Townsend 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

Changes to people’s support needs were not always clearly documented, but one person we spoke with told us they had visited the service prior to moving in. Staff carried out assessments prior to them offering a place in the service. Staff did not always receive the required training to do their job. Staff did not receive regular supervisions where they could discuss their development and any training needs. People had a poor lunchtime experience; staff had little time to encourage people who were not eating and offering them choices with their meals. Recording of dietary intake was varied and little information was available to staff on what to do if people didn’t reach their set targets. However, a handover book had recently been introduced and showed that a person had been referred to a health professional where a risk had been identified. People and their relatives were positive about the food they received. People were having their health care needs met we saw referrals had been made to the dietician, dentist and GP when required. The service is newly built and there were some issues with leaks and limited storage. The environment lacked signage to help people living with dementia find their way around. Staff had made applications to the local authority for a Deprivation of Liberty Safeguards. Further capacity assessment and best interest decisions were required for some people. People, where they had capacity, had signed their records to consent to their care and support.

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 and the relatives we spoke with told us that they had visited the service before they moved in and were involved in the discussion about the care needs that would be required. One relative told us, “Staff had completed an assessment at our home and wrote a care plan.”

People’s care records included reviews of their care; however, some did not show the person or their relative had been involved in their review or care plan. One person’s review stated, ‘not applicable’ when the question was asked ‘Has the person or their relative been consulted during the review.’ 'Resident of the day' records demonstrated that people received support from, catering and domestic staff, to ensure their needs were identified. Staff told us and we saw that they did not always have all the information required to meet peoples needs as people’s care plans, daily notes and risk assessments were not always person centred, some were contradictory and some not up to date. For example, one person’s records stated they required ‘full assistance’ with their personal care, with no further guidance on how to meet this person’s needs. Another person’s care plan referred to them living in another service.

Changes to people’s support needs were not always clearly documented. Improvements were needed to ensure that people needs are fully reflected and up to date in the care records.

During lunch people had access to a choice of meals and drinks, however, staff did not always help them to make their choice, such as showing them what was on offer. A staff member who assisted a person to eat their meal did so without rushing them. We noted that staff were busy and did not have time to offer encouragement to those people who had eaten little. Although a person told us, “Meals are excellent, and the chef is very good. There is not a freezer up here (1st floor) so I can’t have ice cream. I am diabetic and have to have custard, which is very sweet, staff don’t always have the time to go down to the kitchen to get the ice cream for me.” Another person told us, “In the evening we can have drinks, supper drinks are provided and during the night if we need one.”

Staff told us about the recent introduction of handover books which would show a person who had been identified as having a low fluid intake and/or constipation. This book also showed us evidence that health professionals had been contacted.

People’s care records did not always include the amount people had eaten nor the portion size to help staff to assess if there were any issues with their dietary intake. Some people’s care records had a running total on the amount of drink they had in a 24-hour period. Where people had not reached their target. There was little guidance in the care plans on how staff should follow this up. Catering staff were able to demonstrate they were knowledgeable in people’s needs and how they were catered for, for example people’s need for a diabetic diet and any allergies. Although catering staff told us they spoke with people about their likes and dislikes and tried to ensure the menu reflected their choices. Staff serving the food did not always take this into account. Catering staff also told us if people did not want what was on offer on the menu there was a range of alternative meals which could be provided. During our visit people and their relatives gave positive feedback about the food and the choices on offer.

People and their relatives told us they were supported to see other services. One person said, "I see a doctor when I need one." A relative also told us, “The nurses and a GP come in to see [family member] regularly.”

Staff worked well together to meet the needs of people. The manager told us there was a good relationship with other professionals. The manager told us they get together with other managers from other services to share ideas and receive updates from the provider.

The local authority told us they were working with the staff at the service with an extensive action plan to improve the outcomes for people.

The provider had processes in place to ensure they worked together with other services to support people's needs.

People told us that staff support them with their healthcare needs One relative said “[Family member] sees the Nurse and the GP, we have a new GP now [family member] has moved there.”

The manager told us they received a good service from the local GP surgery and community nurses. This included weekly GP ward rounds and access to a frailty nurse. The manager told us that reviews were planned for people with long term health conditions.

People’s weights were being monitored and referrals made to the dietician where people had lost weight.

People’s records demonstrated they were supported to see health professionals when required. However, the outcomes and guidance had not always been incorporated into the care plan. For example, daily notes showed that a person had only been supported with their oral care once over a four-day period. One relative told us “My only issue is with administration… I have gone with [family member] twice into hospital but there is no transfer paperwork, no information pack to go with them, the ambulance driver actually asked where it was the last time. So, they are now working on that, so that’s my only quibble.”

Staff were able to explain how they monitored people’s care and what they did if they had any concerns. Although information was not always incorporated into the care plans.

We asked for information to be sent showing us the important information that would be shared if a person was to be admitted to hospital as this was not available in the care plans that we looked at. This information was not received.

The service had applied for a Deprivation of Liberty Safeguard (DoLS) and a record was maintained to assist the management team to ensure, for example those which had been approved were reapplied for when they had lapsed. Although, where people had DoLS in place the care plans lacked guidance on the lawful restriction of a person’s liberty. However, people had signed records to show they had consented to their care, where they had capacity to do so.

Staff told us the manager completes applications for DoLS, the information is held in the care plan.

There were some capacity assessments in place for areas such as personal care and medicines but not all areas of people’s care where they lacked capacity. In addition, there was a lack of capacity assessments in relation to the use of equipment, such as sensors which alert staff when the person attempts to mobilise independently. There were not always records of best interest decisions made with the person’s representatives. The provider had policies in place to support staff in understanding MCA and DoLS legislation.