Rastrick Hall and Grange

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

At our last inspection we rated this key question good. At this assessment the rating has changed to requires improvement. We looked at the following quality statements: assessing needs, delivering evidence based care and treatment, how staff teams and service work together and supporting people to live healthier lives. People’s care plans were not always sufficiently detailed, or person centred. Relatives we spoke with consistently told us they did not feel involved in the care planning process. However, systems were in place to improve working relationships with health and social care professionals involved in the care of people living at the service.

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.

We received mixed feedback from people and their relatives about their involvement in care planning. For example, one person told us they had spent time with staff developing their care plan. Yet relatives we spoke to did not feel involved with care planning, but this was being addressed.

The management team were aware of the need for improvements to the care planning process. The manager said they had plans to involve staff more in this. They were also contacting relatives, where appropriate, to be involved in the development and review of care plans. Staff told us people were involved in the assessment of their needs where this was possible. For example, one staff member told us, “We do the reviews in line with resident of the day and if the person has capacity, we’ll talk through with them what we’ve written to make sure they’re happy with it.” Staff said health professionals were involved as necessary to support people’s care. Feedback included, “We contact Quest, District Nurses, GPs etc. if we need their input with a resident.”

Care plans varied in detail and person-centred approach. For example, a skin integrity care plan for a person using an air mattress did not inform staff of the correct setting for the mattress. However, a care plan for a person using a hoist gave good detail about how to support the person and the correct sling size for them. Care plans and risk assessments were being reviewed at the time of the assessment to make sure they reflected people’s needs accurately. Where possible, staff were developing the care plans with the person. However, this involvement needed to be better reflected in the documentation.

We received mixed feedback about whether staff delivered evidence-based care. For example, some relatives we spoke to felt staff did not always follow the care plans. However, another relative told us how staff had recognised their relative was suffering from a serious condition and took timely and appropriate action.

The manager told us there was opportunity for clinical reviews of people’s health during a weekly ward round conducted over the phone with the GP. The manager had also arranged two weekly visits from a health care professional from the primary care network to review people’s medicines as needed and discuss any queries relating to medicines. Staff online training was delivered by a national provider and was in line with current guidance and standards. Face to face training sessions related to people’s conditions were delivered by relevant healthcare professionals. Staff said that feedback from healthcare professionals was included in care plans and notes. We spoke with the chef about supporting people with dietary requirements. The chef told us, “When I started there wasn’t even a list of people who needed special diets, so I’ve got that and it’s on the wall”. They also told us how they provided fortified meals and milkshakes and checked people were getting them.

Some care plans included good evidence-based information. A care plan for type 1 diabetes gave information about the condition, signs to look out for and the support staff needed to give. However, we did not always see evidence of staff following the advice set out in people’s care plans. For example, one person’s nutritional care plan included a comprehensive weight loss prevention plan which detailed what and when to eat, snack ideas and how to fortify meals. However, records of the person’s food intake did not evidence the plan was being followed. There were also a number of people experiencing weight loss. The manager had introduced an initiative where all members of the management team were in attendance at the service at mealtimes, would support people with meals and help them to identify any issues which might be contributing to people’s weight loss.

We received positive feedback about how the service worked with other professionals. For example, one relative told us their family member received support as they needed from healthcare professionals. They felt staff had taken appropriate action when their family member became very unwell.

Staff told us that people were provided with relevant information when moving to a new service or going to hospital, to ensure other staff knew their care needs. The manager was also considering ways in which delegation to more senior staff would better support the care teams.

A visiting healthcare professional told us staff were not always aware of why they were visiting, even though their visit was in response to a referral from the service. However, they felt staff were responsive and followed their advice. Another visiting healthcare professional had concerns about how staff managed one person’s medical condition. They had arranged to deliver training to staff but only two staff had attended.

Systems were in place to improve working relationships with health and social care professionals involved in the care of people living at the service. For example, they were looking at a better time for the GP ward round and, shortly after taking the position of manager, had arranged a meeting with nursing services providing care to people living at the service. As part of collaborative working, the manager invited representatives from the local authority to join them in making unannounced visits to the home during the night shift. Whilst this was not possible for the local authority, outcomes of the visits were shared with them. Information was also shared with staff through handover and ‘Flash’ meetings.

A visiting professional told us that the person they were visiting had no family so was reliant on staff and would like to go for walks outside the service, but so far, these had not been provided.

Staff told us that people were supported with access to healthcare professionals as needed. They said activities were provided for people, which included visits out of the service although we saw little evidence of this. All food was prepared fresh on site, considering people’s needs and using herbs and spices in place of salt. The manager told us about how one person’s mental health had improved considerably after staff had worked closely with their family and the mental health teams.

Processes were in place to support people to live healthier lives. For example, we saw some examples of how the care provided had improved conditions such as pressure ulcers. People were supported to participate in immunisation and screening programmes as appropriate, and referrals to appropriate health care professionals had been made as needed. Shortly after the manager’s appointment, they had identified that people living with Parkinson’s disease did not have access to a specialist nurse. A nurse was identified and has been supporting people and staff. However, we found care plans needed to include better detail about the support people needed to improve or maintain their health.

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.

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.