OSJCT Chestnut Court

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.

The last time we rated this key question we rated it 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.

The provider had systems to assess people’s health and care needs and planned care which would meet these needs. These systems contained assessment tools and care plans which suitably trained staff completed.

People’s needs were assessed before admission which helped staff determine if the service could meet the person’s needs. Following admission, health and care assessments were used to develop care plans. These gave staff guidance on how to meet people’s assessed needs.

Care records we reviewed showed people’s risk assessments had been regularly reviewed along with the associated care plans. In one person’s case we found the care plan did not fully reflect the person’s updated mobility risk assessment. This was rectified immediately by the deputy manager during this assessment. The service’s monitoring processes had already identified a need to improve the auditing of care plans to ensure they remained updated; this was work in progress.

Relatives told us they had been involved in discussions about their family member’s care. A relative said, “We were (involved in discussions) when she first moved in and if anything changes, we talk about it.”

People could not tell us if staff had discussions with them about their care plans, but they told us staff were aware of their needs and met these as they wanted them met. One person said, “The staff have a good understanding of my needs and helped me a lot when I first came here from hospital.”

Information in people’s care plans give staff guidance on communicating with people and how people communicated their 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.

The provider’s systems provided staff with assessments and care plans which aligned with national standards, evidence-based practice and guidance. These were widely recognised by health and social care professionals, which meant when they accessed people’s records, they could understand the information provided.

The Waterlow Pressure Area Risk Assessment was used to identify pressure ulcer risks, and the Malnutrition Universal Screening Tool (MUST) was used to monitor risks associated with malnutrition or obesity. Staff were trained to use these tools, and the outcome of these assessments determined the care required.

People with swallowing concerns had their risk of choking assessed, and in some cases, this resulted in alterations to the texture of their food and drink. The required alterations were made in line with the International Dysphagia Diet Standardisation Initiative (IDDSI) guidance. Care and kitchen staff were trained to understand how people’s food and drink needed to be prepared in line with this guidance. People were also referred for assessment by a speech and language therapist.

Some people’s care followed a specific pathway, a structured plan of care for a specific health condition. The pathway was known and understood by the professionals involved and supported a consistent and evidence-based approach to a person’s care. This was the case for 1 person whose health needs required the support of specialist health professionals. This approach was also used for people who lived with dementia.

The provider’s Admiral Nurses (specialists in dementia care) were involved in planning and monitoring the care of people who lived with dementia, to ensure the care adopted was person led, and evidence based.

The provider worked well across teams and services to support people. They shared the information they held about people’s health and care needs appropriately, including when people moved between different services.

There were arrangements to ensure staff and relevant professionals could access the information they needed to effectively assess and support people’s health and care needs. This included quick access to electronic care records and verbal updates when required. Staff told us they were confident about being able to access this information as they needed it and felt well informed about changes to people’s health and care needs.

We observed collaborative working between staff to meet people’s needs. There was good communication between the care staff and the kitchen staff, so people’s dietary needs were met.

Housekeeping and activities staff also knew people and were alert to changes in their demeanour or behaviour and reported these to care staff and nurses so these could be assessed and addressed.

People’s care records showed staff liaised with and worked with numerous health and social care professionals to meet people’s needs. The service was supported by a GP practice who provided planned weekly visits to review people’s health needs. One person told us they had been feeling unwell, and staff had promptly organised for them to see the GP.

Three health care professionals provided us with positive feedback, confirming people were referred to them appropriately, staff followed their instructions and there were good working relationships with staff to support good outcomes for people.

Relatives confirmed they felt well informed about any changes to their family member’s health care.

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’s care plans were person centred and gave staff information on how to support their daily needs and how they could support the person’s independence. We observed staff providing people with opportunities to make choices, about where they wanted to spend their time, the clothes they wore, what activities they wanted to take part in and what they wanted to eat and drink.

A person told us they were receiving physiotherapy to help improve their mobility and people had access to regular chiropody to help maintain good foot health.

People had access to sufficient and appropriate food to help maintain their health, support tissue repair and help them live well with conditions such as diabetes. Staff ensured people had access to enough fluid to support good hydration and prevent health issues such as a lowering of blood pressure due to dehydration, resulting in an increased risk of falls.

People told us they were supported to access optician appointments, organised either by their family or the staff. The same support was in place for accessing private dental appointments.

NHS dental care was only possible if the person was able to visit the NHS dental practice. Managers had been unable to secure a NHS dental service which would visit the care home. In the case of a dental emergency, support had to be sought through the 111 service.

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

Staff worked collectively to achieve good outcomes for people by ensuring people received care which aligned with nationally recognised best standards. Staff worked closely with people, their representatives, including various professionals to achieve this.

For one person, this involved working closely with mental health professionals to develop a care plan which could improve this person’s wellbeing so they could continue to be cared for at Chestnut Court. For another person, staff were working with specialist health care professionals and consulting with family members, to ensure the care planned for this person, remained in their best interests.

Managers present at this assessment had introduced improved arrangements to monitor people’s care so any necessary changes in the level of care required, could be quickly identified and responded to. One person’s needs had increased so arrangements were being made for nursing care to be provided.

Food menus were reviewed to ensure they provided people with a nutritionally balanced diet. Two people commented that the food choices were not always to their liking, although staff had met 1 person’s particular preference by purchasing this for them. Despite this, care records showed people’s eating and drinking needs had been monitored and their nutritional health had improved.

People’s comments about whether they felt staff supported good outcomes for them were mainly positive. One person said, “It’s very good here, the staff are marvellous, it really is a nice place, I have no complaints whatsoever. I was apprehensive about coming but it couldn’t have been better.” Another person referred to the support they had received and said, “They’ve really encouraged me.”

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

People’s care records showed that, where required, people’s mental capacity had been assessed and where this showed people lacked the mental capacity to make independent decisions about their care and treatment, these were made in their best interests. People’s legal representatives were involved in this process, and relatives were consulted, to ensure the care delivered also recognised the person’s known preferences and wishes.

We observed people who lived with dementia sometimes being unable to provide staff with the permission they needed to support them. Refusals to be supported were accepted and we observed staff returning later to offer the same support and it being accepted. A relative said, “They always ask permission, and they ask her by her first name and ask her if it’s ok before they do it.”

People’s care plans gave staff the additional information they needed to support people to make day to day decisions. We observed staff approaching people and communicating with them in ways which enabled people to make simple decisions.

People’s relatives and legal representatives told us staff consulted with them about decisions which needed to be made and helped their family member to understand the care and treatment being provided to them. A relative said, “They communicate with me, and they talk to Mum.”

Medical decisions related to resuscitation and the treatment to be provided in the case of an unplanned medical emergency were recorded. There were arrangements with GPs to review these decisions, with people or their representatives. A relative was aware they were due to have a conversation about this with the GP.