Garland 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 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 83 (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 support was effective by assessing and reviewing their health, support, wellbeing and communication needs with them.

There were effective processes to understand people’s needs and wishes before they were offered a service. People’s health, social and emotional needs were assessed before they moved to the service. This included information about how people communicated their needs, their specific medical conditions and how they liked to spend their time. These assessments were used to develop the person’s care plans, associated risk assessments and make the decisions about the staff skills needed to support them.

Relatives told us they were involved in people’s assessments. People’s support plans were kept under review. One relative told us, “He went there for respite and he chose to stay”.

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. They worked to develop evidence-based good practice and standards.

There was a strong focus in developing staff skills and knowledge to ensure evidence-based practice was delivered by the staff team. This was successfully achieved by assigning lead roles to staff which related to people’s assessed needs. Each staff member had received additional training in the area assigned to them and shared their knowledge with the staff team. For example, the diabetes champion had achieved a level 3 certificate in understanding the care and management of diabetes. As a champion, they were the designated person staff went to if they had any queries about diabetes management. They were also responsible for ensuring the diabetic box was stocked and items were in date. The end-of-life champion had undertaken training with the hospice team. A professional from the hospice team told us, “Staff say just come whenever, you don’t need to make an appointment. I don’t worry about my patients as they are well looked after. I genuinely love coming here”.

The provider had recognised that providing training to staff in short, bite sized sessions was a more effective way of upskilling the staff team. They ran a series of short training sessions for a small number of staff or the whole staff team. Over the last 3 months this had included updates from the infection control champion, oral health and the national early warning tool (NEWS2). NEWS2 is a clinical tool to assess the severity of people’s illness and risk of deterioration.

A person told us they had trained staff about their epilepsy and how it felt to them. They told us, “I spoke to staff about it. I was not afraid. I did it over 2 days. I think it helped staff. X (staff member) helped me about what to talk about”.

The provider worked in line with the principles of our Right Care, Right Support, and Right Culture guidance which apply to people with a learning disability or autism. People’s support plans included person centred goals they wished to achieve and how they would be supported to achieve these.

The provider worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

All health and social care professionals gave extremely positive feedback about their working relationship with the service. The service had also received several direct compliments from additional health and social care professionals. Health professionals told us that staff kept detailed, up to date notes of people’s health needs which were easily accessible. Comments from health care professional included, “They have really good oversight of our patients. Without having to refer to notes, they know who people are”; and” Garland House often prompt me to do referrals if they feel it is needed for their resident."

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

The service had received complimentary feedback from a range of health care professionals about how they supported people with their health and medical needs. One comment received was, ‘You know your residents really well. ‘Top tier’ with staff more knowledgeable about people’s medical needs which is surprising as some nursing facilities aren’t like this and your residential! Top notch care!’

Relatives and health professionals who fed back to us concurred that the service was particularly skilled in identifying changes in people’s health and wellbeing. They said the service was proactive in referring people to other health professionals in order to maintain and improve their health. Comments from health professionals included, “Even though they are not a nursing home, they seem to escalate at the right time”; “They have a good understanding of what their residents' medical issues are, and their mood. They also often bring up queries to me, from their residents' relatives”; “The management of the Garland House is very efficient in communication and proactive. The manager showed proactivity by taking their own initiative to arrange a relevant training session”; and “I have no worries about the health care here. They absolutely follow any recommendations.”

The service was proactive in ensuring that people with the risk of skin deterioration were supported to maintain healthy skin. Staff had worked in collaboration with the district nurse to research alternative treatments for a person who had a skin condition. The service bought a red-light therapy lamp and treated the person under the direction of the district nurse. As a result, the patch on the person’s skin improved. The district nurse complimented the service on their care and knowledge and proactivity in achieving something, ‘I do not see very often as this wound is very difficult to heal at this stage’. “Another health care professional had complimented the service saying, ‘I have never been to a care home where resident’s skin is so glowing, and people are hydrated. Keep doing what you’re doing. These residents are thriving here. You’re doing an amazing job.’

People were encouraged to eat healthily and the menu included a range of vegetables and home cooked food. Drinks and fruit were available for people to help themselves in the lounge. The activity programme included exercises to keep people physically active and staff supported people with any exercises recommended by health care professionals. The importance of exercise had been discussed with people during a residents meeting.

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

The provider had a holistic approach to monitoring people’s care and treatment which focused on what was important to people. They had introduced a ‘Golden nugget’ scheme whereby people and staff could complement one another for things that had improved people’s quality of life. A person had complimented a staff member for their cooking skill: ‘The bread and butter pudding X (staff member) made was absolutely delicious. He is a kind, friendly, helpful lad, but chooses the wrong football team to follow!’ Staff were encouraged to recognise the small little things that were meaningful to people and to share them with the staff team. The positive things staff had shared in the last 3 months included, ‘She had a lovely soak in the bath this evening after lots of prompts and encouragement. She described it as annoying at first, but she liked the fact I was persistent! Overall, what a win’; She has been fully engaged with helping with housework which she had asked to help with. She enjoyed puffing up the chair cushions followed with tea and biscuits and a chat’; and ‘X (resident) feel like her hearing aids are really making a difference! So pleased!’

People and their relatives told us the service was extremely effective in monitoring people’s health and well-being. In the section entitled, ‘monitoring and improving outcomes’ in the provider’s survey, a person had commented, ‘I really feel that some of the staff saved me when I moved into Garland House. They really helped me when I was at my lowest and will forever be grateful.’ A relative told us that staff were very quick at picking up on changes in their family member’s presentation. They explained that their family member had been diagnoses with Alzheimer’s and that staff noticed things about them that were of concern, such as forgetting important things. This relative told us, “It has been a collaboration between me and the home for their care, and it is working as they are really helpful and are checking on him."

Staff understood the importance of gaining people’s consent and respected this when delivering person-centred care and treatment.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

We found that staff had been trained in the principles of MCA. One of the deputy managers had received additional training in MCA and DoLS and was responsible for reviewing all related documentation. We observed staff gained people’s consent before offering any support or assistance such as helping them to mobilise or eat. Staff understood that people were assumed to have capacity but sometimes this fluctuated throughout the day. They told us that if people did not consent to support with their care, they respected their wishes and returned later to see if they could gain their consent.

The service managed DoLS by making and monitoring applications and were aware that no one had any associated conditions. Mental capacity assessments included specific decisions about whether people could understand, retain and weigh up the information and communicate their decision.