Betsy Clara Nursing Home

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. However, the service was in breach of legal regulation in relation to consent to care and treatment.

This service scored 67 (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 had their needs assessed before moving to the service. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person. The assessment included making sure that support was planned for people’s diversity needs, such as their religion, gender, marital status, culture and their abilities.

Assessments included information about what people could do for themselves. Each person’s care plan and assessments were also reassessed once a month as part of the ‘resident of the day’ process. This ensures that every person’s care plan and risk assessment is updated at least monthly. However, some assessments and care plans had not always been reassessed in line with changes to people’s health. For example, a person’s care plan showed they were at the end of their life, which was based on their health at the time of admission. However, the person was no longer at the end of their life, and they had made improvements since living at the service. Some people were able to recall being involved in their assessments and care planning process and some people told us they had not been involved. A relative said, “I met with the home manager to discuss [person’s] care plan.”

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.

We carried out observations at mealtimes. The food looked appealing and smelt appetising. Staff were seen to be attentive in the dining area and lounge. We observed staff showing people plated up options of food to help them make an informed choice. Staff explained that for some people a large plate, even with a small portion of food, could be overwhelming so they would put the food on a small plate to encourage them to eat. Small portion sizes were given to those that were reluctant to eat or had a small appetite.

The food was served from a hot trolley in the main dining area first and then was taken to 2 other areas in the service for people who were eating in those areas. We did see that some hot puddings had been sent to the other areas ahead of the food trolley and were covered in tin foil. This was not sufficient to keep them hot. We checked and they were cold to the touch. We discussed this with kitchen staff who agreed this process needed to be changed.

Care plans and risk assessments clearly described what modified diet people were prescribed and the care plans followed The International Dysphagia Diet Standardisation Initiative (IDDSI) framework. The guidance was also available in the kitchen for staff responsible for preparing, cooking and serving meals. Kitchen staff and those responsible for supporting people with their food had a good understanding of people’s assessed needs in relation to type and texture of food as well as any allergies and food intolerances. Staff told us they helped people to make their meal choices if they needed it.

We received mixed feedback about the food. Comments included, “I like yoghurt, and fish”; “If you don’t like the choice of meal here, you get a quarter of a sandwich instead (we observed people being offered other hot meals if they did not want what was on the menu)” and “They bring me something to eat.”

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. The provider had a clear process in place to escalate health concerns within a timely manner. People’s care plans included hospital passports. Staff worked with health professionals to ensure people got the care and support they needed. A health professional told us, “If there are problems or concerns then [the deputy manager or registered manager] will email. Sometimes we are not informed if the patient is deemed to be EOL (end of life) and put onto a EOL pathway. This is now improving.” They also told us, “Sadly there are so many people with worsening dementia and Pathway3 (Pathway 3 offers an assessment period in a temporary placement within a care home) are struggling to place them in a local environment. [The registered manager] has often tried to help these people and will accept them if she has capacity to do so. She has changed the sitting rooms around to support the residents.”

The registered manager and nurses told us, they worked with the local hospice when people were at end of life, to seek advice and support. Nursing staff and other staff told us there were good links with other health professionals such as SaLT (Speech and Language Therapy), physiotherapy, the GP, TVN (Tissue Viability nurse). Trained nurses within the service reviewed and updated people’s clinical records daily if they required nursing care. People told us staff worked with GP’s and health professionals to meet their health needs. A person said, “I see a doctor but not very often.” Relatives said, “[Person] has seen a GP and had a Covid vaccination” and “I assume my wife still sees a GP when I am not there.”

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 were supported with their healthcare. People said, “I have seen a GP at the home” and “I’ve been to hospital. I’ve two bad toes and needed antibiotics. They went with me.” The GP carried out a weekly visit to the service. People living at the service had access to onsite nurses employed by the provider and other health care professionals, for example, the community mental health team, chiropody, dietician, dentists and SALT (Speech and language therapists). The registered manager said, “We have just received a letter from the dentist advising they will be no longer coming. We have supported some people to go out to dentists, some have refused. We did have the dentist coming regularly.” Visiting was encouraged and people were supported to attend medical appointments. We observed 1 person was supported by their relatives to attend a hospital appointment during the assessment. Staff had a good understanding of meeting people’s changing needs. A staff member told us, “I would keep them safe, remove dangerous objects, and protect their head, if they had a seizure.” Another staff member said, “I would escalate concerns appropriately to nurses/management.”

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.

Staff worked together as a team to support people and to ensure people received their care and support in the way they chose. We observed that staff had recognised a person had become nonresponsive. They pressed the emergency buzzer and nursing staff, the deputy manager, registered manager and the clinical lead attended the area. Collectively they worked to carry out checks such as blood sugar levels, blood pressure and pulse. As this had happened in a communal area a privacy screen was brought in. Staff supported the person to transfer from the chair they were in into a wheelchair so they could take them to their room for further checks and await further medical treatment. The whole time they were trying to rouse them and explaining to them what they were doing. The GP was contacted and nursing staff continued to monitor the person. The registered manager advised us this person had previously had similar episodes and was now moving forward on an end of life pathway.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. We checked whether the service was working within the principles of the Mental Capacity Act (MCA), whether appropriate legal authorisations were in place when needed to deprive a person of their liberty. The service did not always work within the principles of the MCA. When people were assessed as lacking capacity to make decisions, appropriate procedures were not always followed to ensure principles within the MCA were followed. The assessments were not decision specific. Decisions were not always appropriately documented to demonstrate who had been involved in the decision. We discussed this with the management team; they acknowledged the shortfalls within the MCA assessments and the potential impact on people’s rights. They said they would review and update all the capacity assessments in accordance with the MCA.

Deprivation of Liberty Safeguards (DoLS) applications and authorisations were in place for people around any restrictions within their lives that they did not have capacity to consent to. Systems to review these were also in place.

A health and social care professional said, “I have been involved in DOLS assessments at Betsy Clara Care Home for almost 2 years. I have had new assessments, and I have also had assessments that required further authorisation. I have observed that the care home acts on any conditions given to them in the previous DOLS authorisation and are able to evidence that the condition/s have been met during further authorisation assessment.”

Care was person centred. We observed people being offered choices throughout the day and people told us they felt listened to and their views and opinions were important to staff. A person said, “They’re very good to me. They listen to what I like.” Relatives told us people made choices about what they wanted to do and whether to be involved in activities.