Blakesley House Nursing 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

We identified a breach of regulation in relation to nutrition and hydration. People's nutritional needs were not always being met. They told us they were not always given choices. There was limited variety of meals offered and these were not always nutritious. There were systems to help ensure people consented to their care and treatment. The provider was not always effectively monitoring whether these systems were being followed. The provider assessed people's needs. However, people had not always been involved in this and did not always know about their care plans. Staff liaised with other external professionals to help make sure people's needs were monitored and met. People had access to external healthcare professionals. When concerns were identified, the staff made timely referrals to other professionals.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People using the service and their relatives told us they did not remember being involved in assessments or creating care plans. They said they were not regularly involved in discussions about their care.

The manager and nurses told us they were involved in carrying out assessments and writing care plans. They explained they liaised with other professionals to gather information about people's needs.

Assessments and care plans were detailed and included personalised information. They were regularly reviewed and updated. However, the provider had not always assessed all of people's needs or made plans in respect of these. This included assessments about some health conditions.

People did not always feel their nutritional needs were met. Some people told us they did not have enough to eat. Their comments included, ''Sometimes the food is not as good as it should be, and I don’t think there is a choice. If it is something I don’t like, I go without and sometimes I am hungry'' and ''There is no choice at mealtimes, but I like the food.'' Although another person told us, ''The food is good. It is straightforward and not fancy, but it is good.'' People told us they had enough to drink and were offered regular drinks. People felt their other needs, including healthcare needs were met.

Some staff told us people had commented to them that they were sometimes hungry and did not have enough food. We discussed this with the manager. The staff did not always demonstrate a good awareness of best practice for supporting people with their nutritional needs, for example how to meet the needs of people with specialist diets.

The planned menus did not contain a variety of different dishes. There was no variation in the carbohydrate content for meals, which was always some form of potato. The planned protein for meals was mostly prepared processed food such as sausages, burgers and meatballs. Records of food which had been provided showed there was limited variety and no planned options for alternative meals. The planned evening meals was always soup and sandwiches. Staff and people using the service told us they did not usually get offered soup. There was limited selection and variety of sandwiches. Best practice guidance for supporting older people with their nutritional needs recommends low salt and sugar levels, reduction of processed food, high fibre content and a selection of fresh fruit and vegetables. The planned meals and records of food provided indicated this best practice was not being adhered to.

People explained they were able to see healthcare professionals when needed.

Nurses and the manager liaised with other healthcare professionals. They told us they had a good relationship with the GP and other external partners. They explained they shared information with the staff team to make sure they were aware of any changes in someone's planned care and support.

The local authority found that the provider had not always shared information with all relevant parties following a hospital admission. However, they also found that the provider was good at making timely referrals when someone had become unwell, or their needs had changed.

There was evidence of good liaison with external professionals to make sure people's needs were assessed, monitored and met.

People told us they were supported with their health needs. The doctor visited or held a video call weekly. People were able to see other professionals as needed.

The nurses had a good oversight of people's individual healthcare needs and knew who to contact if they needed additional support.

Whilst the staff demonstrated a good knowledge of people's needs and there was evidence of regular external healthcare input, we found that some assessments and care plans needed more information about health conditions. For example, warning signs and how the health condition impacted on other aspects of their wellbeing. We discussed this with the manager. The staff recorded when people had medical appointments and these records showed people had access to the external healthcare services they needed.

People using the service and their relatives told us staff monitored them and checked their wellbeing. One relative we spoke with told us the provider had offered personalised support when their relative's needs had changed.

Staff told us about the processes for checking people's skin condition and reporting any concerns relating to this.

The processes for monitoring people's wellbeing had not always been followed. Staff regularly weighed people, and this was recorded. However, other monitoring charts were not always completed properly. The provider's systems had not always identified this. This meant there were not always effective processes for monitoring whether planned care was meeting people's individual needs. The provider did not implement systems for monitoring people's mental well-being or mood. Care plans and records of care tended to focus on physical interventions rather than emotional support and wellbeing.

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 make 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). People told us they did not know whether they were asked for their consent. Although they said they were happy at the home.

The staff did not always understand about the MCA and their responsibilities under this. They did not know if there were DoLS authorisations in place for people and did not know whether conditions had been imposed as part of these. We discussed this with the manager so they could refresh staff knowledge and organise additional training if needed.

The care records we viewed included forms to show people had consented to their care and treatment. However, these had not always been signed by people and there were no records to show best interest discussions had taken place with some people's representatives. There were no systems to monitor conditions of DoLS and make sure these were being met and information from conditions had not been included in people's care plans. The provider had applied for DoLS authorisations but had not always monitored when these expired or followed up with the legal authority when they were waiting to hear back about authorisations. Whilst there was no evidence people were being deprived of their liberty, the systems and process for monitoring this were not always robust enough.