Esmere Gardens

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people’s needs were met through good organisation and delivery.

This service scored 71 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People we spoke with were aware of their care plan and confirmed they and their family member had been involved in the development of this when moving to the service. One person said, “Yes, I have been involved with the care plan and in its recent revision”. A relative confirmed, “We were asked quite a lot of questions when [relative] first came here, we did answer them all, so yes there is a detailed plan”.

Some staff members worked a mix of day and night shifts and spoke positively about the benefits this had for knowing about people’s routines when they were less talkative and active in the evenings. One staff member said, “I learn more from working in the day about people, so this is great for then working at night. I love it.”

We found the information on people’s individual interests, life history and things that were important to them varied. However, some care plans explored this in detail and were person centred whilst other care plans were brief and had not fully captured things that were important or specific to the person. One healthcare professional said, “I think they do well at trying to make the service person centred but can sometimes over stretch how much work they are trying to achieve.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The provider was clear on the type of care needs the service could provide for and meet. This meant the needs of prospective new admissions were considered alongside the needs of people already living in the service, to ensure all their needs could be met safely and effectively.

Staff told us they felt confident in supporting and meeting the needs of people who had dementia. One staff member said, “I think it helps having experience personally, it gives a different aspect to what they are seeing. It’s hard for families. I think the home is well set up for people with dementia.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We did see some areas where information provision needed improvement. For example, people had to make their menu choices in the morning, and we observed that by lunchtime, some people had forgotten their choice, or upon seeing the food, preferred another option. Whilst this was supported by staff, for people who lived with dementia, the process of making food choices would have been better supported by having visual representations of the meals or being offered choice at the time of serving. The kitchen staff and registered manager showed us that work was underway to provide more accessible ways of choosing food.

People living in the service had been given a life story form to complete. This would enable staff to learn more about each individual and their experiences. However, this information had not always been presented in the most appropriate way. One person told us they had been given the form without explanation and upon reading it had been upset and confused because it referred to the person as having dementia and this person did not have a diagnosis of dementia. A more individualised approach to presenting information to people was needed.

People had not always been asked to provide their wishes for care when they became poorly to ensure staff could provide a person-centred approach at this time. This meant some people were not supported in ways that they had wanted.

People’s communication needs were recorded and supported by staff who understood people’s individual requirements. Staff demonstrated knowledge around how to enhance people’s interactions with 1 staff member commenting, “Speak clearly, actively listen, offer a distraction-free environment, being patient. Ensure communication aids are in place and in good condition.”

People moving into the service were provided with a guide to help them settle in and ensure they had all the necessary information about the home. Relatives we spoke with praised the communication they received from staff about their family member, so they could keep updated and informed.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People and relatives had the opportunity to attend regular meetings and have their voices heard. We saw future dates for these meetings were displayed so people could make arrangements to attend. The feedback about these meetings was positive with comments including, “I go to the relatives’ meetings, they are once a quarter, I find the registered manager and clinical lead are so available. They are always happy to accommodate anything that works” and “We do have regular relatives’ meetings and there is normally a residents’ meeting just before it. They are always helpful in explaining things and what is happening here and how it is developing and more important, for now, how it is involving local people.”

Surveys were used to gather feedback from people, their relatives and staff. We saw positive feedback comments had been made about the environment and the support from staff. The responses from people, relatives and staff were analysed by leaders and any required actions arising from this feedback were addressed. Feedback from a recent staff survey had resulted in the implementation of a more accessible system for staff to access employee related information, and a weekly activity highlighting and sharing compliments to staff about their practice.

The service had several ways in which positive feedback and any concerns could be shared. The positive feedback from people and families about the care provided by staff was shared with the staff team. One person said, “I can go to anybody, but I know if I really wanted to go to anyone it would be the manager.” We saw people had been involved in creating a home calendar with photos of them, in different poses, having fun with the staff. One staff member told us this had been a lot of fun.

The service had a system for responding to any concerns or complaints. Where concerns required escalation, senior management were involved in investigating these and a problem-solving approach taken to understand what the cause behind the complaint was and what lessons could be learnt from the issues raised. Complaint outcomes were shared with the individuals concerned and then highlighted in staff meetings for wider learning. One staff member said, “..Every complaint I take as an improvement. It is not a challenge, we can improve. There are minor complaints, but people open up to me.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The home was easily accessible to meet people’s varying mobility needs. Bedrooms and corridors were a good size allowing for any equipment that people may need to support them, and there was lift access between the floors.

The service was staffed 24/7 which meant people had support available to them at any time they required it. Any concerns could be further raised by staff using the on-call procedure.

People were supported to maintain access to healthcare professionals including GP’s, dentist and opticians. One person said, “I can go and visit my old opticians in [name of place], I said I could phone [name of supporting organisation] to arrange to visit with me but the [receptionist staff]) heard me and she went with me for the appointment. I know I can go to the dentist like this too.”

The service provided a private physiotherapy service to people living in the home which they may not have had access to otherwise. This enabled them to receive any support in a timely way and positive benefits in people’s mobility had been noted.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

People told us they were well treated and felt part of the home. No one had experienced any instances of discrimination or indications of a closed culture. The registered manager undertook monitoring for signs of closed cultures developing, such as poor communication, lack of transparency and a fear to speak up. They did this by completing daily walk arounds and being visible, holding meetings, and gaining feedback from different staff members if concerns were raised.

People moving into the home were supported to retain things important to them and continue having experiences that gave them positive outcomes. The provider motto was ‘life is for living’ and this ethos was grounded in enabling people to live their life to the fullest regardless of age or circumstance. We saw people had been supported to celebrate meaningful events including special anniversaries, milestone birthdays and long followed hobbies and interests were made possible again.

The service welcomed into the home a Dementia Café every fortnight so people who were interested, could be provided with a safe and social community to meet, share experiences, and receive support. A training event had also been held to support older people with accessing and using technology, including phones and emails, to help break down some of the barriers experienced when using these methods of communication. This had also covered an awareness of the dangers or scams associated with technology to help people use it safely.

In the provider information return (PIR), the provider told us, ‘We continue to provide our staff with an Equality and Diversity course. It also provides our staff with knowledge and understanding regarding how to provide personal care and recreational activities in a way that supports equality, diversity and inclusion. Furthermore, we have also introduced LGBT (lesbian, gay, bisexual and transgender) training in care to our staff and enable them to understand people whose gender identity is different from the sex placed on their birth certificate.’ We saw that there was diversity among the workforce, and all staff spoke warmly about their experiences within the service.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw people had end of life care plans however, these were not always completed, or they lacked detail about people’s preferences of how they would like to be cared for and what was important to them at this time. Some people’s end of life care experiences had not always been well managed with their wishes not always obtained or followed prior to their health deteriorating. External healthcare professionals we spoke with highlighted the need for immediate improvements in this area and that some people had not received appropriate care at this time.

The nursing team were not as experienced or confident in recognising and providing good palliative care to people and as a result had relied heavily on external support for guidance. One staff member commented, “No formal training on end of life. Just learn from the seniors.” Another staff member said, “I would rather have proper training for this.” We saw there were gaps on the training matrix where not all staff had received palliative care training although, this was an area that further support and awareness was needed for all staff.

The registered manager confirmed this was an area of care practice where improvements would be made and end of life plans would be revisited with people who wished to share any details.