Archived: The Grove - Care Home with Nursing Physical Disabilities

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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

For this key question we only considered consent as there was a previous breach of regulation 11. During our most recent assessment we identified some improvement but not enough to lift the breach. DoLs authorizations were in place where appropriate and a tracker helped to identify when these had been applied for, granted or needed renewing. Best interest decisions were in place for any restrictive practices such as covert administration of medicines and use of bedrails, lap belts etc. These had not been kept under regular review and records did not clearly show how people were supported to make day to day decisions and take control over their lives . Equally staff did not review risk assessments when incidents had occurred to ensure people were appropriately supported in line with the choices and wishes. Family raised concerns about decisions reached in relation to do not resuscitate orders which again had not been reviewed or show clear consultation and discussion.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

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.

Some people were subject to a deprivation of liberty safeguard ( DoLS) and restrictions for people such as covert medicines, lap belts and, or bed rails had been agreed in the persons best interest. There was a ( doLs) tracker in place which had been updated and extensions applied for when necessary. We found however there was a lack of documentation or understanding of how people should be involved in decisions and where refusals were made in terms of their health and welfare there was limited evidence staff followed this up. This meant people were not always supported correctly to access the services they needed. One persons records stated they lacked capacity to make most decisions yet we were able to easily converse with them about their preferences and preferred routines. Later we observed staff talking to them about an activity they would be doing the following week. The person was described in their records as having short term memory loss so would have difficulty in retaining information but did not have a communication board, diary etc to help them see what had been planned.

Staff received training to help them provide person centred care and in line with peoples wishes and needs. Documentation was in place in regards to peoples capacity to make decisions but this was not always time specific or providing enough detail. So for example one person was described as being able to make simple day to day decisions but this was not broken down within their plan of care. They told us they had to wait until staff assisted them up and it was not clear from their documentation how their preferences and choices were being adhered too.

People had mental capacity assessments in place. These were not reviewed and were generic in nature. For example, we saw one person record who stated they lacked capacity to make decisions. but may be able to make simple day to day decisions, but this was not incorporated in their record of support. Documentation was not signed by them and we found where decisions had been made there was limited involvement from other people relatives or other professionals. Decisions were not time specific. Information relating to end-of-life treatment was signed by a clinician and not reviewed and there was no forward planning taking into account peoples wishes and fears so