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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 75 (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’s needs were assessed before they started using the service. These assessments documented the support required, including with personal care, medicines, communication, diet and nutrition. The information gathered informed personalised care plans and risk assessments. People, their relatives, and relevant health and social care professionals contributed to discussions so that individual needs and preferences were considered and met. Care plans and risk assessments were reviewed regularly to keep them current and aligned with people’s changing needs.

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.

Recognised assessment and monitoring tools were used appropriately to identify improvements and concerns and were integrated into the care planning system. The management team maintained oversight and planned appropriate action with input from relatives and staff. The service also worked with external professionals, including tissue viability services and speech and language therapists (SaLT).

Staff received training aligned with current good practice guidance. They described working with GPs, social workers, and other health and social care professionals to make appropriate referrals and implement recommendations. People’s ability to eat safely and maintain a healthy weight was assessed and monitored, with action taken where required. Staff understood people’s dietary needs, which were clearly documented and updated so changes were communicated. Healthcare professionals were consulted when diets needed to be adapted. Kitchen information detailed the drinks, meals, and snacks required to meet individual needs, while food and fluid charts enabled staff to monitor intake and support people who had difficulty eating or drinking. The chef understood people’s preferences and the specialist diets needed to support their health.

We found evidence that infections, weight changes, and falls were analysed monthly, with records detailing the action taken and referrals made to appropriate health professionals.

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.

People and their relatives said they were supported to access healthcare professionals when needed. Staff told us that, where required, people were supported to attend appointments with professionals including the diabetes team, occupational therapists and the tissue viability team.

Professionals visited weekly to review people’s healthcare needs. Staff found these visits helpful in securing support for people living at the service.

Managers and staff worked collaboratively with other services and professionals to ensure people received timely, effective care. The service maintained positive relationships with external professionals, including district nurses and dementia specialists.

One professional described the service positively and said, “Staff are knowledgeable, and caring towards their residents and it is a welcoming environment, with lots of activities taking place to keep the residents entertained, if I could suggest one thing, I would say trips out would be appreciated.”

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 understood people’s health needs and how to support healthier lives, although this was not always clear in care plans, for example, guidance on reducing smoking and alcohol. Staff however could explain the support they provided and confirmed doctors were involved.

Processes guided staff to support healthier lives. People were encouraged to eat well, drink regularly, remain active and join activities. Care records showed regular reviews and input from GPs, opticians, dieticians, dentists and chiropodists.

People had access to a wide range of nutritious foods. The chef also told us of fresh fruit, snacks and fortified drinks offered throughout the day. Peoples’ weight was monitored and if weight loss or weight gain was identified, the GP and dieticians were consulted and advice sought. Staff encouraged independence and mobility. One person said, “Staff do encourage me to do things and also help me when I can’t manage,” and “They help me keep active, I went for a walk today and another is planned for the weekend.”

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.

Established processes gave the registered manager effective oversight of people’s care and support. Care plans were reviewed monthly, or sooner when people’s needs changed, so staff had current information and could provide effective care.

The electronic care system enabled required updates to be made promptly, helping staff access accurate information without delay. People and their relatives were involved in care planning, and people were supported to maintain their independence.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were encouraged to make decisions about their daily lives. They could choose when to bathe or shower, what food and drink they wanted throughout each day, what clothes to wear and where they wanted to spend their time around the home. In relation to personal care, one person told us they could shower any time.”

Where people had been assessed as not having capacity to make specific decisions this was clearly documented. When this was the case consent was sought from the person with legal authority to consent on a person’s behalf. This was clearly recorded in individual care plans.

The service worked with partner agencies where necessary to ensure people’s rights under the Mental Capacity Act 2005. Staff we spoke to understood, the key principles of this legislation and worked in people’s best interests when providing care and treatment.