Heartly Green

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 changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s support plans were not always person-centred or contained sufficient detail for staff on how to meet their needs. The provider was aware of shortfalls in this area and was reviewing care plans to ensure they were fully person-centred as part of their service improvement plan in conjunction with the local authority.

People and their relatives had been involved in planning their care following admission to the service.

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 manager used nationally recognised tools to assess people’s needs. Outcomes from these assessments were used to inform care plans. For example, assessments identified people who were at risk of falls, choking or malnutrition.

The provider did not always work well across teams and services to support people.The provider could demonstrate they contacted professionals when there were changes in people’s health, but this was not always consistent across all units. Communication and outcomes were not always effectively recorded, which meant they could not always be effectively monitored or followed up.

One person had been placed in the home a month before our inspection on an emergency placement. Whilst the home were supporting the person to the best of their ability, this was difficult due to the limited information shared by commissioners and the delays in contacting social care professionals who had arranged the placement.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We spent time on all 4 units during this assessment and found some managed mealtimes better than others. A lunchtime service felt rushed on 1 unit; staff removed a jacket potato which hadn’t been eaten and the person wasn't asked if they wanted an alternative meal. Consent wasn’t always sought regarding whether people had finished. One person was able to voice that a drink hadn't been finished with, whereas not everyone was able to do this. Feedback about meals was mixed. The main meal was served at lunch time, and we noted lots of food waste on units. We provided feedback to the manager about this.

People were supported to access their GP, optician and chiropodist. Feedback from people and relatives was positive regarding this being accessible for them when required. A relative told us how the manager had acted promptly in relation to a person’s weight loss. There was a referral to the dietician and meals were fortified immediately.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Feedback we received from people indicated the service worked in partnership with external agencies. However, we found the care plans and risk assessments for people had not always been updated following a review or advice from professionals. This meant people were potentially at risk of having unmet needs.

We found a lack of consistency in the activities available for people during the inspection. In the main, people were observed to be seated in the communal lounge for extended periods of time with a lack of interaction with staff, as they were busy supporting people with personal care.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Where there were concerns about people’s capacity to make a specific decision at a specific time, we saw mental capacity assessments were not always completed within electronic care plans; record keeping in relation to best interest decisions was also limited. We identified the use of a specialised chair for one person to reduce the risk of falls. It wasn’t clear what other options had been considered in this best interest decision. However, the person had not had a fall for over 5 months.

We observed people who were deemed not to have capacity being restricted with the use of equipment that limited their movement, such as lap tables and reclining chairs. It wasn’t always clear from electronic care records that these were the least restrictive options, or that other options had been considered.

The provider had processes to obtain consent in line with legislation and guidance. We observed staff asking people for consent before supporting people with care and support. A relative with Lasting Power of Attorney told us they were fully consulted and involved and said, “We have that kind of relationship.”