Ingleby 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

The service was not always effective and has been rated requires improvement. We found a breach of regulation governance and record keeping. Staff worked well together and understood people’s needs. Recognised tools were used to assess health related risks. Records in relation to nutrition and hydration were not detailed and consistent. People’s communication needs had not been assessed which impacted on the quality of care they received. People were supported to access health services; however, some key information was not recorded in care plans. The principles of the Mental Health Act (2005) were followed, and staff supported people to make informed choices on a day-to-day basis.

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.

People said they were asked what support they needed. One person said, “We don’t have reviews, but they do listen and if there’s something you don’t like they put it right.” However, people’s experience was affected by limitations in the completion of processes.

Staff told us care plans had information in them in relation to people’s needs and were updated to reflect changes. However, we were also told, “I’m not aware of relatives being involved with care planning.” people’s communication needs had not been assessed and the regional manager said, “We need to do better.”

An electronic care planning system was in place which included people’s needs and preferences. Recognised tools, including MUST and Waterlow were used to assess people’s needs in relation to areas such as nutritional risk and pressure sore risk and risk assessment were completed. However, people’s communication needs were not assessed and not all care plans were person centred.

People commented there were no problems with personal care, skin care, nutrition and hydration. Relatives said they were happy with diabetes care and dietary needs. People had access to GP services, dentistry, community matron and district nursing teams. However, record keeping was not consistent.

We noted that it was documented on a flash meeting that some people had gone for up to 8 days without a bowel movement with no evidence of any action taken in response to this. We discussed records with the manager who told us, “Staff are not knowledgeable on recording food and fluid on the system.”

Processes were in place to record the delivery of care and support. However, the recording of people’s food and fluid intake wasn’t robust. People’s fluid intake was not consistently recorded, and people rarely met their targets for fluid intake. There was no evidence action was taken in relation to this. Nutritional intake records were also limited, for example recording 'snack' with no detail on what the snack was, or the amount of food eaten.

People told us they thought the staff team worked well together. They also mentioned having access to doctors and dentists when needed.

The manager said the GP did a regular ward round and would see anyone who staff had put on the list.

A health care partner said, “They are proactive in the management of patient care and work in partnership with the practice.”

Processes were in place for senior care staff to add people to the list for the GP ward round and would update family members and provide updates, as well as logging it on the care planning system. Staff also worked to make sure people had access to medical advice and emergency out of hours where needed.

People told us they had access to a GP if needed and said, “If something isn’t right, they sort it.” One person said they were encouraged to stay fit and to eat healthy options. However, another person said, “They don’t give me any exercises to do.

The deputy manager told us some people have chosen to stay with their own GP when moving in if they remained within the GP’s catchment area. We discussed diabetes care with the manager who advised this was the responsibility of the district nursing team with no oversight from the care home staff.

People had regular access to GP and district nursing if needed. Referrals to other healthcare professionals were made as required. Care plans were in place for things such as diabetes, however there was no information on people’s blood glucose levels or who monitored this. A regional manager, who was new to overseeing the home said this would be followed up on and an update provided, however we did not receive an update by the agreed time.

Whilst people had access to healthcare professionals their experience was affected by the monitoring of outcomes within the home.

We discussed procedures for people living with insulin-controlled diabetes and were told the district nurse manages the insulin and blood glucose monitoring. We asked about base-line levels and the regional manager said this should be recorded. They tasked the home manager will following up on this with the district nursing team and updating the inspection team. However, we did not receive an update by the agreed time. The manager did confirm that people’s diabetes was well controlled with no issues.

Weekly monitoring of weights, falls and skin integrity was in place, and actions were identified. However, actions did not have a name person responsible for completion and not all actions were signed off as complete. Outcomes of district nursing visits were not recorded.

People were supported by staff who included them in day to decision making and respected their views.

Staff explained that if someone refused care, they would respect that decision and try again later. Some staff said they would ask senior care staff for support, and others mentioned documenting that care had been offered and declined. They also gave examples of how they involved people in their day-to-day care.

Processes were in place to assess people’s capacity and make best interest decisions in line with the Mental Capacity Act 2005. When appropriate Deprivation of Liberty Safeguards (DoLs) had been applied for and authorised. Appropriate notifications had been submitted to the CQC. Relevant assessments had been completed in relation to restrictions, such as sensor mats. Best interest decisions were recorded and the least restrictive options were implemented. It was also recorded that family members and lasting power of attorneys, if in place were involved in decision making. We saw no evidence of advocacy services being involved, however the manager said they would involve advocates as needed.