Ardent Residential Care Home

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

This key question is rated requires improvement. We found a breach in relation to consent to care and treatment. People’s rights were not protected as the principles of the Mental Capacity Act (2005) were not being followed. People’s care had not been planned with them and care plans were not sufficiently detailed to enable staff to provide safe, appropriate care which met people’s needs and preferences. People were not always supported to access health professionals, and we were not assured that people received care that was evidence based and in line with best practice guidance

This service scored 46 (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 told us they were not involved with planning or assessing their care needs prior to moving into the service. One relative told us, “She was moved from hospital into the home very quickly. Nothing was discussed with me.” Another relative expressed concern about the lack of robust care planning and assessment of their relative’s needs. They told us, “We don’t feel this home is the right place for my Mum’s needs. They don’t understand the care package that has been set in place by the social worker and there are big gaps in what she is doing as the notes aren’t comprehensive enough.” Failing to ensure people and relatives were involved with assessments of people’s needs meant staff were not able to ensure people were receiving the care they needed, and their rights were supported.

The trainee deputy manager told us that staff did not complete an assessment of people’s needs prior to people moving to the service. They told us that they received information about people from the local authority and hospital discharge teams and used this to complete a care plan.

The provider did not have a process in place to assess people’s needs prior to them moving into the service. The service used information received about people from local hospital discharge assessments to complete people’s care plans. However, we found that care plans were not sufficiently detailed and contained minimal guidance for staff on how to care for people safely and according to their preferences and wishes. We also found that important information from these assessments had not been transferred into people’s care plans. This put people at risk of harm. Please see the safe section of this report, ‘Involving people to manage risks’ for more information. We were not assured that people were involved in their care plans. There was no evidence within care plans to demonstrate that people or their relatives, where appropriate, had been consulted about their care and support. We were not assured that people’s care plans were up to date and reflective of their current care needs. Whilst we saw a record sheet in people’s care records that stated their individual care plans had been reviewed; we found care plans did not reflect changes in care. For example, one person’s review sheet stated that they were now having a modified diet. Their care plan had not been updated with this information and stated they were having a normal diet. This placed the person at risk of harm from choking. The concerns detailed above contribute to the breach of regulations in relation to safe care and treatment.

We received mixed views from people and their relatives about their experience of the meals at the service. Some people were happy with the food and the amount, they were given, comments included, “Yes, they know I like my food, I enjoyed today’s beef casserole” and “He seems to eat enough, he looks healthy and fit.” However, other people and relatives expressed concerns. For example, one relative told us, “When she was at hospital, she ate everything, now she isn’t eating as much, as they don’t give her enough food.” Another relative was concerned about the lack of variety as their relative was on a ‘soft’ diet. One person told us their food preferences were not always respected, they said, “I’ve told them I don’t like ‘greens’ but they’ve given me broccoli today!”

Staff told us they sought advice from speech and language therapists regarding people’s eating and drinking and support needs. We saw this information displayed in the kitchen. However, we found staff were not putting their knowledge into practice as we observed one person had not been supported with their meal according to their assessed need.

People were at risk of harm because they were not receiving care that was evidence based and in line with best practice guidance. Care plans did not always reflect current guidance and recommendations made by health professionals in relation to people’s needs and risks. For example, people’s nutritional needs were not always recorded appropriately or accurately to ensure people received the correct diet to prevent aspiration and choking. One person’s review sheet stated that they were now having a modified diet. Their care plan had not been updated with this information and stated they were having a normal diet. This placed the person at risk of harm from choking.

People and their relatives did not always feel they had sufficient support from the service to access health professionals when needed. One relative told us an appointment with a health professional had been delayed because the service was short staffed. Two relatives told us they were told by staff to arrange medical appointments themselves for their relative, such as, an optician’s appointment and the winter flu inoculation. However, people and relatives told us care staff at the service were good and kind to them. One person told us, “The carers are very good in here, this one (staff members name) is lovely – they are all kind to me.”

Staff told us they worked well together to meet people’s needs. However, although we saw staff working well as a team to support people during our site visits, the concerns we found and what people and relatives told us, did not assure us that staff were always working well to meet people’s health needs.

Prior to the assessment, the service was being supported by the local authority quality team who told us they were supporting the trainee deputy manager in the absence of managerial oversight of a registered manager and the provider. They told us staff were receptive to their input and were working well with them to improve outcomes for people.

Whilst we found staff had made referrals to people’s GP and community nurses, recommendations and guidance from healthcare professionals was not always translated into people’s care plans and monitoring records. For example, one person had fallen and injured their arm, advice and physio instructions from the hospital had been sent to the service following their discharge. However, we found this advice had not been included in the persons care plan and the advice and physio instructions were not being followed by staff.

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 received mixed views from people and their relatives about the impact of living at the service. Most people and relatives felt aspects of the service and staff had a positive effect on the people living at the service. One person told us, ““When I first came here, I stayed in my room it was boring. Much better now as I go downstairs and chat with the others, play games and I’m much happier. My daughter and the carers have encouraged me to socialise.” A relative said, “On the whole it’s been positive, full-time care has benefited him.” However, some people told us they were unhappy, and they wanted to leave. Whilst most people we spoke with had no concerns in this area, our inspection found elements of care did not meet the expected standards as processes for monitoring outcomes were not robust.

The deputy manager told us they monitored care delivery by looking at ‘red flags’ on their computer system which indicated that a care intervention had been missed.

We found systems and processes in place to monitor and improve outcomes was not effective and needed improvement. For example, quality checks of care monitoring were not robust or effective in identifying care interventions, such as, continence support checks, had been missed placing people at risk of harm. Whilst there was this visual check, there was no structured auditing process in place and there was no record of any actions taken when the deputy manager had identified that a missed care intervention had taken place. People’s care plans were not always up to date or reflective of their current needs.

People's care needs had not been discussed or agreed with them prior to and since they moved into the service. Whilst people did not raise concerns about how they were supported, we could not be certain people had been involved in decisions and given consent to the care they received.

We discussed what we found in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards with staff. We found the provider and staff lacked knowledge and did not understand the processes that must be followed to ensure people were not being restricted unlawfully.

The service was not always working within the principles of the Mental Capacity Act 2005 (MCA). Whilst Deprivation of Liberty Safeguards (DoLS) had been applied for where staff were placing restrictions on people, mental capacity assessments and best interests decisions had not taken place. For example, people’s DoLS applications detailed the restrictions placed on them such as having their medicines administered, not being able to leave the service unsupervised and the use of a sensor alarm mat in place to keep them safe. There were no MCA assessments or best interests decisions recorded to show that the decisions had been made with the appropriate people, all possible options had been considered and the restriction was the least restrictive option. Some DoLS authorisations were made, with conditions in place. However, these conditions were not met by the staff team. For example, one person’s DoLS was authorised on the condition that staff facilitate access to the local community and maintain a separate log of when this was offered, what was offered and how much time the person spent in their local community. Records showed that this person was not supported to access their community according to the conditions of their DoLS.