Harrier Grange

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.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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

People were assessed face to face before moving to the service, so that the service could assure themselves they were able to meet people’s needs. This information was shared with staff before the person moved to the service.

Most of the relatives of people we spoke with told us they were included in care plan reviews. One person’s relative said, “The nurses go through [the care plan] with me.” Staff told us they were informed of changes made to care plans during handover between shifts, and also that they were encouraged to inform staff who were responsible for writing care plans of any changes that needed to be made. One staff member said, “Usually the care staff inform the nurse and tell them what’s been happening. The nurses will go and assess the resident, update the care plan and give a handover to all the care staff at the start and end of each shift.”

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.

The service used nationally recognised assessment tools to assess people’s risks and support needs. There were good links with external health professionals who in the main, told us staff listened to and acted on professional advice and recommendations.

There was good oversight of weight loss and malnutrition risks across the service. People’s weight was monitored, and the chef told us that nursing staff kept them informed when people had lost weight, so that they could adjust portion sizes and ensure food was fortified.

We observed lunch during the inspection. Dining tables had been set, and we saw several people sat in small groups around tables; some people chose to eat in their bedrooms, and this was respected. Drinks and assistance were offered to people throughout the meal. One person’s relative told us, “The food is amazing. I can eat with [name] if I want to. Since [name] has been at the home, they have put on weight. [Name] looks healthy.”

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 told us communication within the service was good. They said there were daily meetings, with a staff member from each department attending. This enabled key messages to be shared and then escalated to staff within the wider teams.

Staff worked with a range of health professionals, including the tissue viability nurse team, the older people’s mental health team and the Speech and Language Therapy team. Referrals were made when needed, and overall, staff followed up on actions and recommendations with external professionals. One health professional told us, “We have contact with Harrier Grange most weekdays either via phone or email. All staff that we have regular contact with all seem to have a good understanding and knowledge of people’s health needs and medications; we have no concerns.” However, another health professional told us they did not think communication from the service to them, was timely or effective. We shared this feedback with the provider who told us they would look into how staff communicated with external professionals.

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 healthcare needs were assessed and care plans in relation to these aspects of care were informative. For example, some people were living with diabetes and their care plans informed staff of the blood glucose level that was usual for them, and the signs, symptoms and actions to take if people had a high or low blood sugar.

People and their relatives told us they were supported to access healthcare services, both at the service and other appointments. One person said, “I prefer to go to my own dentist, and the staff will take me.” Another person’s relative said, “[Name] gets regular reviews from the doctor. [Name] has diabetes, but it's better controlled now than when [they] were at home.”

The activities programme included activities to promote movement as well as activities to engage people mentally, such as armchair exercises and quizzes.

There was oversight of people’s needs in place. Clinical governance meetings took place regularly and any wounds, weight loss and falls for example, were monitored and analysed for any trends or actions required. People’s relatives told us their loved ones were well looked after. One person’s relatives said, “[Relative] has been unwell at times. The nurses always ring me and handle it well. And in a timely manner.”

We reviewed some wound care plans. Several photographs of wounds we looked at, lacked any form of identification of whose wound had been photographed. Although wound measuring tools were in use, staff had not consistently completed the date or name section. This meant it would be difficult for staff to easily identify which wound they were looking at. We fed this back to the management team, who following the inspection provided us with records of staff supervision in relation to best practise for wound care.

Some people had air mattresses in place to reduce the risk of skin damage. Not all of the air mattresses we looked at were set correctly. We fed this back to the management team and were provided with assurance that this had been addressed and that all mattresses were now set correctly.

Despite this, records showed that people’s wounds had improved. One person told us, “The nurses here got rid of the ulcer on my leg. They were much better than the hospital.”

People had been assessed for their capacity to consent to aspects of their care. When people were assessed as lacking capacity, best interest decisions had been made, and in the main, records were in place to show who had been involved in the decision making and any less restrictive taken into consideration.

Staff had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted to the local authority in line with legal requirements and when conditions were in place these were included within people’s care plans.

However, not all records were an up-to-date reflection of people’s needs. One person had a sensor mat in place to alert staff if they tried to walk unsupported, but there was no mental capacity assessment in place. Another person had a mental capacity assessment in place for the use of bed rails, but the information documented conflicted with the bed rails risk assessment. Another person’s care plan referred to conditions relating to a DoLS authorisation, but the condition listed no longer applied. We fed this back to the management team and records were updated by day 2 of the inspection or added to the service improvement plan.