Belsfield 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 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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Relatives spoke highly of the assessment process. One relative said, “(The assessment) was done in detail, in [person’s] room there is a detailed chart all about [person]

, such as what she wants to be called, how to communicate with her and that she needs to be fed. It makes sure the staff are familiar with her, and it changes as her needs change.” Another relative said, “Both my brother and I sat with the social team and the doctor and staff from the home and went through things. They asked what [person] liked and didn’t like and what they did at home.”

Staff told us they were made aware of new admissions to the service through regular meetings and handovers and that initial assessments were carried out by nursing staff and shared amongst the staff team. Initial assessments were very detailed and were used to write person centred-care plans. Extensive care plans were in place which guided staff on how to safely care for a person. When a person first arrived at this service, a welcome pack was given which includes forms to be completed by staff about a person’s preferences, cultural needs and interests. This ensured staff knew how to care for that person.

The service always 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. They worked to develop evidence-based good practice and standards. Relatives spoke of how the service ensured specialised diets were met including low fat, gluten free and pureed meals. One relative said, “[Person] seems to like the food, they always get enough to help maintain their weight and nutritionally they always looks good and well.” Another relative spoke of how staff encouraged plenty of fluids throughout the day to avoid dehydration.

Staff were aware of specialised diets and how best to support people. One staff member said, “We sit and encourage people at mealtimes. The policy is 1 staff member serves, and 1 staff member sits on each table either assisting or encouraging people to eat. People have different diets such as fortified, high calorie and puree. The food is really good quality. There is always a choice.”

The kitchen had a board detailing people’s dietary requirements and staff held regular meetings to communicate any updates or change in need. Referrals were being made to the SALT (Speech and Language Therapy) team and dieticians as appropriate, and any recommendations were detailed in people’s care records. There was a varied menu which was on display including options for a range of specialised diets to ensure inclusivity. We noted during our observations that there were plenty of fluids and snacks offered throughout the day including ice lolly’s, chocolates and milkshakes. Some people were on a weight loss plan and records evidenced this had been successful. People’s lives were positively impacted by staff desire to ensure all diets and special requirements were catered for. This meant people were receiving effective care tailored to their specific needs.

This service offered a unique vaccination programme. Specialist fridges have been installed at the service and some staff are trained to administer the vaccines. This reduces the risk of people declining any vital vaccines as they're familiar with the staff team so anxiety in this area is decreased.

The service always worked well across teams and services to support people. Relatives told us staff worked well together to ensure any important information was acted on and reported to them as required. One relative said, “If I have any questions, they (staff) will answer it.” Staff told us they worked well together as a team. One staff member said, “Staff work really well together. We don’t hide anything; we all share with each other.” Partners told us staff engaged well with them.

Staff handovers took place twice a day. During these handovers, concerns about people were shared as well as any updates. Bite sized videos were shown to staff, with different themes each month to give staff the opportunity for learning. For example, the topic may be about dignity and short videos would be shown on that subject. Staff were encouraged to think about how they would incorporate this into people’s care provision by acting out scenarios or suggestions made for how a person may be impacted. This ensured people were receiving high quality person-centred care and staff had continuous learning through these innovative handovers. In addition, 4 walkaround were completed during each shift were the nurse reviews all monitoring systems including assessment tools and speaks to the staff team. This provides the opportunity to identify any concerns and take action without delay.

Allocation sheets were completed daily including where staff would be allocated and where 1-1 care was required. Staff were allocated 1-1 care for 2 hours only then this would be allocated to another staff member to ensure staff members were alert and able to engage at a high level, rather than becoming fatigued or less responsive over longer shifts. We saw evidence of partner working and referrals made as appropriate.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support. Relatives felt people were supported and encouraged to live healthier lives. One relative said, “They do chair exercises and yoga. [Person] can’t raise their arms so they (staff) do it gently for them and they use a large ball to help them move, throwing it from one to another.”

Staff told us that although some mornings can feel rushed due to appointments or visits, there were plenty of staff to ensure things ran smoothly and, plenty of time to spend with people. The registered manager told us changes health conditions were escalated to the nurse in charge, and any referrals would be made without delay. Exercise and mobility are prompted based on individual capacity including chair-based exercise, physiotherapy programmes and walks in the community or gardens. Partners told us referrals were made as necessary.

The service arranged a dentist to visit the service regularly and focus was put on people’s oral health needs. People’s oral care provision was logged in people’s care records and oral care advice was in people’s bedrooms on how best to support them.

The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves. Relatives told us people had access to various services such as GP’s and chiropodist when needed. One relative said, “[Person] sees the GP connected to the home, he sees a chiropodist once a month, the staff cut his nails. I go with him and a staff member to the dentist, he sees an optician who goes into the home.” Staff told us people were encouraged to live healthy lives by doing keep fit exercises and that any health concerns would be reported to the nurse who could escalate this should they need to.

Tools for monitoring outcomes were robust and included MUST (Malnutrition Universal Screening Tool) and Waterlow (skin care) risk assessments. Incident charts including behaviour logs were robustly monitored by the clinical lead, deputy manager and registered manager to ensure all safety events were reported and to identify any measures that could be implemented to help reduce future risks. People’s weights were closely monitored. Charts included whether people had lost or gained weight and comments were made for each person, detailing the level of support the person required for example diabetic, blended or pureed diets. Information was held about any SALT plans. These records were very detailed and guided staff on what diet a person should be receiving. Weights records indicated no significant weight losses expect planned weight loss.

This service adapted a unique approach when it came to risk taking and encouraged people to take positive risks by adapting care provision. The registered manager was constantly looking at new and innovative ways of improving outcomes for people and case studies evidence how people’s lives had become more fulfilling since their admission to Belsfield House.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. People and their relatives told us they were involved in decision making. One relative was asked whether they feel people were supported in decision making. They said, “Yes, they are really supported. I am led by the knowledge of the (staff) team and their knowledge of [persons] needs.”

Staff told us they ensured people’s consent was always sought. They said, “We always ask for consent and I remind staff to knock on people’s doors and say please and thank you.” Staff told us people got a choice at mealtimes and other options would be provided should a person not like what they are offered. Capacity assessments and best interest meetings were held for various decisions that needed to be made, ensuring the service was always doing the right thing for people. A range of consent forms were in place which were signed by either the person, relative or advocate as appropriate.