Flora Innes House

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,treatmentand support achieved good outcomes and promoteda good qualityof life, based on best available evidence.At our last assessment we rated this key question Good.At this assessment we have ratedthis asOutstanding.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were assessed in an exceptionally thorough, holistic and person-centred way. Assessments explored every aspect of a person’s physical health, mental wellbeing, sensory needs, communication preferences, social relationships, life history and cultural needs. Care records showed staff took time to understand what mattered most to individuals, what they found difficult, and what helped them thrive. This ensured care plans were not only accurate, but deeply reflective of each person’s identity ,preferences and goals.

The provider also assessed, and took into consideration, the physical environment people lived in to ensure their home was safe, suitable and capable of meeting their assessed needs. This included environmental assessments focusing on accessibility, sensory comfort, and layout. An example of this was making sure the garden was large enough for the people living there to be able to socialise and spend time together if they wished to. Each person had an area in the garden where they could grow plants or flowers. Some people used these as memorial spaces for people they loved who had died.

When 2 people in the home had a change of needs, the provider worked sensitively with them and their family to identify alternative rooms in the home that better supported their independence, comfort and future needs.

Assessments were carried out by staff with the right specialist skills and knowledge, including training in sensory profiling, communication strategies, positive behaviour support and mental health. Staff demonstrated strong insight and the ability to recognise subtle changes in people that might indicate shifts in health, behaviour or emotional wellbeing.

Assessments were regularly reviewed and updated to keep information current and ensure care, support and treatment continued to meet people’s needs and outcomes as expected. Reviews involved the person, their relatives and relevant professionals to ensure a full, shared understanding of any changes. Adjustments to support were made swiftly and appropriately.

Staff kept clear, detailed and person-centred records, which supported ongoing reviews and ensured continuity of care. These records provided strong evidence of appropriate communication and timely action when changes were noted in people’s needs, health or wellbeing. Staff documented observations thoroughly, including what had changed, what actions had been taken, which professionals had been contacted and the outcome of this communication. This ensured emerging concerns were never missed and that responses were swift, proportionate and well-coordinated.

There was clear leadership oversight of assessments, records and any actions taken in response to changes. Managers regularly audited care documentation, reviewed assessment outcomes, and held reflective discussions with staff to maintain high standards and ensure consistency across the team. This strong oversight contributed significantly to the safety, effectiveness and responsiveness of the service.

Staff used accessible formats such as easy read documents, photos, symbols and objects of reference, to help people understand and contribute to their assessments and reviews as much as possible.

One external stakeholder told us, "They tailor activities and community visits to suit individuals’ preferences and choice, which is always nice to see, as well as joint activities withing the home, and joint community adventures.”

This assessment process ensured people consistently received the right support, at the right time, delivered in a way that respected their individuality and maximised independence, wellbeing and quality of life.

People received care and support that was grounded in recognised, evidence-based practice. If needed, staff could use Positive Behaviour Support (PBS) approaches, to understand the reasons behind people’s distress and emotions and to promote proactive, personalised strategies rather than reactive interventions.
We saw staff following guidance provided by external professionals. One of the health professionals said “I have recent experience of implementing recommendations in this home and staff have been observed following these at reviews and seeking further support as needed”
Staff applied guidance, including communication passports, visual timetables and objects of reference, to ensure people could express their needs and make informed choices.
Health needs were addressed and recorded, and staff supported people to access regular health checks, and monitoring. When people’s needs changed, the service requested timely input from external professionals and incorporated their recommendations into everyday support. This consistent use of proven approaches meant people benefited from care that was safe, effective and tailored to their individual needs.
 

Staff, teams and external services worked together in a coordinated and proactive way to ensure people received seamless, well-informed support.

Communication between staff was observed to be good, with consistent handovers, detailed daily records and reflective team discussions ensuring everyone understood people’s needs, routines and any changes in their wellbeing.

Staff worked collaboratively with health and social care professionals, including learning disability nurses, pharmacists, GPs and speech and language therapists, to ensure people’s support was built on shared expertise and up to date clinical advice.

Staff across the team demonstrated a unified approach, using shared tools such as communication passports ,and support strategies so people experienced consistent, reassuring care. One member of staff told us they used communication tablets and these “help residents communicate their needs effectively with staff”.

This coordinated team approach meant people benefited from the right support at the right time, delivered confidently by a staff team who understood their needs, worked together exceptionally well, and were flexible when needed.

Staff excelled at supporting people to live healthier, more fulfilling lives by promoting wellbeing in ways that were proactive, personalised and fully aligned with each person’s assessed needs and goals.

Staff demonstrated an exceptional understanding of people’s physical and mental health conditions, and they worked closely with individuals to identify lifestyle choices and daily routines that would help them stay well. This included indoor and outdoor activities and learning to cook healthy meals independently with somebody who had been dependent before. Staff told us they had enough time to support people well, and their rotas were always considered if more support was needed e.g.to access a health appointment.

Staff were aware of potential health inequalities and strived to reduce these. People were supported to access regular health checks and specialist assessments, ensuring their health needs were consistently monitored and met. Staff used easy read information, visual prompts and personalised communication tools to help people understand their health, make informed decisions and take an active role in managing their wellbeing.

The service built strong partnerships with healthcare professionals, including GPs, learning disability nurses, and Speech and Language therapists. These relationships ensured people’s health plans were based on expert advice and best practice. We saw clear evidence of staff implementing strategies recommended by professionals, such as specific eating guidance. Staff took timely action when concerns arose, ensuring people received early intervention and avoiding deterioration wherever possible.

Staff encouraged positive routines such as regular trips out ,and opportunities for physical activity. Where people experienced anxiety, sensory overload or health related barriers, staff used personalised strategies including desensitisation techniques to support them which included role playing to the GP surgery. The manager understood the different needs people had with accessing health appointments. Some people they knew it was best to say in advance and some people to know on the day. The manager told us, “We have options for the health professionals to come to us at the home to reduce anxiety.”

The provider supported a person having an examination recommended by Public Health. The manager advised us, “They spoke a lot about the procedure and used easy read booklets to help her understanding.”

We saw that all staff complete annual training on oral care. The manager advised us they worked very closely with the dental practitioners to make sure people are receiving the oral care they need. Because of this the dental surgery offered sessions to help to teach people the correct ways of brushing their teeth. All residents receive regular check- ups with their dental practitioners and we were able to see the dates of these.

This person-centred approach meant people were not only healthier, but also more engaged and more in control of their own wellbeing. The provider was deeply committed to supporting people to live healthier lives.

The service demonstrated an exceptional commitment to monitoring people’s progress and continuously improving outcomes in ways that were proactive, and personalised.
There was a focus on maintaining or improving people's quality of life. We saw care records which evidenced people had been supported to learn to read and write, to look for employment, learn how to travel alone to relatives, and increase social engagement. One relative told us, “In the past it was difficult to get (relative) to do things, they (staff) have helped them to start to mix. I don’t know how they did it.” A person told us, “I can cook now and cook for the other people here”. We observed people to be proud of their achievements with their independence.
Staff closely monitored people’s health, wellbeing, behavioural patterns and quality of life indicators, using detailed daily records, review notes and professional guidance to identify even subtle changes in need. This meant early intervention was routine rather than reactive. An external health care provider advised us that, “The efficiency and professionalism in promptly sending blood test results via email whenever requested, has greatly supported clinical decision-making.”
Outcomes were regularly reviewed with the person, their relatives and relevant professionals, ensuring plans remained current, and meaningful. People could make requests about their care in several ways for example, weekly and monthly meetings with their key workers. People had their own meeting without staff approximately every 3 months. The manager and staff would then start to research and plan for what had been requested. We saw examples of this where people had requested to go somewhere on holiday. They were supported to save money for this and then staff took them. This was an overseas holiday, and the service were committed to helping people with their individual requests.
Managers had robust oversight of outcomes and used data, reviews and learning from incidents to improve practice across the service. Staff told us they felt confident raising concerns or suggesting improvements, and we saw clear evidence of leaders acting on feedback.
Staff understood the need and reasons for monitoring of nutritional and fluid intake for those who needed it. They told us, “This is important so staff can monitor changes, identify concerns early and ensure the resident stays healthy.” However, they also understood that these checks did not need to be carried out routinely but only as needed and it had been explained to the person.
People benefited from support that was continually monitored, reviewed and improved in ways that directly enhanced their safety and overall quality of life.
 

People were supported to give informed consent to their care and treatment in ways that respected their individual communication needs and levels of understanding. Staff understood that people had a right to refuse care and knew how to respond to this if needed. One member of staff gave us an example that somebody might refuse food that had been prepared, so they would ask if they would like something else instead. We were further assured that staff would escalate any concerns they might have to the managers.

Staff had a clear and confident knowledge of the Mental Capacity Act (MCA) and applied its principles consistently throughout daily support. We observed staff using a range of accessible tools -such as easy‑read picture guides to explain medicines, visual timetables to discuss plans for the day, and objects of reference to help people choose activities or places to visit.

When decisions were more complex, such as attending health appointments or agreeing to treatment, staff took extra time to explain options using photos, symbols and step-by-step breakdowns.

Care records showed detailed notes of consent discussions, demonstrating that people’s choices, rights and wishes were respected at every stage. This ensured care was lawful, respectful and tailored to the needs of people being supported.