Elstow Manor

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

We identified 1 breach of the legal regulations. We found that people's needs were not always well assessed and planned for, and their nutritional and hydration needs were not always well met. There were concerns about the local GP not conducting regular visits to the home; the provider was taking action to improve this. We received mixed feedback about people being able to take part in activities. However, people had support to attend appointments, and external professionals were involved where needs were identified.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A relative told us they were concerned about staff not supporting a person to wear their glasses and hearing aids as they could not see or hear without them. We followed this up during our second visit and observed the person did not have one of their hearing aids as it was in pieces without a battery in their room. Although their care plan highlighted that they needed these, we found no explanation in their records for why this was the case. This increased the risk of their communication needs not being met. Moreover, this person was known at times to experience emotional distress where effective communication is of great importance. However, people who were able told us they were aware of their care plans and had been involved in relevant discussions. A person said, “We did a care plan, and my [Relative] came in, and we all discussed what I liked and needed.”

In response to our findings about people's care plans, the provider told us they would take action to review people's care plans to ensure accuracy and up-to-date assessment of people's needs. They told us they had arranged additional staff training on care planning. We will check for improvements at our next assessment.

People's needs were not always well assessed and planned for. Care plans did not always provide guidance on managing the risk of social isolation, continence support needs and religious or cultural needs. People’s care plans were not always effectively updated when they experienced a change in needs. This increased the risk of people's needs and preferences not being met.

A person’s records showed they had, on 2 recent occasions, received food they were allergic to and, on one occasion, felt very upset. Another person told us they often “went without” as dietary alternatives were not always available for food they were intolerant to. However, we observed that people had access to adapted cutlery to facilitate their eating where required.

In response to our findings about people’s nutrition and hydration needs the provider told us they would take action which included ensuring people’s nutrition and hydration needs were reviewed weekly and they would make improvements to monitoring systems and processes. We will check for improvements at our next assessment.

People's nutritional and hydration needs were not always well met. We found a person's care plan contained conflicting information about what kind of food and drink they could have due to their swallowing difficulties. Records showed staff had inconsistently thickened their drink. This increased choking-related risks to this individual. Where a person was cared for and ate in bed, care plans did not show what position they should be in to manage choking-related risks. Staff and relatives told us a person had not been eating well, but their care plans did not include staff guidance on promoting their nutrition and hydration. The provider used a nutritional assessment tool (MUST) to identify people who may be at risk of malnutrition. This tool was also used to support further assessment tools in relation to pressure sores, further increasing the risk that people may be assessed incorrectly.

People and relatives raised concerns about the local GP not conducting regular visits to the home and opted for virtual appointments and ward rounds. While this does not directly reflect on the provider, it did affect people due to the home's location in relation to the GP surgery. We shared this feedback with the provider and the local authority. However, people confirmed that opticians came to the home and had access to hearing check-ups. Relatives confirmed staff were available to take people to appointments, but most chose to accompany their relatives. Relatives told us they could speak with staff about people's care needs.

Staff gave us examples of external professionals they had worked with in relation to people’s health and care needs. For example, a staff member told us a speech and language therapist had carried out an assessment on the first day of our assessment and had made recommendations on how a person’s diet needed to be modified. Nurses understood when they would need to contact emergency services. A nurse told us, “As a nurse, depending on the incident or accident if, maybe someone had a fall. Depending on my assessment, I would do my observations and neurological observations and contact emergency services.” They also told us they would update people’s relatives if needed.

Although there was evidence of external professionals being involved in people’s care planning, where advice was given, this was not always documented clearly in people’s care plans. For example, one person’s care plan stated that they could and could not eat bread due to swallowing difficulties. Leaders have taken action to support people to have face-to-face appointments with GPs where needed. This included meeting with the GP surgery to discuss concerns.

There was mixed feedback about how well people’s social wellbeing needs were met. People told us community-based activities were available, but they did not always feel there were enough opportunities to participate. A person told us a change in transport arrangements meant only 3 people who mobilised in wheelchairs could be accommodated, which meant not everybody who wanted to go out could. Another person said, "I love to go out on trips because I don't have any friends locally or many visitors. I do ask [name of activities staff]. They've been to the embankment 3 times, and I haven't been able to go once. It's very disappointing." Relatives gave us mixed feedback about how people were encouraged and supported to socialise or participate in activities. For example, while we were told there were church services and activities such as knitting groups, not all relatives felt people were encouraged to join in as much as needed. During our first visit, a person told us they were looking forward to pet therapy on the day. However, this had been cancelled, and they were disappointed that the staff had not informed them. However, A relative told us in relation to us asking if they felt staff understood their relative's health needs, "They do understand" and "they did refer [relative] when [relative] had lost weight, but they also ordered build-up drinks and [relative] is doing better now."

In response to our findings about risks related to people’s skin health, the provider told us they had taken action, including reviewing people’s repositioning records to improve accuracy and consistency. As stated in other parts of the report, the provider told us they would take action in relation to care planning. We will check for improvements at our next assessment.

We could not be assured the provider always effectively supported people with their health needs. We found there to be an inconsistent approach to care planning for people living with diabetes, as some people’s care plans provided guidance on warning signs that required intervention, and others did not. We identified and observed concerns in relation to people’s oral care needs being met. Risks related to people’s skin health were not always well managed. We found concerns in relation to people’s air mattresses being incorrectly set. Records showed that people were not always repositioned in time and that the application of prescribed topical creams that help prevent sores is inconsistent.

People and relatives did not raise any specific concerns in relation to monitoring and improving outcomes.

In response to our findings the provider told us they would review their governance arrangements to improve service quality and safety. We will check for improvements at our next assessment.

Our findings concerning care plans not always being up to date or consistent and reporting and follow-up of accidents, incidents, and complaints meant we were not assured the provider always effectively monitors people’s care, treatment and outcomes. Where it had been assessed that people needed to be checked consistently (for example, hourly) for their safety needs, records showed this was not always achieved, increasing safety risks to people. Staff did not always document outcomes or what follow-up action had been taken where health concerns were raised by people or on their behalf. For example, staff had documented they would discuss with the GP that a person told them they had been struggling to sleep, but there was no evidence this had been done or what the outcome of this was.

Where people had a preference about the gender of staff that supported them with personal care, records showed this was not always upheld. For example, one person’s records showed that only female staff should support them to avoid distress, but records showed that male staff had supported them. As per our findings in the safeguarding part of the report, a person and their relatives told us about an incident where a staff member had proceeded to examine a person’s intimate area without their consent. The provider has taken action in response to this concern. However, we did observe staff seeking consent before delivering care and offering choices, for example, in relation to meal options.

The provider told us they would take action to ensure care plans reflected people’s preferences and included more detailed information about decisions people were able to make. However, staff told us they had received training on the Mental Capacity Act and understood the importance of gaining people’s consent. Staff had a good understanding of the processes involved in people being lawfully deprived of their liberty.

People's care plans were not always of good quality regarding their capacity to make specific decisions and ability to consent to aspects of their care and treatment. For example, a person's care plan stated they could become distressed and resistant to support with their hygiene needs and, at times, could require additional staff to support them. However, there was not information about whether the person understood that their hygiene needs needed attention. Where people needed to be deprived of their liberty, the provider did have effective systems to seek the legal authority to do so.