Longview

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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

Effective - this means we looked for evidence that people's care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people's care, treatment and support did not always achieve good outcomes or was inconsistent. During our assessment of this key question, we found concerns around assessing needs, monitoring and improving outcomes and supporting people to live healthier lives.

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 and relatives told us they were not always involved in the planning if their care and support needs. We found limited evidence to demonstrate people using the service were involved in the assessment of their needs or developing their care plan and risk assessments. Although people told us that staff knew them well, a relative told us, “My [relative] had a rash and I had to tell staff about it. I know they would have seen it but I don’t know if it was recorded.”

People's care plans and risk assessments were not always personalised, and support was not always in line with people's care plan. Records we looked at failed to demonstrate people’s needs were being regularly reviewed through assessment to ensure their support plans continued to reflect their needs.

People told us they had enough to eat and drink at the service. A person told us, “if I wanted more, they always offer it to me. The only thing I would suggest is offering a cooked breakfast. I would love for that to be added to the menu.”

Staff knew people well and how they wished to be supported with food and drink. People were given options at mealtimes and were able to choose what they wanted to eat. People discussed menu’s at their monthly meetings and changes they wished to make to the menu. However, staff were not always recording people’s fluid intake accurately and people’s fluid targets were often not being met.

People's care plans and risk assessments were not always personalised, and support was not always in line with people's care plan. Records we looked at failed to demonstrate people’s needs were being regularly reviewed through assessment to ensure their support plans continued to reflect their needs. People who had a daily fluid intake target did not have their daily targets met. The manager completed care plan audits but these lacked detail and did not include action plans and dates. A health professional told us, “Resident on resident concerns are not being raised until requested. Sizes of bruises and grade of pressure sores are not been recorded appropriately.”.

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.

People were supported to access healthcare but this was not always recorded in their daily notes and care plans. For example, 1 person was being supported to administer their own insulin as they had been deemed competent to do so by the district nursing team. However, staff were not following the instructions from the district nurses or the diabetes team. They were sometimes not giving insulin before food in line with the instructions. This meant that they weren’t managing the person’s diabetes properly and putting the person at risk of developing hyperglycaemia. The diabetic care plan in place was not reflective of the person’s needs. Mixed feedback was received from people and relatives. A relative told us, " I have seen [relative's] care plan but we have never had a review." A person told us, "I've had a couple of falls in the last few months but nothing has been put in place for me. I hate calling the staff as I know they are so busy." Another relative told us, "[Relative] has a rash on [relative] back and I had to say to them about that, I know that they would have seen it, they got cream from the doctor 6 months ago”.

People's care plans and risk assessments were not always personalised and support was not always in line with people's care plan guidance. There was a lack of clear guidance and key information in care plans to enable staff to deliver the right and consistent support people needed when distressed. Improvements were required to ensure completed care plans and risk assessments were person centred and included how risks to people were to be mitigated and reduced. Some information was generic and not personalised to the individual people using the service. A health professional told us, "When carers or senior care team leaders notice skin abnormalities/bruises, they are often not reported or managed appropriately."

We received mixed feedback from people and relatives. People told us they met with staff and spoke with them but relatives felt that they were not always kept informed. A relative told us, "If I ask, I get given feedback but I don't always get told. The communication needs improving."

The providers processes for monitoring and improving people’s outcomes was not always robust. Record of people’s fluid intake were incomplete which meant we were not assured people were meeting their fluid intake target. One person was being supported to administer their own insulin as they had been deemed competent to do so by the district nursing team. However, staff were not following the instructions from the district nurses or the diabetes team. They were sometimes not giving insulin before food in line with the instructions. This meant that they weren’t managing the person’s diabetes properly and putting the person at risk of developing hyperglycaemia. The diabetic care plan in place was not reflective of the person’s needs. Some people at the service had their dementia managed using regular medicines to control behaviour. The service was not working in line with current guidance to use alternative tools to support staff to manage people without the need for medicines. The service should consider a non-medical model such as psychological interventions or de-escalation techniques to support people living with dementia. We recommend the manager develops tools that monitors people’s outcomes to measure if they are positive or need further improvements.

Consent to care and treatment was sought in line with legislation and guidance. People we spoke with told us they were able to make some informed choices. For example, the times they like to get up in the morning and go to bed, what clothes they like to wear, choice of meals and drinks and whether or not they choose to participate in social activities. One person told us, “There are times where I don’t want to get involved in the activities taking place here at Longview so I can stay in my room.”

Staff Had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the need to gain consent from people for care and to encourage people to make decisions for themselves. Staff told us, “I have recently completed my training and I understand the importance of gaining consent from the people I support.”

Ensuring consent to care and treatment in line with law and guidance The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. People had capacity to make day-to-day decisions. We found staff practice reflected the principles of the MCA. People were encouraged to make their own decisions, while still minimising risk. Staff understood their roles and responsibilities in relation to the MCA 2005 framework.