Herewards 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 inspection we rated this key question good. At this assessment the rating has remained the same. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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.People had different needs and information was noted in plans of care. However, we also identified that people did not always have clear care plans for certain aspects of care. For example, one person had a condition due to deficiency of specific vitamin. There was no specific care plan to guide staff how best to support this person and recognise any signs of deterioration to ensure timely support. Another 2 people were spending most of their time in bed. However, there were no care plans for skin integrity and how to manage any risks of pressure ulcers. There was no documentation regarding turning regime or rationale to prevent skin breakdown and how to manage it. People did not have clear and detailed plans of care for emotional wellbeing and dementia. This meant staff did not have detailed guidance to enable them to provide timely and effective support to the people.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. Relatives were kept up to date with people’s care and support and informed about any changes. People, and their relatives as appropriate, had been included in discussions and reviews around their care and how this was to be delivered. The provider worked with and sought support from different stakeholders to ensure the care was in line with legislation and current evidence-based good practice and standards. The registered manager and the staff team were motivated to plan and deliver people’s care and treatment, including what was important and mattered to them. This also reflected in the whole team approach to the care provision that had a positive effect on the service. The registered manager and the staff team communicated with people, their relatives and partners about their care and treatment relevant to people’s care.

People’s nutrition and hydration needs were met in line with current guidance. People and relatives were mostly positive about mealtimes and choices. Relatives and people said, “[The person] is eating well. They offer me lunch and we have a laugh together and the mealtimes are jolly", “The food is good and I am given choices about what to eat” and “The food is lovely. There are things I don’t like and [the chef] knows dietary needs. I don’t have any but other people do and [the chef] does his job well.”Kitchen staff communicated with the staff team on a regular basis to ensure they had the right information on what people’s diets; preferences and any specific requirements were. People could have a drink or snack at any time. We observed people had drinks available to them and were encouraged to have those. People received support where needed with meals and drinks to maintain a balanced diet. During mealtimes, we observed people were not rushed and maintained their independence with having meals.

The provider worked well across the teams and services to support people. The information was shared between teams and services to ensure continuity of care and when people were referred between services. Staff were sharing information and speaking with each other about planning tasks throughout the day. People were able to access some health services without needing to leave the premises. The provider worked in collaboration across teams and services to support people as they moved between services so that people had positive outcomes. When people transferred from other services, there was a process to manage initial assessments and plans of care were compiled to ensure they considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Relevant teams and services were involved in assessing, planning and delivering people's care and treatment and staff worked collaboratively to understand and meet people's needs. People told us they were supported with their needs and received care and support from the staff who knew them and their needs well.

The provider and staff supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live a healthier life and where possible, reduce their future needs for care and support. The staff team worked together to oversee people’s needs and preferences. When people needed medical support, this was sought to prevent any deterioration of health and wellbeing. Families were kept informed of the changes and actions taken. Relatives agreed they were informed of any changes in people’s health or wellbeing. People were involved as much as possible in reviewing their health and wellbeing needs where appropriate and necessary. The care and support for people's health and wellbeing was organised well. The service liaised with different external professionals such as the mental health team, physiotherapist, speech and language therapist, district nurses and GP surgeries. The managers and the staff were knowledgeable and informed about people’s health and wellbeing. One professional added, “[Staff] guarantee that [people] receive a care intervention that is tailored to their individual needs.”

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.Plans of care and risk assessments were available, but some records lacked detail and did not always outline steps to mitigate identified risks relating to people’s emotional wellbeing, cognitive changes or mental health support. This could increase risk to people not experiencing positive and consistent outcomes. For example, for one person, there was no emotional well-being or mental health care plan in place. The person had a history of paranoia and delirium. The current assessment and plan did not address how these symptoms impacted the person’s daily life, what specific risks it posed, or how staff should meet person’s mental health and emotional needs. This meant staff did not have clear guidance on how to support the person, manage distress, or reduce risk of deterioration. There was a risk of inconsistent care, unaddressed distress, and possible safeguarding incidents.

The provider considered people’s rights around consent and respected these when delivering person-centred care and treatment. However, some of the records relating to consent and decision-making needed improvement. For example, people’s rights were not always respected in line with the Mental Capacity Act 2005 (MCA). People had a consent form noting different aspects of care or support. These records were signed by a third party without it being clear that they had the legal authorisation to be doing so. There were no clear capacity assessments and best interest decision meetings held to demonstrate people have given their consent and made an informed decision. This did not demonstrate people’s involvement and consideration of their wishes. We considered this under the key question of well-led.

We observed staff were polite, kind and respectful towards people and respected their decisions. Staff sought people's consent before providing care or support. If people did not want to do something or take part in an activity, the staff responded appropriately. Staff understood individual needs of people and helped them make decisions. Staff supported people to make decisions, choices and look after themselves. People agreed that staff were respectful when supporting them and they did not feel rushed.