Hayes Park Nursing Home

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 rated inspection (published 8 March 2022) we rated this key question Good. At this inspection, the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Whilst people’s clinical care needs and treatment had been well assessed and planned for, care plans that provided staff with guidance of how to meet people’s mental and psychological health needs were less detailed. Some people were living with dementia and relied on staff to support their communication and emotional needs at times of increased distress that impacted their health, wellbeing and safety. We discussed this with the registered manager and nursing team who agreed to review and improve care plan guidance.

People were involved as fully as possible in discussions and decisions with their relative or representative, about their care and treatment needs. Relatives confirmed they had attended review meetings and had been asked to read their relation’s care plan to ensure it was reflective of their relation’s needs.

Staff overall were knowledgeable about people’s care and treatment needs. Whilst staff had received training in dementia care, their knowledge and awareness of emotional needs in relation to dementia care needed to be further developed. Following the inspection we discussed this further with the management team who agreed this was required and advised they would arrange further staff training.

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. However, some shortfalls were identified, and improvements were required.

People’s personal routines, preferences and important information were not consistently recorded in care plan guidance for staff. Whilst some care plans reflected in detail the person’s routines and what was important to them, others did not. This meant there was a greater risk of people not receiving personalised care and treatment. Our observations recorded in key questions Caring and Responsive of this report, showed staff did not consistently provide care based on people’s individual needs.

The provider’s policies and procedures reflected current legislation and best practice guidance. Overall, care and treatment were delivered in line with evidence based practice. Where improvements were required such as ensuring the mental capacity act was fully adhered to, this was known and understood by the registered manager and action was being taken.

People’s dietary and hydration needs were assessed and planned for. Staff, including the cook, had detailed and up to date information about people’s individual needs, including any identified risks such as swallowing difficulties. We observed people were supported in line with their care plan and risk assessment.

People had a choice of an Asian and English menu that provided a daily option of different meals and drinks, and snacks were provided throughout the day and evening. Food stocks were good and managed in line with food hygiene and safety standards.

We received mixed feedback from people about the meal options. Whilst some people were positive, others told us they did not receive a choice. We shared this with the registered manager who agreed to follow this up.

Observations of lunchtime confirmed that people overall enjoyed their meals. Meals were presented well and looked appetising and were of a good portion size. People were offered a choice of drinks throughout the day.

Staff culture and effective team working was an area of current development. The management team had recognised difficulties within the staff team that had a negative impact on how well the team worked together. This put people at greater risk of not receiving effective care and treatment. This was being addressed and the management team and staff confirmed improvements had been made and were ongoing. This showed the management team were being responsive in recognising and improving the service.

However, we identified communication and staff accountability continued to be a concern. For example, we overheard a person using the service who was in a wheelchair telling another person how they had banged their leg into a wall. When we asked the person about this they told us they did want to talk about it. We shared this with the registered manager who followed it up. They advised us the person’s leg had been banged into a wall when staff were pushing the wheelchair. However, this had not been documented in the person’s care records, the accident book or reported to the management team. The nurse was asked to check the person had not sustained any injuries.

Systems and processes were in place to share information with external health and social care professionals. Care records confirmed referrals to external healthcare professionals for further assessment and or guidance, were made in a timely manner and recommendations made by others were implemented.

Feedback by external healthcare professionals were positive about how well the nursing team and staff worked with them in a collaborative approach.

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 physical health needs had been assessed and planned for and were regularly reviewed and monitored. Staff were knowledgeable about health conditions including signs and symptoms of a deterioration in health and the actions required to follow this up. For example, staff were able to provide details of how a person may present if unwell with a urine infection, diabetes, how to manage a catheter and how to provide care to prevent skin damage. This meant changes in people’s health needs were able to be identified quickly and acted upon.

Nursing staff were well experienced, competent and knowledgeable about people’s health needs. This was confirmed by external healthcare professionals. A healthcare professional said, “The nursing staff are very knowledgeable during interactions with the practice. Any recommendations given are acted upon. Staff seek urgent help appropriately and use other services such as the physician associate ward round for routine problems.”

Staff had received training in a variety of health conditions and nursing staff received clinical training, support and had their competency assessed.

People and relatives confirmed that staff supported health needs well. A relative said, “My relation was discharged from hospital with their legs that had been bandaged for some time and weren’t improving. But the staff sorted the problem and now [relation] can just wear socks.”

Observation of staff interactions in relation to health care needs showed staff were responsive to any concerns. For example, we observed a person coughing at lunchtime. The staff member alerted the nurse, who then gave the person some water saying, “Let me see what your swallowing is like. Are you in pain apart from the cough? I’ll see if you can have some cough syrup and put you on the GP list."

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.

The provider’s systems and processes that monitored quality and safety were effective in supporting people to experience positive outcomes. For example, outcomes of audits and monitoring checks including feedback the provider received from people, relatives, staff and external professionals were routinely analysed to identify issues and learn lessons. These were discussed with staff and actions taken to make improvements.

People’s individual care plans, risk assessments and monitoring care records confirmed these were regularly reviewed and amended as people’s care and treatment needs changed. This showed effective monitoring systems used to improve outcomes.

External healthcare professionals confirmed people experienced good clinical care outcomes due to the quality of nursing care provided.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Mental capacity assessments were not fully completed in line with the Mental Capacity Act (MCA) 2005. MCA assessments and best interest decisions had been completed for specific decisions about a person’s care and treatment where the person lacked capacity to consent. However, the assessment did not record how and when it was completed. This meant it was not clear how people had been supported to be involved as fully as possible in decisions about their care and treatment. Without clear recording it was difficult to ascertain decisions were the least restrictive and in the person’s best interest. We discussed this with the registered manager and senior nurse who agreed to make improvements.

People and relatives confirmed they were involved and consulted in discussions and decisions about care and treatment needs.

Observations of staff engagement with people showed examples of staff offering people choices and how consent was sought before care and treatment was provided.

Staff were aware of the principles of the MCA and had received relevant training and had access to the provider’s policy.