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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

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 62 (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.

Managers and senior staff completed an assessment of people before they moved to the home. The assessment covered people’s physical, communication and social needs and explored any protected characteristics, as defined by the Equality Act 2010. This included any disabilities or cultural and spiritual needs. Assessments were used to formulate a basic plan of care which was reviewed and developed based on observations and feedback from staff, people and their relatives.

Whilst most people could not recall their care plans, relatives said they were involved in reviews. One relative told us, “We discussed [name’s] care plan a few months ago, there was a review as well.” Another relative said, “I’ve been involved in their care plan update. I’m always kept updated with their care.” One person explained, “They updated my care plan with me and my son.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, there was inconsistency in recording to demonstrate this was always in line with legislation and current evidence-based good practice and standards.

Where people were at risk of choking, records showed referrals had been made to the Speech and Language Therapy team (SALT). These therapists work to assess, diagnose, and provide interventions for people facing difficulties with speech, language, communication, and/or swallowing. However, information within people’s care records was not always accurately recorded. For example, 1 person’s nutrition and hydration plan contained conflicting information as it stated they were on an easy chew diet (known as level 7), but later within the same document stated, ‘snacks between meals to be pureed’ (known as level 4). Information within the kitchen stated the person was on a Level 6 soft diet. The registered manager told us “[Name] is supposed to be on a modified diet, we discussed it with SALT and [Name] doesn't want it, we allow them to do what they want at risk.” Whilst we found limited information within the person’s care records of discussions around food, staff were able to explain how they managed foods which may be a potential risk to the person. One staff member told us, “[Person] will ask for toast, however I would remove the crusts and cut into small pieces.”

People's nutritional requirements had been assessed and were reviewed monthly, and people were weighed and a malnutrition universal screening (MUST) score recorded. One person who had lost weight, had a MUST score of 2, however there was no guidance for staff what this score meant or actions they should take. The registered manager told us the person’s food was put on a blue plate and the person had started eating. Another staff member shared the person’s foods were fortified with butter and cream to support their increased calorie intake. The registered manager told us staff had recently received specialist training from dieticians to support their understanding of fortifying food, assisting people with modified diets and using thickened fluids to help prevent choking incidents.

People received a choice of meals and different options were offered when people did not want any of the choices. People were generally happy with the food and told us they were regularly offered drinks. Comments included: “The food is lovely. You choose it the night before and if you don’t like it, you can have something else” and “The food is always on time and hot.”

People received care, treatment and support that was evidence-based. We reviewed care records for 1 person with diabetes. Their care plan clearly detailed the indicators to show the person was experiencing a fluctuation in their blood sugar levels and the actions staff needed to take in response.

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.

Care staff were able to access information to understand people’s needs and their planned care through the electronic care planning system. Any changes in people’s needs were shared with staff during the handovers between shifts and through the electronic system.

Staff described good communication and teamwork to ensure people received the support they needed, when they needed it. One staff member told us, “Teamwork is very important, everybody has to work together." Another staff member commented, “Communication is spot on. When we come in, we get the handover. We assign tasks on strength. You must always be willing to ask for help and help is always available."

The GP had a weekly virtual ward round where any concerns about people were discussed. Following this meeting, the GP visited the service to review those people who needed to be seen in person. Staff spoke of a very good relationship with the GP with 1 staff member saying, “I have seen him with some of the residents. He will always get down to their level, he will hold their hand and reassure them." There was a system to ensure advice from GP ward rounds and district nurse visits was recorded, and where necessary, care plans updated to reflect the advice given. Records demonstrated relatives were kept up to date with any changes following healthcare professional visits.

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.

People told us they saw other healthcare professionals to maintain their health and support their sensory needs. One person told us, “The doctor is here every Thursday. I have had an eye test and seen the chiropodist.” Relatives confirmed people had been referred to other healthcare professionals as required. A relative commented, “The doctor is here to see [Name] a lot, he comes every week. [Name] has got new glasses, and I take them to the dentist.”

Lifestyle co-ordinators supported people’s emotional health and physical well-being. People were encouraged to take gentle exercise and spend time outside in the gardens. A member of staff described the importance of positive engagement explaining, “It is vital to keep their body active, to keep their mind going, for them to meet up with people from the other floors and join in activities together."

The provider 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. However, there was inconsistency in the detail in monitoring records.

Staff regularly reviewed people’s care records and risk assessments so they could escalate concerns to other health and social care professionals if a need was identified. However, improvements were needed in the oversight of daily monitoring charts to ensure timely action to promote positive outcomes for people. For example, monitoring charts in relation to dietary intake, bowel monitoring and catheter care had not always been completed in accordance with the provider’s expectations. Other monitoring charts in relation to fluid intake and social engagement were better maintained. Staff monitored people’s engagement in activities to ensure they remained relevant and people were being supported to attend activities that promoted positive outcomes for them.

The provider respected people’s rights when delivering care and treatment, however the documentation in relation to capacity assessments and best interest decisions needed to be improved.

People’s capacity to make their own decisions had been considered, but this had not always been recorded for each separate decision. Capacity assessments had limited information about how people had been supported to understand the decision to be made. Where a decision had been made in a person’s best interests, it was not always clear whether people who knew the person well, such as a relative or power of attorney had been involved.

However, we saw people were encouraged to make their own decisions and were offered choices about their care and treatment. People told us they could choose how they spent their day and felt able to share this with staff. Comments included: “I’m free to do whatever I want”, “I can get up when I like, and I can shower and dress myself” and “I’m fairly independent and can get up when I want and go to bed when I like.”

Staff could explain how to offer people choices based on people’s individual needs. One staff member told us, “It’s their (people’s) choice and it’s about respecting their decision as long as it causes no harm to them and if I was concerned, I would raise it higher.” Another staff member explained the importance of seeking consent and respecting people’s right to decline support. They told us, "We sit down and keep trying to encourage them. It might be because they are in a low mood, but they may then change their mind. We want them to have their freedom of choice, but we encourage them to make sure they are getting the best care at the end of the day." Where people with capacity had made decisions with risk, this had been respected.