Archived: Lyme Valley House Residential Care Home

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

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 Requires Improvement. At this inspection we found there had been no improvements made. People's needs were not always adequately assessed or updated to ensure staff were able to support people with their current needs. The provider failed to assess people’s needs effectively. Decision-specific mental capacity assessments were not carried out to ensure people were supported in their best interests. The provider had failed to ensure people's consent and decision making had been appropriately assessed and recorded. During our assessment of this key question, we found concerns regarding the assessment of people's needs, which resulted in a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the provider was not acting in accordance of the Mental Capacity Act 2005, which resulted in a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

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.

We received mixed feedback about staff about how well people know their needs. One person told us, “I have to fit around other people’s needs. Staff do what they have to do but never what I need. I prefer to stay in the lounge in the evening but staff take me to my room anyway.” Another person told us, “Staff are brilliant. They check on me and help me when I need it.”

Although care plans did not always include up to date information, staff were able to tell us about people’s individual needs. One staff member told us, “[Person] requires a lot of support when moving around. Staff know to guide them and remove any potential trip hazards. Staff also support them to make food choices as they cannot say what they would like.” The provider told us care plans required improvements and the care home manager was reviewing and updating them.

People's needs were not always adequately assessed or updated. Where people received support from external health agencies in relation to skin care, nutrition or their mental health, care plans had not been updated to include sufficient information about how staff should support them. Care plans contained conflicting information about people’s needs. For example, the care plan for a person who had recently absconded and which had been investigated by the local authority, their care plan indicated they had not made any attempts to leave the property alone. Another care plan for a person with communication needs indicated they had limited means of communication however they were able to communicate their views about their care to inspectors without any adjustments. This meant people were not supported effectively.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

The provider had failed to ensure appropriate decision-specific mental capacity assessments were carried out. For example, where staff told us a person who had specific dietary requirements relating to a medical condition and staff made decisions in their best interests about what to eat, a mental capacity assessment had not been completed. This meant people were not being protected by the MCA. The provider failed to use best-interest decision making terminology in people’s records, this made information regarding restrictions confusing. We were unable to determine whether these were least restrictive and understand the rationale for determining these decisions. This meant the provider could not be assured the staff who were recording these decisions had a good understanding of MCA. Although the provider kept a list of which people had been referred to the local authority for a DoLS assessment, the provider could not evidence the referrals had been made. Where one person’s DoLS authorisation had expired, there was no evidence the provider had submitted a referral to the local authority to review this person's DoLS to ensure it was current and relevant.

Staff were able to tell us about the principles of the MCA and how they used it in their day-to-day roles. One staff member told us, “People can be deprived of their liberty in their best interests to keep them safe, for example preventing them from leaving the building or using bedrails.” Another staff member told us, “People can be kept in for their own safety if there is a legal authorisation in place.” However, we found the provider had failed to ensure appropriate decision-specific mental capacity assessments were carried out where required.