Archived: Nutbush Cottage

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 not involved in reviews of their care which meant opportunities to set goals and empower people in making choices were missed. During our assessment of this key question, we found concerns around people not receiving person centred in line with best practice guidance was a breach of regulation. Leaders and staff did not work together to implement systems and enhance people’s quality of life. People’s general health was monitored although a greater emphasis on people’s oral healthcare was needed. You can find more details of our concerns in the evidence category findings below.

This service scored 38 (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 needs were reviewed annually and where appropriate people’s family and representatives were involved. We received mixed responses regarding the content of the reviews and how these supported people to move forward. One representative told us that whilst they felt the review had been positive they had concerns from observations and other information received that information may be being withheld. Others told us they felt involved in the processes and able to contribute.

Staff told us they were not involved in the review processes as this was the responsibility of the management. This meant the those who supported people most closely were not able to fully contribute to their reviews and plans going forward. The registered manager told us they felt recent reviews of people’s needs had been more positive.

The process of reviewing people’s needs was the responsibility of the management team with little input from people or staff regarding what people had achieved and any their experience. There was no evidence people had been involved in their own reviews and how they had been able to contribute. Whilst it is acknowledged in some instances there were improvements noted, there are also concerns that full information was not presented due to staff not consistently recording incidents and people’s anxiety.

People were not always supported in line with best practice guidance. Right Support, Right Care, Right Culture guidance was not followed to ensure people were able to live the life of their choosing. We observed throughout our assessment neither the service as a whole or individual staff members demonstrated and understanding of people's right to have an ordinary life and the opportunities this afforded them.

As at our previous inspections, staff were not able to speak about best practice guidance for supporting people with a learning disability, Right Support, Right Care, Right Culture (RSRCRC) and did not demonstrate understanding in their practice. We asked staff to tell us about the main principles RSRCRC. One staff member told us, “Everybody needs to have the right support and care, I’m sorry, I don’t understand the question.” A second staff member said, “Everything is good here now. The residents are happy. We need to keep our jobs.” When speaking with the registered manager and Nominated Individual about how they felt they were meeting the guidance both spoke of people going out more. This did not demonstrate an understanding of a holistic approach to empowering and enabling people to have a good quality of life.

Nationally recognised, evidence-based guidance was not used when designing, delivering and reviewing people’s care. There was a continued lack of understanding and failure to implement the principles of RSRCRC across the service. As detailed throughout the report, there was a continued task based focus to people’s support which was not challenged by the management team or quality assurance systems in place.

There was a disconnect within the leadership team regarding how they believed support was being delivered to people and how systems were being improved. The provider told us new systems were being implemented with the support of the registered manager whilst the registered manager told us these were the responsibility of the compliance manager. We found a number of examples where systems the provider and registered manager believed to be in place had not been implemented. For example, the registered manager told us they had implemented a system of weekly menu planning which ensured people had regular choices regarding what they wanted to eat. However, we found this had not been implemented as described. The registered manager did not ensure staff worked together to implement these processes.

Partners told us there had been some improvement in the responses from the management team with someone getting back to them more promptly in the majority of instances. However, they felt it could be difficult to get through to the right person on occasions. One professional told us, “Staff answering the Nutbush landline phone continues to be a ‘ropey’ process, just not clear at all, as if no-one wants to deal with a caller, or their enquiry, just getting the phone passed to someone else to deal with.”

Processes to support staff working together within the organisation and with external professionals were not always effective. Communication from the management team was instructional rather than consultative which led to a task orientated approach to people’s care. With the exception of accompanying people to medical appointments, staff were not always involved with professional discussions regarding people’s care so were unable to share their views and observations.

Relatives/representatives told us they felt people were supported to access health appointments and staff understood their health needs. One relative told us, “They always share health information and I receive phone calls if there are any concerns with [their] health and wellbeing.” Despite these positive responses we found guidance from the speech and language therapy team had not always been implemented in relation to people’s communication needs.

Staff told us people were supported to attend their health appointments. One staff member told us, “It is important we look after their health.” However, when asked about completing oral health assessments staff told us they supported people with cleaning their teeth and checked them but were unable to say what or how they checked. Whilst people were supported to visit the dentist regularly, it is still important that comprehensive oral health care checks are completed on a regular basis.

There was some improvement to the processes for supporting people with their health care needs. However, our review of these processes which included feedback from professionals, identified that the registered manager needed to strengthen the monitoring of health care reviews and outcomes of appointments for people. This would help ensure any established process was fully effective.

People were not supported to develop skills and interests. People continued to spend the majority of their time with their iPads, walking around their home or in bed. With the exception of one person there was no planned strategies for how they would be supported to increase their engagement and develop other things they may enjoy.

The registered manager told us they had tried numerous ways to minimise the length of time one person spent using their iPad but had been unsuccessful. We asked if this information was recorded in their care records and if staff had used approaches consistently. The registered manager stated, “I hope so.” However, we found no reference to this goal within the persons care plan, risk assessment or daily records. Staff we spoke with were unable to share any specific goals they were supporting people to achieve.

There was a lack of structure and processes in place to monitor and improve people's outcomes. There was no record of people’s goals and no holistic assessment or monitoring of their quality of life. We found goals and aspirations had not been explored with each person and no plans developed as to how they would be supported to move forward.

People were not always consulted regarding their care although staff were observed to gain consent from people before supporting them. However, relatives/representatives told us they were involved and supported people to make decisions. One relative told us, “I am always asked and involved in my [relatives] care.”

Staff were not always able to describe the principles of the Mental Capacity Act 2005. One staff member told us, “That is to do with the managers, I am responsible for the care.” Other staff members understood that whilst people may lack capacity to make some big decisions they should continue to seek their consent prior to supporting them.

People’s capacity to make specific decisions had been assessed and best interest forms completed in areas including 24 hours support, the locked gate and medicines management. However, where more recent restrictions had been introduced assessments had not been completed. Staff told us two people’s clothes were locked away outside of their rooms as there was a risk they would be damaged if this was not done. No capacity assessment or best interest decision had been recorded in relation to this. Where appropriate Deprivation of Liberties Safeguards applications had been made and where approved, the conditions imposed were in the process of being followed.