Overslade 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 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.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People were not always able to recall how their admission to the home was organised, but some people said they had been supported by relatives. One person told us, “I’ve been here for 1 year, my son and daughter chose here, I was very ill on my own, not eating properly, sleeping properly, shopping, I had to move.” Records showed that people’s care and support needs were discussed and assessed before they came to live at the home. Assessment information and risk assessments were available on people’s care plans; this included a communication assessment and their ability to use a call bell to alert staff. A staff member said pre assessment visits were completed by the deputy manager or heads of units. The manager or deputy were required to agree any new admissions to the home.

Staff told us there was an expectation that care plans were fully developed within 7 days of a person’s admission. Risk assessments were required to be completed when people moved in to ensure risks were identified and managed. The manager told us if there were areas of high risk there was an expectation those care plans were completed first. This was to ensure staff had the guidance needed to support people safely. However, 1 person had been admitted with a pressure wound, and we saw a care plan relating to their skin had not been completed until 6 days after their admission. The manager told us this was not usually the case and staff were aware of the expectations around completing care plans. This had not resulted in any detrimental impact on the person. Nurses told us that once initial care plans were completed they were reviewed again at 6 weeks or if there were major changes which required a review sooner.

The manager told us information of new people coming into the home would be communicated to staff at handover meetings at the beginning of each shift. Information would also be displayed on staff handheld devices and discussed at daily “stand up” meetings with staff from across the home.

We saw 1 person had experienced a fall when in hospital. Once they were admitted to the home action had been taken to complete a detailed assessment which included a falls risk assessment, along with information relating to their health. Information was collected about their next of kin, social care contacts and social/jobs history. A body map had been completed to show the location of their wounds, and a moving and handling assessment identified a need for a pressure cushion which had been obtained. People had regular check-ups with health and social care professionals to help maintain their health and wellbeing.

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.

People’s nutritional needs were assessed and where people were identified as being at risk of not eating and drinking well, they were referred to other healthcare professionals so that appropriate advice could be sought. Guidance provided helped staff to follow best practice when providing support. People told us staff knew what they were doing when supporting them. One person told us, “I think the staff here are well trained for this work.”

At breakfast time staff were seen supporting people to the table and they made sure people had enough to eat. Some people were provided with their meals in their rooms supported by staff where needed. For example, 1 person was a risk of choking and had a respiratory condition. This meant they needed support to eat and drink safely. Staff encouraged people to decide what meals and drinks they wanted and listened to their responses. Where people elected not to eat their chosen meal they were offered alternatives. Some people declined food and staff were seen encouraging them to eat. In 1 lounge a staff member was directed to support a person who was sleepy, this person was given 1:1 support from staff to ensure they had enough to eat to remain well. Good eye contact was seen between people where staff were supporting them to eat and staff assisted people at their own pace. Staff assisting people were mindful to ensure they were offered opportunities to have a drink during their meal.

The provider followed best practice guidance and used recognised tools to monitor people’s nutrition and hydration, skin integrity and pain levels. This ensured care and support was delivered in an evidence-based way. The provider planned and delivered people’s care and treatment with them where possible.

The chefs knew which people required specialist diets and ensured food was prepared to support their needs. This included pureed and fortified meals (calories added). In the dining areas people were provided with meals and drinks of their choice.

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.

Care and nursing staff regularly shared information during key stages of people’s care so that they could identify when other health care professionals may be needed. One staff member told us, “I ask questions, it’s my job to.” The staff member explained about the benefits of speaking with other staff and said, “It’s important you ask questions. The electronic care plan (on the handheld devise) is a backup.” The staff member explained through this dual approach they were able to understand what care people wanted.

Staff confirmed there was a good relationship with people’s GPs, and they were responsive to requests for advice and health visits. This included when new people moved into the home. One staff member said, “If people’s health decline you contact them.”

The manager told us if people were admitted to hospital, information about them was sent with them. They said, “We have an emergency pack which we print from the system with the care plans and emergency contact and MAR (medicine administration record) charts with medication.

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 had opportunities to join in activities provided by the home and also in the community to help support their wellbeing.People told us staff usually supported them to complete tasks independently. One person said, “Staff are great, I don’t need much support, but they just keep an eye on me, you know?”

People had access to health professionals and were supported to access specialist health advice when they wanted it to maintain their health. For example, from speech and language specialists, podiatrists, dentists, opticians, mental health teams and memory teams. One person told us, “I’ve seen the doctor once. They do checks on me, weigh me and take my temperature.” Where there was a significant weight loss, people were supported with their nutrition to ensure this did not impact on their health.

The provider had arrangements in place to monitor people’s care and treatment to continuously improve it. Outcomes were not always consistently recorded to show they met clinical expectations.

People felt that staff knew about their needs and recognised when they may need additional support. A relative told us, “When my wife presents with an issue, which is very very rare, the staff are willing to step in and help.” Another relative said, “Everyone responded very quickly when she had a fall, they assessed her, monitored her closely, and called the ambulance when they became more worried about her. They kept us informed the whole time.”

Records to monitor people’s care and support included repositioning charts for people at risk of skin damage. However, we found 1 person had not been repositioned in accordance with instructions on 2 occasions which increased the risk of potential skin damage. Another person’s records were unclear in regards to catheter bag monitoring, to make sure it was emptied when needed to prevent any potential infections.

Where people had underling health conditions such as diabetes, regular checks were made on their physical health. Staff had been provided with the information they needed to guide them on what the likely symptoms would be of a person experiencing high or low blood sugar levels. Staff understood what actions to take if they had any concerns for the person’s health. This included contacting the diabetic nurse via the person’s GP.

Staff knew what was expected of them to monitor people in an emergency situation. For example, if people had experienced a fall. One staff member explained how they had completed additional monitoring of a person who had fallen and sustained a head injury.

Where 1 person was found to have lost weight, a referral had been made to dietetics, and fortified (increased calorie) foods were introduced with immediate effect. The frequency of monitoring had been increased to weekly to ensure advice provided was effective.

The provider did not always ensure decisions about people’s rights around consent were made clear to them so that their rights were respected when delivering care and treatment.

We found that some improvement was needed in relation to the management of mental capacity assessments (MCA), to ensure people were not subject to restrictions unnecessarily. Whilst people on the dementia care units had mental capacity assessments (MCA) in place, these had not always been completed for people with mental health conditions on other units. One person had a care plan that identified family members needed to make decisions on the person’s behalf but there was no MCA assessment in place. This was important as some people can lack capacity to make some decisions but have capacity to make others. Mental capacity can also fluctuate with time – someone may lack capacity at one point in time but may be able to make the same decision at a later point in time.

People’s consent was usually sought. Staff knocked people’s doors and sought their permission before entering their rooms and people were given everyday choices such as where they sat or what they ate. However, 1 person told us their consent was not sought. They said, “Oh, they don’t ask, they just do it” (when referring to care). Another said, “We are not always consulted first”, when discussing plans for their care.

We saw best interest decisions had been made where appropriate. For example, 1 person used a specialist bed and mattress. The person’s relative had signed a ‘best interest’ decision form to confirm they had been consulted, their views sought, and they were in agreement for this equipment to be used. The form also prompted staff to consult health professionals such as the GPs for consent. Records showed GPs were consulted around decisions such as medication usage, vaccinations, and sensor mat use (used to alert staff when people get out of bed).

Care staff told us their views were considered when decisions needed to be made in people’s best interests. One staff member said, “We would all be involved as we are their eyes. Decisions can change from 1 day to another. It is people’s rights.”

Staff understood that if people refused care or support, they needed to respect that decision. One staff member gave an example of how they encouraged people to accept personal care, but respected their decision if they declined, and would try again later, sometimes with other staff.