OSJCT Chestnut Court

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good.

At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People told us staff were aware of their personal preferences and choices and met these when they provided their care. A family member involved in their relative’s care planning said, “They have been through it with us, and they know all of their wishes.”

Care plans were completed by staff who were competent to do this, and the plans gave staff guidance on how to support people’s individual needs.

During the assessment a person’s needs were reviewed by healthcare professionals. A member of staff reviewed the person’s assessments and care plans to ensure these reflected the change in care and treatment and to highlight the person’s individual wishes and choices.

We saw people’s care plans had evolved over time as staff learnt more about people’s needs, individual choices and preferences. Most gave detailed guidance, and all provided enough information about people’s personal likes, dislikes, choices and wishes. It was clear the individual person was at the centre of the care planning process.

Staff discussed with people, or their representatives, their care and treatment options so people could make informed choices about these. This had been the case for 1 person, who had made the choice not to always accept the care as outlined in the relevant care plan. We fed back to staff this care plan reflected the care that should be provided and not the person’s individual choices. This care plan was reviewed and amended during this assessment.

A care plan review took place regularly and when people’s needs altered. These reviews were recorded for staff information. Action was being taken to ensure, that following the review, the care plan itself was amended so it also reflected any changes in care needs.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff and managers understood the health and social care needs of the group of people they cared for, including the needs of their representatives. People had diverse needs, stemming from their protected characteristics and staff were able to work flexibly to meet these.

The service worked with commissioners of care including health and social care professionals to support people’s needs and, to ensure, where there were gaps in care provision, additional care support could be accessed. This included advocating for people to receive funding from commissioners for additional care support. This had been the case for people who were receiving one to one care to support them with distressed behaviour and high risks of falls.

Where people required the support of other specialised services, staff worked collaboratively with those services to ensure the person’s needs could be met and continuity of care was maintained. Examples of this included collaborative work with mental health and palliative care services.

Managers of the service worked with health and social care commissioners to also support continuity of care for people, either on admission to the care home, or when they were returning to their own homes after respite care.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s communication care plans gave staff guidance about people’s verbal and non-verbal communication needs. Care plans provided guidance for staff on how they should support people to understand what was being communicated to them. For, example, the need to repeat what was said because of memory loss or the use of gestures to support what was being said verbally.

Information about people’s eyesight and hearing was included, if they wore glasses or a hearing aid, so staff were aware of their needs to support effective communication.

Written information such as minutes of ‘resident and relative’ meetings, safeguarding advice and how to make a complaint were in small print, but we were informed information could be provided in larger print and in different languages where required.

People’s care plans were stored on the provider’s electronic care system. Staff could access care plans on individual electronic devices, however, if people wanted to read their care plans, these could be printed if preferred.

Staff had received training on handling and managing confidential information, including cyber security, and they understood the importance of keeping information about people confidential and secure.

Consent was sought from people or their legal representative(s) for the sharing of confidential care information with relevant professionals and agencies.

The provider had arrangements for the safe and secure storage of confidential information, kept either electronically or in paper form.

The provider had arrangements for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider had a complaints policy and procedures for people, their relatives and visitors to be able to raise a concern or complaint. Information about how to raise a complaint was seen on notice boards.

Most relatives told us they felt able to raise a complaint if needed. A relative told us they had made a complaint (not about care) which had been managed to their satisfaction by one of the managers.

A manager present at the assessment reviewed with us the complaints received in the last year. All closed complaints had been resolved at stage 1 of the provider’s 2 stage process, indicating the complainant had been satisfied with how their complaint had been managed and resolved at care home manager level. These complaints had not needed to progress to stage 2 for further investigation by the provider.

The provider sought the views of people by sending out formal questionnaires. In addition to this, feedback was sought through regular ‘residents and relatives’ meetings. Minutes of a recent meeting were displayed on a notice board. We saw relatives had raised frustration at having to wait to gain access to the care home and not having their telephone calls answered outside of normal office hours. This feedback had resulted in action being taken by managers to address this. One option being looked at was an increase of reception staff hours.

A person told us they had attended one of the ‘resident and relative’ meetings and their feedback had been acted on.

The provider took steps to support people to access the care, support and treatment they needed when they needed it.

Staff were aware of those who may be vulnerable to discrimination and inequality when it came to accessing health and social care support. For example, people who did not have representatives to advocate for them, and people who could not advocate for themselves due to communication difficulties or because they lived with dementia. Staff took steps to ensure everyone could access the support they needed by taking into account their individual needs and protected characteristics.

There were arrangements to support people to access health appointments and to escort them to their appointments if necessary.

Staff were aware of how to access services for people in an emergency including the out of hours GP service.

The provider had formal arrangements to ensure people would receive care in the case of emergencies or staff sickness.

Managers had been unable to support equitable access to routine dental care. NHS dental care was limited and did not offer home visiting service. People not able to leave the care home or who did not have the means to register with a private dentist, could not access routine dental care.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The provider’s policies and processes supported and promoted equality in care and a zero tolerance of any form of discrimination.

The provider took action to minimise and mitigate risks associated with inequality and discrimination in care.

Staff were provided with appropriate and relevant training to improve their awareness on these subjects and to provide them with the knowledge and skills needed to deliver care to people, as well as recognise people’s diverse needs.

People’s care plans were generally detailed giving the information required for staff to be able to support good outcomes for people.

Managers advocated for people so they could access the care and treatment they needed to support better outcomes. Examples included following up health professionals’ assessments for mental health support, speech and language assessments and equipment such as specialised seating and mobility equipment, so people had equal opportunities to an improved quality of life.

Arrangements were made to ensure people were not discriminated against when in care. This included ensuring their ability to remain on the electoral register and to vote.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider’s care planning process supported opportunities for staff to discuss with people their future care choices and wishes. This included discussions related to emergency medical treatment and end of life wishes and preferences.

Some of this information was gathered on admission so staff and emergency services were clear on what action to take in an emergency. Discussions relating to end-of-life care had sometimes evolved over time, when people felt comfortable to discuss this. Care records showed these discussions had often involved people’s representatives and their GP.

Do Not Attempt Resuscitation (DNAR) decisions were available to staff and emergency services if they were called to attend. A relative told us they were involved in reviewing their family member’s care plans and were aware they needed to have conversations about DNAR with the GP and staff.

Staff worked closely with primary healthcare professionals which included regular reviews of people’s frailty. This helped healthcare professionals and staff identify increases in people’s frailty so where needed, conversations about future care, including end of life wishes, could be planned.

Where people lacked mental capacity to make independent decisions about their future care and treatment, decisions were made in their best interests, involving their legal representative and their GP.