The Close

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 requires improvement. At this assessment, the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 involved in reviewing their care needs on a regular basis. Some feedback from people we received was “I had a review with [registered manager] 2-3 weeks ago, with the update [registered manager] gave me [relatives] weights, medication, bathing and shower routines” and “yes, always involved in the reviews.”

Speaking to staff they were informed of changes to peoples care needs. One staff member said “the seniors or the manager update care plans, they do it every month, if I have any concerns then I will report it to the manager and they will check the care plan. Any changes are communicated at handover, in the handover book.” We reviewed peoples care records and saw regular reviews were being conducted and people’s needs were being assessed on a regular basis.

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 told us how they were supported by the staff to follow best practice guidance. One person we spoke with said “I am diabetic, medication controlled. So, I have sweetener instead.”

Speaking to staff they could tell us about clinical tools they use in the service to monitor peoples care and support needs, one staff member said “we use national tools likethe Malnutrition universal screening tool(MUST) score to assess nutrition andthewaterlow score to assess pressure sore risk.These help us understand each person’s needs and puttheright care in place.Thescores are recorded in care plans and reviewed regularly, so we can act quickly if risks change.” We reviewed people care records and saw these tools being used effectively, with appropriate actions taken where concerns had been identified.

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. People felt supported by staff when they needed to see other healthcare professionals. We observed how different services worked together and the effectiveness of the communication between them. One healthcare professional that we spoke with said “handover of people’s needs are a very good level of information on their medical issues and mobility ability. Information I give is always recorded in peoples care plans.”

We reviewed peoples care records and saw that guidance and support from healthcare professionals was embedded within them, and staff knew the advice and made sure it was being followed. One staff member said “there is good communication with the matron that comes weekly, and district nurses visit a couple of times a week, they always say what they are going to do. The team communication is good.”

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. One person we spoke with said “the food is nice, and I get a variety of choice. I am vegetarian and if I did not like it, they would change something. Tea and biscuits come round. I am sure if I wanted something in the night they would get it for me.”

We reviewed the services processes, and we found that people had access to appropriate healthcare. The GP matron visited once a week and while we were onsite the optician visited a number of people in the service. Staff had received training in diabetes, pressure ulcer and falls training to enable them to support people in the service. One healthcare professional said, “all staff seem very knowledgeable on people’s health and well-being.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves. For people who required assistance with repositioning to reduce the risk of pressure damage, we found gaps in recording charts. This meant we could not be assured people were being supported to reposition in line with recommendations from healthcare professionals to minimise the risk of developing a pressure ulcer. The provider investigated these concerns and spoke with staff about the importance of accurate reporting and recording and acknowledged this was an area requiring further development.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. People told us staff always gained consent before conducting any task. One person said “staff support me how I want to be supported. If I like things done a certain way they will do it, and they always gain consent.” Speaking to staff they told us how staff always gained consent. A staff member said “we always ask for consent when we help, speak with them throughout personal care or if helping with a meal to check they are still ok. Make sure that the daily notes are written to include their choices. I have done mental capacity training, and it is recorded in their care plans.”

We reviewed the services processes and where questions around people’s capacity were identified, mental capacity assessments were conducted on each individual decision. The service had best interest meetings in place where people lacked capacity and these evidenced involvement from relevant relatives and professionals. The service had a policy in place around consent for staff to follow.