Townsend Manor

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We found a breach of regulation in regards to person centred care. Care records and daily notes require improvement to ensure they are meeting people’s needs in a consistent way. People were not offered meaningful activities or engagement. A complaints procedure was available, a log of complaints was made available although it did not detail any action taken and if lessons had been learned. Most people and relatives we spoke with knew how to make a complaint. People’s end of life decisions had been recorded. Other health professionals had been involved with people and their families to complete RESPECT (Recommended Summary Plan for Emergency Care and Treatment.) forms. There was limited use of the accessible information standard at the service. There was a lack of signage round the service to help orientate people.

This service scored 61 (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 relatives had mixed views on how they felt involved in their care. Although people and their relatives told us staff were accessible to discuss their care. Staff knew people well and were able to describe their care needs and the support they required as individuals. One relative told us, "I think they did have a care plan when they moved in but I don’t remember any reviews or being asked anything since.” Another relative said, “Staff ring me up sometimes to go through the care plan, I’m happy with the care plan.” A third relative said “[Family Member] has been in since last year, a care plan? Well I am not sure, the manager left the week [family member] came in and there has been a lot of changes in staff, we have had a chat with [name of manager] and discussed what [family member] needs.”

Staff told us that care plans were not often up to date to reflect people’s changing needs and sometimes when new people moved into the service, there were sometimes little information provided to guide them in how the people’s needs were to be met.

People’s care plans, daily notes and risk assessments were not always person centred, some were contradictory and some not up to date. People’s care plans varied in detail, some required more detail regarding the support people required and preferred. 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. Where people’s care records had stated the person was depressed or had self-harmed in the past, more details was required to guide staff on the signs and indicators of their distress, how to support them and when to report. There was inappropriate use of language such as, “Piddle,” for when the person had been supported with their continence care. The use of the English language did not always make clear the support provided. The records were not person centred with some entries referring to the person by name and some as ‘resident’. One person’s daily notes at the same time on the same day stated they had received personal care and was settled in bed, the other entry stated they were in the lounge. Another person’s records referred to them as a different person’s name.

People received care from a range of relevant health professionals to support their individual needs.

Staff told us they knew how to escalate any changes in people's needs in order to ensure referrals were made to the relevant health professionals promptly.

Health and social care professionals told us they were working with the service to improve the overall quality of the service.

The provider had a process in place for making referrals to and working alongside other services to support people's needs. Relevant information was documented in people's care plans. However, this was not always fully updated to ensure it was an accurate reflection of people's assessed needs. This meant there was a risk people may not always receive consistent support.

People did not always have access to information in different formats. For example, we found a lack of pictorial and easy read information in the service. Menus, activity guides and care plan documentation had not been adapted to suit people's individual communication needs.

Staff told us that activities are provided on a sheet each week, but these are not in a pictorial format. These can get cancelled due to staff having too support other people and ensuring their personal needs are being met.

There is communication policy in place aimed to support all service users and staff in delivering person centred care maintaining their Equality, Diversity and human rights.”

There were mixed views from people and their relatives in whether they feel listened to or involved in the care provision. One relative told us “Well I have complained more than once, but things have improved a bit, they are more on the ball and staff numbers are better.” Another relative said, “I don’t know about care plans or reviews, I don’t remember being asked anything.”

The manager told us and we saw in the entrance hall to the service they had a complaint and suggestions box and details of who visitors and people could approach if they needed to raise any concerns.

A complaints procedure was available, a log of complaints was made available although it did not detail any action taken, if the complaint was upheld and if lessons had been learned. Most people and relatives we spoke with knew how to make a complaint.

People were supported to access appropriate care and support services which best suited their needs.

Staff understood people’s right to equity in accessing care and support. Staff understood how to make referrals to other services in order to meet people's needs.

Health and social care professionals told us they were involved with the service and provided input into people's care and support, giving feedback and recommendations to staff to support their understanding of people's individual needs.

The provider had policies in place to ensure compliance with human rights requirements. This included consideration of the needs of people with different protected characteristics and how to make reasonable adjustments to ensure equity.

People were able to access services appropriate to their support needs. However, we found people’s individual needs were not always fully considered to ensure equity in their experience of care. For example, people did not have regular access to meaningful activities to ensure people experienced equally good outcomes.

Staff understood people’s human rights and their right to equality and the provider promoted access to appropriate healthcare to ensure people's physical and mental wellbeing was supported. However, we found the service did not always support people to fully engage with community activities and services which met their individual needs and preferences.

The provider had systems in place to identify changes in people's needs and liaised with other healthcare professionals such as the GP, speech and language team and community nursing team to ensure people had appropriate support in place when required.

Where people had chosen to discuss it, their end of life decisions were documented. Where health professionals had assessed people as requiring end of life care, records demonstrated if anticipatory medicines had been made available. However, this was not consistently recorded in care plans which varied in quality and detail. – the syringe driver had been taken out of use as it had not been serviced and not all nursing staff had been trained. This could have an impact on people that may not receive good quality end of life care.

The manager told us the frailty nurse from the local GP attended the service and spent time with people and their families in completing their Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices.

The provider considered people's future plans and end of life care wishes as part of their initial assessment and monitored these through their monthly review process.