulate some people due to their individual needs. Staff said they explored different activities both in and away from the home. We were told that due to the complex needs and behaviours of some people living on the 1st floor, activities were facilitated downstairs in the larger lounge area. However, everyone was invited to join should they wish to.

People’s care records explored their individual social, emotional, and physical needs. A review of records showed social profiles lacked sufficient detail and were not always up to date. Records lacked evidence of people’s participation in any of the activities. Records did evidence where healthcare support had been provided including health care teams such as dietician, speech, and language therapist, falls team, continence team, opticians, and podiatry. To help monitor and maintain people’s health, additional monitoring records, such as repositioning, food and fluid, skin integrity, and weights were also in place. However, these too were not always completed in full so that people’s changing needs could be easily identified and responded to.

Systems to routinely monitor people’s care and treatment ensuring outcomes are positive and consistent needed improvement. Better opportunities for people and their relatives were needed enabling them to feedback on matters important to them and improve outcomes.

Whilst staff had recently met with the regional manager to discuss current issues they were not fully aware of the plans or systems in place to continuously improve outcomes for people. The regional manager spoke about regular visits to the home as part of the monitoring. Findings had been used to inform the development plan. This included work required to the environment however there was no clear timescales for completion due to the current financial constraints on the service.

The regional manager was liaising with the local authority on a regular basis as part of the multi-agency concerns meetings. The purpose of the meetings enabled commissioners to monitor events within the home. Systems to routinely monitor people's care and treatment ensuring outcome are positive and consistent needed improvement. Better opportunities for people and their relatives were needed, enabling them to feedback on matters important to them and improve outcomes.

Not everyone was able to give informed consent about the care and support they wanted and needed. Interactions between people and staff varied. For example, we observed when serving morning and afternoon drinks people given same drink, there was no choice offered and where people required clothes protectors during mealtimes they were not asked or made aware this was being placed on them. The relative of one person said they had no concerns and were consulted with about their family member. They told us, “They [staff] are very caring and seem to do things in his best interests.”

Staff were aware of people’s individual needs and those who required additional care and support. Staff said they had completed training in the MCA and DoLS. However, staff were not fully aware of those people subject to a DoLS and how this protected people’s rights.

Policies and procedures were in place regarding (DoLS), MCA and Consent. However, these were not always followed in practice. Applications for new or to renew DoLS applications were not completed in a timely way ensuring lawful authorisations were in place. Care records did not evidence people’s involvement, where able, or those important to them giving consent to their care and treatment. Records did not clearly outline where a person was subject to a DoLS or where decisions had been made in their ‘best interest’, ensuring their rights were upheld and protected. Information about the advocacy service was available where people needed support from an independent person to help them express their views and wishes.