The Radcliffe

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's needs were not always assessed before they came into the service. Care provided to people did not always follow best practice guidance. Feedback was mixed about whether people and relatives had been involved in care planning, with some saying they had and others saying they hadn’t. The providers Mental Capacity Act policy was not always being followed which could have led to people being unlawfully restricted. Despite this, people told us they could make choices about their care.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people and relatives told us they felt safe living at the service. People's comments included, "I have no worries here" and "everything is ok." Another person said, "I feel safe here because the people here that look after me are professional." Relative's comments included, "[Person] is safe here and [they] love it here."

The registered manager was not documenting how they assessed people before admission. They did not always visit the person to assess their needs in line with best practice. During this inspection, we found lack of evidence of initial assessments being completed and we also found a lack of risk assessment and care planning for people living at the home.

Processes did not support the full assessment of people's needs. Initial assessments were not documented to show people's needs and preferences had been assessed before admission to the home. The registered manager told us they would review the assessment completed by the social worker, gathered information from the person or relatives remotely, but would not always complete a visit to assess the person's needs. This did not reflect best practiced guidance. During this inspection, we found lack of evidence of initial assessments being completed and we also found a lack of risk assessment and care planning for people living at the home.

People shared positive feedback about the care they received.

Peoples nutritional and hydration needs were not always being met. Staff members were not aware of when people were at nutritional risk. Care plans did not highlight that people were at nutritional risk. We saw evidence of people not receiving sufficient fluid intake but there was no evidence that this had been identified and action taken to encourage better fluid intake.

The processes in place were not effective in ensuring people's needs were assessed and planned for. We found care provided to people did not always follow best practice guidance and evidence based care. For example, we found medicines were not managed in line with best practice guidance of managing medication in care homes. We found that people who had specific risks in their care, such as risks to their skin integrity or the risk of falls, did not always have a relevant risk assessment or care plan to minimise risks. After our inspection, we reviewed evidence confirming the provider was taking action on the issues identified.

People told us staff worked well together. People's comments included, "I think the staff do well here with what they have got to do" and "The staff will listen and sort things out for you."

Staff were not always aware of peoples needs. For example, where people had bed sensors or air flow mattresses in place. When asked about bedrails, we were told by some staff members that these were not in place. However, we found that these were in place.

The local authority had shared concerns identified after their monitoring visits. These concerns were linked to medication, staffing and infection prevention and control. These had been shared with the registered manager. However, during our assessment, we continued to find shortfalls in these areas.

The team did not always work well together to ensure the care provided was safe. We found the care delivered was not always monitored by senior staff to ensure staff were providing person centred care. We found a lack of oversight and guidance to ensure care staff were, for example, supporting people with regular baths/showers and that care was recorded appropriately.

People enjoyed the food and accessed support from external healthcare professionals when needed. Comments from people included, "It is good, the food. If there is something I don’t like, I can have something different" and "The best thing is the staff and the food." A relative told us, "[Person] is on build up shakes. The [staff] would get [person] a doctor if [they] needed one. Every Thursday the hairdresser comes. [Person] has the chiropodist and [their] nails done."

We received mixed responses from staff with some seeming to know people well and others displaying a poor knowledge of people they cared for. Food was well prepared and people told us they enjoyed it very much. Some snacks were available throughout the day. However, where people required extra support around hydration and nutrition, this was not always given by staff.

People were supported to live healthier lives by accessing relevant external healthcare when needed. In our review of people's care, we found people were being referred to and seen by their GP. Some people were under the care of district nurses and specialist care teams where this was required. During our visit, the opticians visited the home and reviewed people's eye care.

We received mixed feedback about people and relatives being involved in reviewing care arrangements. Comments included, "I have seen my care plan." A relative said, "They do discuss [person's] care plan." However, another relative said, "There has been no discussion about the care plan."

Staff did not always understand how to monitor outcomes or use this information to plan for people's care. Whilst the staff completed some monitoring charts, they did not use these to assess people's needs or develop new care plans.

There was a lack of evidence of care reviews taking place and if or how people and relatives were involved in these. During this assessment, we found several examples of risks to people not being assessed and care plans not being in place or not being detailed enough. The provider took action and told us of future action they would take to ensure people's care was assessed, planned and reviewed as appropriate.

People told us they could made choices about their care and consent was sought. Comments included, "I can choose what I want to do during the day" and "I can make my own choices through the day."

Staff did not know if anyone using the service were subject to a Deprivation of Liberty Safeguards order (DoLS), which meant they did not know how they should support people to ensure they complied with the principles of the DoLS. A DoLS ensures people who cannot consent to their care and treatment are protected if those arrangements deprive them of their liberty. When staff were asked about their understanding of DoLS procedures, we received mixed feedback, with some being able to explain and others not. This meant we were not assured staff had sufficient knowledge in this area.

The provider's Mental Capacity Act policy was not always being followed. Consent to care was not always recorded, in particular, for people who lacked capacity to make decisions about their care and health. On our first visit, we found one bathroom was locked to restrict access to one resident who required additional support with their continence., The provider had not considered how this also unreasonably restricted others. We discussed this with the manager and this was rectified by our second visit. Apart from this instance, we did not see any evidence of people receiving care in a way that was restrictive and not in their best interests. Deprivation of Liberty Safeguards applications had been submitted.