St Nectans Residential Care 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.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff worked effectively alongside health professionals to provide the best outcomes for people. Health professionals told us how well staff worked with them, and that they were knowledgeable and professional. The provider used known tools to monitor and evidence improvement and outcomes. People were encouraged to be as independent as possible and were asked for their approval and agreement when being offered support.

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's health and social needs were assessed before coming to live at St Nectans; (This had ensured the service could meet the identified needs of the person and that staff had the necessary training to keep them safe and well. There was evidence of family involvement within the documents.

People’s communication needs were assessed regularly and reviewed so as to ensure people were offered opportunities to participate in their care decisions. Most people’s care records were reviewed regularly to ensure they remained an accurate reflection of people’s needs. People's assessments included sufficient detail about their individual care needs and preferences, which had ensured their needs were met consistently and effectively.

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.

Relatives told us that checks did take place and that where staff have concerns, these are taken forward and routine monitoring put in place to track improvements or concerns. One relative said, “They weigh them, check their skin. I trust them,” and “Healthy well-cooked food, good nutrition and choice. I have seen the menus and when I’ve visited the food looks lovely, and she eats every bite. She also has plenty of fluids, I always see her with a juice, and she has water in her room.”

Staff told us that they are given training which follows current good practice guidance, and that they get updates and refresher training. One staff said, “We get training refreshers and supervisions. We also have competency assessments.”

We saw evidence of multi-disciplinary team meetings to discuss people’s needs and wishes and ensure sharing of good practice. The provider used a computerised care record system for all their care services that used recognised assessments to assess people's support needs. Recognised assessment and monitoring tools were used appropriately to track improvements or concerns, and the manager had oversight of these and planned action appropriately. The service had links with other organisations to access services, such as tissue viability services and speech and language therapists (SaLT).

The provider worked well across teams and services to support people. However, they did not always share their assessment of people’s needs when people moved between different services.

The staff confirmed that they gave verbal handovers when staff moved between different services, but they were not able to download or print the care plan and assessments. This meant there was a potential that not all important information was shared. During the assessment process, the provider ensured that all staff now knew of how to download and print care plans and hospital passports.

Staff told us how they work as a team. One said, “We are a good team, support each other.” Staff told us that all new staff were buddied up with an experienced staff member who knew people well, which helped them to settle in.” Another staff member said that they felt that the home had gone through a bad time but now was going forward in the right way.” The staff confirmed they have regular staff meetings and are supported to contribute can ideas and suggestions.

Health professionals told us that working relationships had improved over the past year and were knowledgeable about the people they support.

All relevant staff, teams and services were involved in assessing, planning, and delivering people's care and treatment. Staff worked collaboratively to understand and meet people's needs. When they needed advice, they sought it from the appropriate health professional and listened to their advice. The Information to ensure peoples safety and well-being was shared between teams and services to ensure continuity of care, for example when tasks were delegated or when people are referred between services.

Families told us, “Yes, once when she had a fall as a precaution, she went to hospital, as her arm was sore. I was updated throughout, and she was well looked after, including when she went back to the home."

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 and families told us that they were supported by staff to attend appointments to maintain their physical and mental health. A family member told us, “Yes, she attends all her appointments and this is well organised. She is supported well to be able to attend and participate in her appointments. I’m kept informed throughout.”

There were processes in place to guide staff about how to support people to lead healthier lives. People were encouraged by staff to eat healthy meals and drink regularly to maintain their physical health. They were encouraged to walk and be active

Staff described to us the ways in which they support people. Comments included, “We encourage them to be independent with daily choices,” and “We organise appointments for people, doctors, opticians and hospital appointments."

Care documents showed there was evidence of regular reviews and input from the GP, Optician, Dentist and Chiropodist. Equality and diversity were embedded in the principles of the service and the provider had an equality and diversity policy in place to protect people and staff against discrimination.

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.

Comments from relatives were positive, and included, “[Relative] has improved so much since they moved here, their mobility has improved.”

Staff told us they carry out care reviews monthly and discuss changes in peoples care frequently. Comments included, “we have handovers and talk each day at shift change. We continuously monitor to make sure we are meeting their needs.”

The staff team worked closely with the GP, dieticians and speech and language therapists (SaLT). Care plans and assessment tools were in line with guidance from the national institute for health and care excellence (NICE). The provider carried out assessments and reviews to ensure they were regularly monitored for changes in their level of need. There were organisational systems in place to monitor people’s care and treatment and their outcomes. Audits were used to identify issues and themes and to learn lessons to provide positive outcomes for people.

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

People were asked for their consent and were involved in day-to-day choices and decisions. People told us, “They do ask me if I need help, I haven’t been well, so ask for the help I need, Relatives told us, “Yes, my Mum has choice which was another important part of my search criteria for a home. They are very good with this, my Mum decides what she wants to wear for the day, what she would like to eat and if she wants to spend time in the communal area or her room (she loves spending time in the communal area which is a really good sign of how comfortable she is made to feel at St Nectans. They give gentle encouragement to participate in activities however they respect her decision when she decides she does or doesn’t want to participate in an activity.”

Staff said that they have received training on the Mental Capacity Act. One staff said, “We do ask people first, it is their right to refuse, but we go back later usually.” Staff received training in the principles of the MCA and understood their role and responsibility in upholding those principles. People were asked for their consent and were involved in day-to-day choices and decisions.

Staff had received training in safeguarding and The Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff interaction with people demonstrated that people's choice and involvement was important to how care was provided. We saw people making choices about where they sat, and what they ate. However, we were told that there were currently no DoLs in place, despite many people living with a diagnosis of dementia. There was no evidence to support the use of sensor aids. There were also discrepancies in peoples’ documentation regarding their decision making, and some did not reflect peoples’ fluctuating capacity. This was addressed by the provider and confirmed by the local authority.