The Shrubbery

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

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 assessment we rated this key question good. At this assessment the rating has remained good. However, improvements were needed in people’s assessed needs and monitoring and improving outcomes.

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.

The provider did not always ensure people’s needs were assessed and plans put in place to meet them. We saw care plans were not regularly updated and at times care plans contained conflicting or outdated information. Staff told us people’s care was reviewed, they could easily access people’s care plans, and they were kept updated with changes in people’s needs. One staff member said, ''People’s needs change all the time, it's important that we read care plans and make sure they are up to date.'' This showed it was important to have correct and up to date care plans in place as staff used these to understand people’s needs. People were at risk of receiving inappropriate care if these were wrong. One relative told us, “Communication is excellent. They always let me know if anything has changed”. Since the inspection the registered manager responded to our feedback by updating the relevant documents.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff were observed offering choices, following guidance and ensuring people’s nutrition and hydration needs were met. Staff were able to provide examples of how they monitored people's health regularly, such as people’s hydration and nutrition. People’s care and support needs were monitored in accordance with their care and risk assessments. One relative told us, ‘’The staff know my relative very well and know their likes and dislikes.” Systems and processes were in place to deliver evidence-based care. Daily records were completed consistently and actions taken following concerns raised by staff or recommendations made by professionals were clearly documented.

The provider worked well across teams and services to support people. People attended health appointments as and when needed. Relatives told us the provider worked in partnership with other health professionals such as doctors and dentists. Staff told us they worked in partnership with other professionals. One staff member told us, “We will contact the district nurse if we need any support, they are helpful.” Partners told us the provider shared information promptly, transparently and followed their recommendations and are quick to escalate any concerns. Records documented the provider worked in partnership with other health and social care professionals.

The provider supported people to manage their health and live healthier lives.

Relatives told us how staff supported people with their wellbeing, diet and exercise.

Staff supported people to make healthier choices and decisions. Staff gave us examples of how they encouraged people to live a healthy life. One staff member said, “We encourage fruit and vegetables and encourage people to drink plenty of fluids.” Another staff member told us, “If we notice a person has lost weight we will inform the manager.” We saw an exercise session was taking place. People were encouraged to take part in physical exercise.

Care plans recorded different approaches to encourage people to live healthier lives.

People’s diet and weight were monitored in accordance with their assessed need.

The provider routinely monitored people’s health and treatment to continuously improve it.

One person told us, “Before coming to the home I had been in an unsafe environment. I don’t have to worry now. I’ve got friends here today.”

Relatives told us people were being monitored safely.The registered manager told us, “We have regular training which gives us the skills to monitor people. We make sure care plans and risk assessments are in place and are reviewed often or when a change takes place.”

People’s health and care needs were monitored and the provider worked alongside other professionals such as physiotherapists and district nurses to ensure positive outcomes for people.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. We carried out a mealtime observation and found the environment was restrictive. We saw staff removing walking aids from people that were sat at the table. This meant people did not have access to their equipment should they choose to leave the dining room. We raised this with the registered manager. The registered manager acknowledged this and had taken steps to mitigate further risk. People and relatives told us staff consistently sought their consent before providing care and support. One relative told us, “My relative makes their own decisions regarding their care and support. However, I have observed staff gaining consent from people that lack capacity.” Staff told us they received mental capacity training and promoted people's best interests. One staff member said, "I ask for consent when administering medication, or if I'm carrying out people’s personal hygiene. We also have consent forms.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA and found appropriate legal authorisations were in place when needed to deprive a person of their liberty.