Holywell 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.
This was the first assessment for this service under the new provider. This key question has been rated good. This meant people experienced positive outcomes and staff worked consistently to ensure care was effective and based on people’s needs and preferences.

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.

People’s needs were assessed and reviewed to support safe and effective care.

Staff understood people well and used information from assessments to plan support. People confirmed staff knew their preferences. One person said, “It’s [the home] run very well; they know me and have read up about me”.

Initial assessments ensured the service could meet people’s needs, and staff told us handovers helped them stay up to date. One staff member told us, “At handover they will tell us if someone’s needs have changed.” Where new needs or changes were identified, the management team took prompt action to ensure these were met.

The management team planned and delivered people’s care and treatment with them, including what was important and mattered to them. They were aware of legislation and current evidence-based good practice and standards.

People said they liked the food served in the home. One person said, “The food is marvellous” and another told us, “The food is excellent; there is a choice.” People chose what they wanted to eat and drink. There were menus on the dining tables to remind people of the choices available. If people did not want either of the meal choices, staff were perfectly happy to make them something else.

Some people ate and drank independently; others needed support. People could choose to eat in the main dining room, in the main lounge or in their own room. Plated meals were served to each person by staff. No one had the opportunity to serve themselves or others they were sat with although some people would clearly be able to. We therefore suggested people's mealtime experience should be reviewed to ensure it was person centred and people's independence respected and promoted. The management team were receptive to this and would add this to their improvement plan for the home.

When we first visited everyone in the home had their fluid intake monitored. There was no clear rationale for this. Some people drank independently so it would not be possible to accurately record how much they had to drink. The use of fluid charts for everyone in the home was therefore reviewed by the management team prior to our second visit. People now only had their fluid intake monitored if there was a clear reason for doing so.

Staff were aware of the need to involve people in all aspects of their care and ensured they met their assessed needs. Staff understood each person's care needs. Staff told us people's care plans included their nursing and personal care needs, how these were to be met and desired outcomes.

Nationally recognised assessment tools had been used to assess people’s needs in relation to the risk of pressure damage to their skin, eating and drinking and the risk of choking. We noted no person at the home had any pressure damage to their skin.

Staff told us they ensured people were supported by other health care professionals to ensure people received care based on best practice and current guidance. Staff were described as knowledgeable and skilled. One care professional had commented: “An incredible staff team. I could feel the care and extraordinary atmosphere they create."

The management team 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.

A member of the management team completed an assessment prior to people being offered care to ensure they could meet the person's needs safely and effectively. If a decision was reached to provide care, a care plan and risk assessments were developed, put in place and a moving in date agreed.

Relatives told us communication was positive. One relative said, “They talk freely and email me regularly.” Staff worked closely with the person, their family members and other care professionals to ensure people received safe and effective care and good practice guidelines were followed. Staff confirmed they worked with GPs, therapists and community nurses, despite challenges with obtaining GP visits.

Staff worked well together as a team and understood the importance of communicating effectively. A staff member said, “The staff team get on really well” and “Handover is very helpful.” People told us there was consistent teamwork. One person said, “The home is very good, staffing is good, enough staff around."

The management team supported people to manage their health and wellbeing and supported their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. One person said, “When I first moved here, I wasn't taking care of myself. I've certainly improved since I've been here. I’m much better now and I thank them [staff] for that.”

Staff said they supported and encouraged people’s independence. One person told us, “I do what I like, I am not forced to engage if I don’t want to.” People had varying levels of needs and abilities. Observations showed staff ensured people were not restricted, and people were free to move around the home as they wished. People told us there were activities such as gentle exercise, which helped them to remain mobile.

Staff liaised with external health and social care professionals to ensure people received consistent care and support. Preventative medicines were encouraged. People had the choice to be vaccinated if they wished to. Staff made sure this was organised for people who chose this option.

The management team 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.

People said they were well cared for. Relatives felt the quality of care was very good and led to good outcomes for people. One relative said, “They [staff] have improved [name’s] quality of life. He now doesn’t have to go in and out of hospital [as they used to have to]”.

The service monitored outcomes through audits, care plan reviews and ongoing observations. Staff acted quickly when concerns were identified. Staff used electronic medication systems to reduce errors and regularly reviewed medicines with GPs and pharmacists.

The management team told people about their rights around consent and respected these when delivering person-centred care and treatment. Some improvements in record keeping were required.

People were supported to make their own decisions, make choices and be involved in their care. Staff understood the principles of the mental capacity act and asked for people’s consent before providing care or support. One staff member told us, “I always ask people, would you like me to [before providing care].”

There were systems in place to ensure people consented to their care, if they had capacity to do so, and to ensure the principles of the Mental Capacity Act 2005 (MCA) were followed when people lacked capacity to make decisions about their care. Details of others involved in people's care, who could support with decision making or had legal status to make decisions on their family member’s behalf, were included in people’s care records.

However, records of people’s capacity and best interest decisions were inconsistent. Care records did not always show who had been consulted when a decision needed to be made for an individual who lacked capacity to make the decision themselves. This was discussed with the management team who would ensure clear records were kept and people’s legal rights protected.