Shenstone Court Care Home

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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.

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

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The provider generally made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Care records were detailed and person-centred, with risk assessments, communication needs, mobility needs, nutrition, choking risks and end of life preferences assessed and reviewed. Staff used systems to monitor changes in people’s needs, including reviews, MDT notes, MUST assessments and tailored daily tasks that prompted staff to complete specific checks and support. Staff described how changes in people's health, wounds, medicines and risks were communicated through care records, reviews and handovers. A nurse practitioner told us staff, “Know the residents well and report deteriorating patients appropriately,” and “Recognise when residents have declined in health.”

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 had assessments and care plans to manage risks such as falls, pressure damage, choking, nutrition and skin integrity. Staff worked with healthcare professionals to ensure wound care, nutritional support and treatment plans were followed, and staff demonstrated a clear understanding of how to obtain advice when people’s needs changed. Staff described using referrals to district nurses, GP reviews and escalation systems when health concerns arose. A healthcare professional told us the service was, “Very good at managing weight loss in their residents.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff used handovers, flash meetings, multidisciplinary team (MDT) notes, daily records and electronic care systems to share information about people’s needs. Staff understood how to communicate changes in medicines, wounds and health conditions between shifts and with healthcare professionals. The service maintained regular links with GPs, district nurses, clinical nurse specialists, dentists and other health professionals, and staff described clear escalation pathways when concerns arose. A professional said, “Staff communicated concerns in a timely way and recognised deterioration.” However, they also told us, “Treatment plans were not always shared consistently with care staff, which sometimes led to duplicated escalation to other services.”

The provider supported people to access healthcare services and monitored aspects of their health and wellbeing. People had access to a range of healthcare professionals including GPs, nurse practitioners, district nurses, dentists, opticians, chiropodists and specialist teams when required. Staff monitored nutrition, hydration and weight and took action when concerns were identified.

Relatives spoke positively about communication regarding changes in people's health. One relative told us, “In the two weeks since they have been back [Person] has put on 5kg.” A healthcare professional described the service as, “Very good at managing nutrition and hydration.”

However, evidence identified during the assessment showed concerns in relation to medicines management. These concerns meant systems were not always effective in ensuring people consistently received safe and appropriate support to meet their healthcare needs. Whilst people were supported to access healthcare services, the provider could not demonstrate a consistently effective approach to supporting people to live healthier lives in all areas of care.

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 service monitored accidents, incidents, falls, weights, call bell response times, audits and adverse events. Managers completed daily oversight, weekly reviews and monthly governance checks and used information to identify trends and improve practice. Staff explained how concerns were reviewed through flash meetings, governance systems and management monitoring processes.

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

Staff understood the importance of supporting people to make decisions and described how they adapted their approach according to people's needs and abilities. Staff described involving next of kin or those with legal authority where appropriate and supporting people to make day-to-day choices without overwhelming them.

We saw evidence of Mental Capacity Act assessments and best-interest considerations where required. For example, records showed discussions involving a person, their family and the service to agree personal care arrangements and ensure care reflected the person's wishes. Care plans documented when people had fluctuating capacity and identified how staff should support decision-making.