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• 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 79 (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.

Thorough pre-admission assessments were carried out and documented, to ensure the home was right for the person and to understand any of their complex needs prior to admission. New admissions were discussed at staff meetings and staff knew to read people’s pre-admission assessments and care plans; however, staff also spoke about how they like to get to know the person’s needs themselves by, “by speaking directly with the resident to understand their wishes, routines, and choices.” Staff also emphasised the importance of involving family members and relevant professionals where appropriate.

Nationally recognised clinical assessments tools were used to better understand people’s needs, for example Cornell Scale for Depression in Dementia (CSDD). People’s preferred way of communicating was documented at pre-admission to ensure staff were aware of how to best communicate with people straight away, these communication plans were developed further as staff got to know people’s individual needs.

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 hydration and nutrition needs were documented, these included people’s preferences which enabled staff to support them, for example, one person preferred milk rather than water to maintain their fluid intake. Another person who had poor fluid intake had a very clear plan in place to guide staff one when and how to offer, including what words to use to encourage the person to drink. Where people were at risk of weight loss or malnutrition, professional input was sought and people were supported with fortified drinks.

Best practice was shared with staff through meetings and training; there was also information available to them, such as NHS guidance posters in the medicines room, to enable staff to deliver evidence-based care.

The provider worked well across teams and services to support people. The provider worked alongside other healthcare services to ensure people received the right care.

Staff worked well together, they said, “Communication is very effective in my team, and this is achieved by thorough handovers and the use of emails. There is a culture of mutual respect, and this ensures effective co-ordination in the team.”

We saw evidence of appropriate referrals being made to other services, such as dementia outreach team, to ensure people receive the care they needed.

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 were supported to see healthcare professionals to maintain their wellbeing. People’s oral health needs and required support was clearly documented in care plans, with clear guidance for staff.

People told us they were happy with the support they received. A person said, “They make sure everything is done like getting the dentist.” A family member said, “[Person] did see the optician. My relative does grind their teeth and the dentist came here to see my relative.”

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.

People were monitored to ensure they remained safe, and risks associated with certain health conditions were avoided. For example, people at risk of dehydration had their fluid intake recorded and people living with diabetes had regular blood sugar monitoring.

Staff knew how to identify and escalate concerns with outcomes, they said, “Changes in people’s needs can be identified by first knowing what the person’s normal presentation is and then comparing it to the current presentation. Use of clinical tools such as MUST, Waterlow and other assessment tools are very useful in giving a quick assessment on any changes occurring in a person.”

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

Consent was detailed in people’s care plans, where people lacked capacity to make certain informed decisions, staff were informed that the need for consent should still be sought and actions explained to people.

Staff said, “We respect people’s right to make their own decisions…Support is given through information, discussion, and risk awareness.”