Sandstone Brook

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.
 

This service scored 75 (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 needs were assessed before they moved into the service to ensure these could be safely met. Pre-admission assessments were comprehensive and covered areas such as communication, health conditions, mobility, equipment needs, lifestyle preferences, social interests, and people's likes and dislikes. Where appropriate, information was obtained from family members, hospital staff and other professionals to support effective care planning. The registered manager told us admissions to the home were only accepted following a pre-admission assessment to ensure the service could meet the person’s assessed needs. This approach had been strengthened following lessons learned and helped ensure people experienced a safe and effective transition into the service.

The provider used an electronic care planning system which staff were familiar with and able to access. Care plans contained detailed information about people's health conditions and support needs. Staff told us they were kept informed about changes in people's needs through handovers, staff meetings and care records. One staff member said, "The care plans are good and give us a lot of information to support people safely."

However, we identified some inconsistencies within one person's care records, including conflicting information regarding special diets and thickened fluids, a call bell assessment and information relating to urinary tract infections (UTIs). We discussed this with managers, who reviewed and updated the records during the assessment. We confirmed the amendments had been made on the second day of our site visit.

Risk assessments were completed on admission, and care plans were developed and updated as staff got to know people and their needs. The provider used review systems and care plan trackers to monitor people's care, with formal reviews completed at least every six months and involving people and their families where appropriate. However, most we viewed had been reviewed monthly. This helped to ensure care remained effective to people's changing needs.
 

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.

Staff had completed training relevant to their roles and were supported to maintain their knowledge and skills. This helped to ensure people received care and support in line with current legislation, best practice guidance and their assessed needs.

Where people had specific health conditions, care plans contained detailed guidance for staff on how to provide safe and effective support. People's nutritional and hydration needs were assessed and managed appropriately. Staff followed guidance from GPs and Speech and Language Therapists (SaLT), including texture-modified foods and thickened liquids recommendations, to reduce the risk of choking, malnutrition and dehydration and support safe swallowing.

The registered manager had developed a network of staff champions, including Nutrition and Dementia Champions, who undertook additional training and worked closely with external professionals to promote good practice. Champions provided advice, support and training to colleagues, including new staff, helping to embed evidence-based approaches across the service. This demonstrated a commitment to maintaining staff competence and ensuring care and treatment reflected current best practice.
 

Staff worked in partnership with health professionals to support people’s health needs, including professionals from the local medical practice. Feedback from these health professionals told us there were sometimes inconsistencies in staff knowledge about people and the availability of appropriate staff to provide clinical information to them when they visited the home. They told us staff also on occasion, interpreted symptoms or changes associated with people’s existing health conditions as new or acute problems. This could lead to requests for repeated assessment where a clearer understanding of the person’s established clinical history might otherwise have prevented unnecessary intervention. They also told us staff and management at Sandstone Brook had demonstrated a willingness to engage with their feedback since the home opened and to make improvements.

Information was shared appropriately when people moved between services, including with paramedics and hospital staff, helping to ensure continuity of care and support.

Staff told us they were kept informed about changes in people's needs through handovers, team meetings and regular communication, and felt able to raise questions or concerns when needed. The registered manager had established systems to promote effective communication across the service. This included daily staff "huddles" attended by senior staff, where key information and risks were reviewed. This included recent admissions, any clinical concerns, accidents and incidents, nutrition, maintenance issues and housekeeping. This helped to ensure important information was shared promptly within the staff team, and risks were identified and managed effectively.
 

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’s care records identified and planned for health concerns which could affect their physical health, emotional wellbeing and identified risks. They worked with people to help ensure, where possible, this did not affect their future care needs. People told us staff had supported them with improving their mobility. People were encouraged to participate in varied activities and had access to communal and outdoor space and told us these social interactions helped improve their mental and general wellbeing.

People’s weight was monitored at a frequency depended on their assessed risk of weight loss and malnutrition. Staff also monitored people’s bowel movements, pain and skin integrity where necessary. People had access to healthcare services when required, including GPs, advanced nurse practitioners, district nurses and specialist healthcare professionals.

People were supported to maintain good oral health. Oral health needs were assessed, and the service had an oral health champion who was leading the Care to Smile programme and working towards accreditation. People could access dental care through visits from a private dentist to the home or local community dental services. Care to Smile is an NHS programme designed to improve the oral health of residents in residential and nursing care homes and provides care homes with tailored resources and ongoing support.
 

The provider monitored all people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

People told us they experienced positive outcomes and improvements in their health, wellbeing and quality of life whilst living at Sandstone Brook. People and staff gave positive examples of how support had enabled people to achieve their goals and maintain meaningful lifestyles.

One person, who had limited verbal communication but was independently mobile around the home, experienced a significant health event which left them with poor mobility. After the person was discharged from hospital, the registered manager used their knowledge from a music therapy course they had completed to support the person to engage with the music and walk again. A member of the person’s family was involved and together they used the person’s favourite music to help get them moving from soft arm and hand movements to walking. The family member told us, “[Person’s name] has thrived here, when they were in hospital, they were stuck in bed and was fading away. The difference in them now is amazing.”

People told us staff understood their personal goals and supported them to achieve improved quality of life outcomes. One person explained staff knew they wanted to improve their mobility and remain active, adding, "They help me do that. I am now walking again after major operations on my legs." Another person told us, “Excellent care and they have really helped with my recovery and my mental health as I was really low when I came here.” These examples demonstrated how staff worked with people to support improved outcomes which were important to them.

People spoke positively about the activities provided and the impact these had on their wellbeing and social inclusion. One person told us, "Excellent activities. Llamas and karaoke, and the manager and staff join in. I have made friends and am no longer lonely and on my own." Staff also described seeing positive outcomes for people who had initially been reluctant to engage but had gone on to enjoy activities and develop social relationships with others.
 

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

People told us, and we observed, staff involved them and sought their consent before providing care and support. We saw many examples of staff confirming and supporting people to make choices and decisions, which included eating, drinking and participation in activities.

Staff understood the importance of supporting people to make their own decisions wherever possible and sought consent in a way which reflected people's individual needs and abilities. Staff demonstrated an understanding of the Mental Capacity Act 2005 and told us they considered people's capacity when supporting decision-making. One staff member told us, "I always check the care plan if I have doubts about someone's capacity. Some people may have capacity at some times and not at other times, so we would wait and discuss decisions when they are able to make them where possible."

Records of people’s capacity assessments demonstrated how they had been supported to understand the decision to be made. Where people did not have capacity to make their own specific decision, records showed how the decision had been made on their behalf. These meetings involved the person’s relatives where appropriate. By following this framework people's rights were protected and their best interests considered when decisions were made on their behalf.