Gingercroft Residential Home

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• 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 did not assess all quality statements within effective at this assessment. The rating from the previous inspection has been partially used to rate this key question. At this assessment, there was mixed feedback about the food, some people were positive, but others felt there was not always enough choice. We observed 1 person who did not have a meal that was fully inline with their dietary advice, although they did not come to harm as a result of this. Another person had a choking incident recorded, but there was a lack of evidence action had been taken in response to this. People were supported to make decisions and staff understood what mental capacity meant. However, improvements were needed in the assessing of people’s capacity and in ensuring all restrictions had been considered and included in assessments and in referrals to others.

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.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

There was mixed feedback about the food. One relative said, “I don’t think they offer enough choice around food.” Whereas a person told us, “The food is very good.” We saw people had access to regular drinks throughout the day, particularly due to the warm weather. However, we observed 1 person had a meal that was not fully in line with their dietary advice. The person’s meat was cut into small bite-sized pieces; however, their green beans were not cut up and were longer than the recommended size as advised in the ‘International Dysphagia Diet Standardisation Initiative’ (IDDSI). IDDSI is a standardised approach and used by Speech and Language Therapists to advise the consistency food and drinks people are safe to eat, dependent on someone’s needs. This could put the person at risk. Staff had recorded in handover records one person had a choking episode. The person had not come to harm as a result of this. However, there was no reference in their professionals records this had been referred for health professional input and it was not clear what action had been taken in response to this. This meant the person could be left at risk.

Staff were aware of people’s dietary needs and knew who was at risk of choking. However, as we observed 1 person not having their meal in line with guidance, we could not be sure people would always be supported appropriately.

One person had a care plan in place about their diet and fluid needs. This stated their food needed cutting up into small pieces. However, the ‘diet notification’ document, which is what gets shared with the catering staff, did not contain the same level of detail. A handover record for 1 person stated they had a choking episode, but this had not ensured action was taken to reduce the ongoing risk to the person. Therefore, there was a risk staff may not be aware of this. As we observed and records did not confirm people were always being protected, we could not be sure people would always be kept safe.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

One person said, “Staff help me think about what to do.” Staff interacted with people in a kind manner and asked their opinion – such as whether they wanted to be involved in activities – and their choice was respected.

Staff were able to tell us about capacity and how they supported people to continue to make their own decisions.

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 take particular 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 MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. We saw DoLS applications had been made. People had mental capacity assessments in place, however these did not always consider all decisions about restrictions. For example, one person had bed rails in place which would restrict them being able to get out of bed. There was no assessment about this decision, and this had not been included as a restriction in the person’s DoLS application. Following our feedback, the registered manager completed an assessment and we saw evidence of this. However, this updated assessment said the bed rails were in the approved DoLS, however they were not referenced. Therefore, this restriction could not have been authorised if it was not included in the application. We saw relatives or other specified people had their legal right to make decisions on behalf of people checked to ensure the correct authorisations were in place.