Ancasta Grove

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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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People were assessed face to face prior to moving to the service. The registered manager told us this enabled them to assess if they were able to meet people’s needs. Care plans were reviewed at least monthly or when people’s care needs changed. One staff member said, “I have seen that whenever someone’s needs change, the nurses assess it and discuss it with families. A couple of our residents used to live on the residential floor, but now they have moved to the nursing floor because their needs changed.” People’s oral health and eye health needs were met, with support from visiting health professionals.

People’s relatives told us they were involved in the assessment process and the care review process. One person’s relative said, “They assessed [name] before [they] moved in. It was a very smooth process. They are very much aware of [name’s] needs.” People’s relatives told us they had been provided with a copy of care plans and were contacted and involved in any discussions regarding care. They told us this source of communication was appreciated.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider used nationally recognised tools to assess and monitor people’s needs and risks, including the risk of malnutrition and skin damage. Staff understood the importance of good nutrition and fluid intake for people, and people were supported with this where required. People’s relatives told us they were aware that staff monitored people’s weight. One relative said, “[Name] has been losing weight so the staff often give [name] high protein milkshakes to build their weight back up.” Kitchen staff told us they were kept informed about people’s dietary needs and preferences. One staff member said, “As a standard, every Monday we have the diet notification sheets re-distributed to the dining room, we have a whiteboard on the kitchen for all staff to see people’s needs and dislikes. On top of that if we have a new resident moving in, then it’s reprinted or if anything changes then we get an email from the nurses updating us. It’s something I’m quite hot on.”

Minutes of clinical meetings showed that there was good oversight of weight loss and malnutrition risks across the service. One staff member said, “We have clinical meetings every week and we discuss wounds, weight loss and action plans. The head chef usually attends for the weight loss section of the meeting so that they are kept up to date with people who need fortified foods and snacks and milkshakes. We do monthly weight checks, or more frequently depending on people’s individual risk.”

We observed lunch during the inspection. It was a sociable experience with people encouraged to eat with others in the dining rooms. In the main, people told us they enjoyed the food. One person said, “There is a good choice of food here. You can find food to eat if you’re hungry between meals.” We saw “snack stations” placed around the building. Records showed people were supported to have enough to eat and drink. Staff told us they monitored people’s fluid intake throughout the day so that action could be taken if people hadn’t had enough to drink.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider worked with a range of health professionals, including the local surgery advanced nurse practitioner, the Speech and Language Therapy (SALT) team, and the Tissue Viability Nurse (TVN), to support people’s care and treatment. Referrals were made when needed, and staff followed up on actions agreed with external professionals.

Staff worked well together to share information and plan care. They told us they had easy access to care plans, which helped them provide consistent support. Staff said communication within the team was “very good” and that information about people’s needs was shared promptly. One staff member said, “When new people move in, we are given a proper description of what their needs are, such as the person’s mobility, food and fluid needs. The management team share the pre-admission assessment with us. When the resident moves in we get another update at the handover so if there are any changes we are updated with the information.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff monitored people’s health and escalated concerns appropriately. Exercise classes were available for people to attend if they chose to, in order to promote strength and mobility. Staff we spoke with had a good understanding of people’s health needs. For example, they knew which people had diabetes and were aware of the signs and symptoms of low blood sugar and the steps to take if this happened. Some people had health conditions which affected their movement and again, staff demonstrated good knowledge on what to do during periods of poor mobility or stiffness.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Systems and processes were in place to monitor clinical care outcomes and support ongoing improvement. There was oversight of people’s needs in place. Records showed that wounds, weight loss and falls for example were monitored and analysed. Records showed that staff worked closely with external professionals to improve outcomes for people. This included a range of professionals including nurse practitioners, specialist nurses, opticians and dentists.

Although mental capacity assessments had been carried out, they were not consistently decision specific and best interest decision making records did not always describe in detail how decisions had been reached, or what, if any, less restrictive options had been considered. Despite this, other records were completed in line with legislation and guidance. We fed this back to the management team who advised us this was a known area for improvement and that work had begun to review all records.

During the inspection we observed staff asking people’s consent before supporting them. We saw that staff routinely knocked on bedroom doors for example, and we saw people being asked, “How can I help you?” One person’s relative told us, “The staff always knock and explain what they want to do and ask if it is OK.”

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 2005 (MCA). In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). 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. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The registered manager kept a record and tracker of DoLS applications and authorisations.