Turning Point - Hollygrove

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.

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.

People’s needs had not always been re-assessed when things had changed. We found some assessments were not up to date when significant changes had taken place such as reduced mobility. This meant corresponding guidance was not relevant in some cases and did not reflect people’s current needs. One member of staff said, “We know the person and understand their challenges. We have enough guidance; however, I think they [management] need to improve on moving faster to update care plans to keep up with pace of person’s changing condition.”

The registered manager took immediate action during our assessment to update people’s care records. We discussed with leaders the need to have more robust systems to ensure assessments were reviewed in a timely way.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff were providing support to people who had a percutaneous endoscopic gastrostomy (PEG). This was a delegated healthcare task which meant the overall responsibility was overseen by a healthcare professional. The provider had introduced a ‘delegated safely checklist’ which recorded who the delegator was and steps to make sure management of this task was safe. Whilst we found this was all recorded for 1 person, it was not in place for another person. The registered manager was prioritising work to have the ‘delegated safely checklist’ in place, but at the time of the assessment they were not sure who the delegator was. They were working with health professionals to identify this.

The provider had nationally recognised tools for assessing people’s needs for pressure damage and malnutrition. However, these were not being used to assess people’s risks. Whilst risks to people’s safety had been identified, using the nationally recognised tools would provide staff with a framework and help to makes sure all safety measures and ways to reduce risk were considered.

People’s nutritional and hydration needs and preferences were recorded. We observed mealtimes and saw they were a relaxed and inclusive experience for people. People were supported to make choices and staff demonstrated they knew people’s needs well.

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.

Staff worked with various healthcare professionals involved in people’s care. Records demonstrated contact was made in a timely appropriate way. The local GP visited monthly or more if needed. Feedback from professionals was that staff communicated well and took action where needed to meet people’s health needs.

Relatives said staff kept them updated with any changes to people’s care or if people were unwell. One relative said, “They [staff] update me every day, all the time. Once they had to call an ambulance and they called me straight away.”

Staff communicated with each other about people’s needs. There were regular staff meetings which were recorded. Minutes demonstrated staff discussed individual’s needs and any changes to care and support required. Staff told us they worked well as a team. One member of staff said, “There is brilliant teamwork. We liaise whenever needed [with healthcare professionals] as we are on the front line. We are always involved in any discussions.”

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 health needs were assessed, and a range of healthcare professionals were involved in helping people stay as healthy as possible. People had an annual health review and regular reviews of areas such as medicines.

People were encouraged to eat healthily and stay active as much as possible. The provider had an initiative called ‘Care to cook’ which had promoted healthy eating. Easy read recipes and menu books had been created which helped people to be more involved in cooking. Recipes were healthy and included options for lower fat and diabetes. One person had been supported to improve their health condition by having consistent support with their diet. The registered manager said this initiative had improved people’s experiences of meal preparation and given them motivation to cook for themselves.

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 with people to identify goals for the future and outcomes they wanted to achieve. These were kept under regular review and action taken to help people do what they wanted with their lives.

If people needed monitoring with aspects of their care, this was recorded in care records. One person was in need of fluid monitoring. Whilst staff were recording what fluid was being consumed, they were not adding up the totals to make sure people reached their targets. The provider took action during our site visit to alter the electronic care planning system so it would prompt staff to total fluids consumed. People’s care records demonstrated staff had liaised with healthcare professionals to seek clarity on supporting people to consume enough fluids.

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

Where needed and appropriate mental capacity assessments were completed in line with the Mental Capacity Act 2005 (MCA). Where a person had been assessed as lacking capacity, there was evidence of best interest processes. Records were kept demonstrating who had been involved in decision making.

Staff had training on the MCA and understood the principles and the importance of gaining consent from people. People and their relatives did not share any concerns about this.