Lenthall House

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 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.

Systems and processes were effective in identifying people’s assessed needs and reviewing them to ensure people’s care, treatment, health and communication needs were met, with the involvement of relatives. A relative told us, “Overall, staff are trained well and give excellent care. What I see is good, and there are regular review of [person’s] care plan.” Another relative said, “There has not been a formal review of the care plan, but only recently, I could see [person] was really flagging in the afternoon, so I asked them to build in a quiet rest period for her, and they have done that.”

The manager informed us care plans were created in partnership with the person, their relatives or next of kin. Where processes or routines which worked well prior to admission were shared, they made sure these were carried forward, as this provides familiarity and reassurance to the person, supporting a smooth transition into the home and promote overall wellbeing. A relative said, “Staff did ask lots of questions when he went in there, it was all written down.”

People’s care needs were stored electronically, providing all staff with access to people’s care records via handheld devices, which they could update, documenting any changes in people’s health and wellbeing. People’s care and support was reviewed monthly, or sooner if any changes were noted.

Staff told us they had access to people’s care plans, some staff did say finding time to read care plans could be challenging. Staff were made aware of people’s needs when they first moved into the service. A staff member told us, “When someone comes in, the manager or senior carer will tell us about the resident’s needs, what they are like, what help they need. They go over the care plan, which we can read.” Staff felt handovers were effective in keeping them up to date up with changes in people’s needs. Staff knew where paper care plans were kept for reference, along with the electronically stored care records.

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 spoke positively about the food and the meals. A person told us, "We can have as much or as little as you want. I've never requested anything else other than what was on the menu, but you could if you wanted to." A second person said, "Very satisfactory, you get a choice. I don't eat meat anymore; they accommodate my choice. I really enjoy vegetables and puddings. At breakfast I usually have cereals and toast, sometimes I enjoy having egg and tomatoes." Relatives in some instances visited at mealtimes to support their family members to eat and support social interaction.

Relatives’ views were mixed when asked about the meals. A relative told us, “My husband loves the food, maybe a bit too much as he has put on 2 stone since December. He could have a fry-up every morning if he wanted one.” A second relative told us, “Food is currently a bit of an issue, some vegetables are too hard.”

Themed days were organised to celebrate food from around the world, along with meals being prepared to celebrate days for special events. A relative told us, “They have had themed days for food. On Father’s Day they had hot dogs and beer for everyone, which went down well.”

Recognised clinical assessment tools were used to assess and review people’s care and support needs, such as skin care, dietary and hydration needs. Appropriate observations were carried out when people presented as unwell. People were referred to health care professionals in a timely way, who told us staff assessed risk and put in place measures to mitigate risk and improve people’s outcomes prior to a referral being made. A health care professionals informed us, “A referral was made for deteriorating skin care. The staff had already reviewed the resident’s dietary intake and fluid intake, including adding supplements where required. Equipment had been updated and repositioning charts put in place.”

People who required monitoring and support with hydration and nutritional intake had a nutritional care plan in place. Nutritional care records included information about modifications to people’s food, using recognised tools. For example, International Dysphagia Diet Standardisation Initiative (IDDSI). This is important so all staff supporting people to eat, and drink know the consistency of nutritional intake to reduce the risk of choking. We found the chef to be knowledgeable about IDDSI, and told us feedback about the meals was gathered after mealtimes. They told us information detailing people’s dietary requirements was kept within the kitchen to ensure the catering team had the relevant information.

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.

The provider had systems and processes that supported the exchange of information about people’s care and support needs with others. Staff had access to people’s care records via handheld devices, which they updated following all care interactions, and provided real time information, that could be accessed by both the staff and management team.

There was a collaborative approach to supporting people. People’s care records confirmed referrals to external health and social care professionals were made when required, and in a timely manner. We received confirmation from the community therapy and podiatry team, that they had received appropriate referrals.

Where required, Multi-disciplinary Team meetings involving nurses, carers, therapists and the management team were held to review and discuss people’s care and treatment needs, and co-ordinate effectively. A health care professional from the therapy team confirmed they left a form advising the staff of a change in the plan of care, for example, the use of a particular mobility aid. Follow up visits found the person was observed using the equipment, which demonstrated the advice and instructions had been acted upon, so supported good outcomes.

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 health conditions were assessed and monitored using recognised clinical tools. Care plans provided staff with guidance on how to provide effective care and support. Health needs were monitored. For example, people living with diabetes were monitored to ensure their condition was managed well. A relative told us, the action taken by staff when their family member lost interest in eating. They said, “After a fall, staff went out of their way to present food that might get them interested in eating again. When I told them in the kitchen that they loved milkshake, they created some wonderful fruit filled ones to tempt her, and it worked.”

People’s care records provided information regarding any health conditions, and how their health affected the person. Staff were trained to identify early signs of health issues and escalate their observations to the management team. A relative told us, “The carers showering [person] had identified 2 lumps. The GP was called as it was presenting as a [specific type of cancer]. The staff have arranged a [health test] at the hospital.”

Staff we spoke with understood the signs of urinary tract infections and pressure ulcers, and demonstrated good knowledge about people’s health concerns and knew how to act. Staff were aware of information available about the signs of sepsis and infection. Staff confirmed referrals to health care professionals, including the GP, continence team, speech and language therapy were made, and via the use of 111 and emergency services.

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.

A relative told us how staff worked in tandem with an occupational therapist, who had devised exercises to support their family members rehabilitation following an infection which they acquired following surgery. The relative said, “It has really been a team effort.”

The provider’s electronic record system informed staff of all care interventions which were required. This supported staff in monitoring people’s care and support. Where changes were noted, these were documented and reported to inform the review of people’s care needs.

The provider had systems and processes which monitored clinical outcomes. The manager told us concerns were highlighted to the senior carer and care team, at each shift handover, sharing updates on people’s clinical needs and wellbeing. Outcomes from multi-disciplinary meetings were documented.

Health care professionals informed us there was a proactive approach to maintaining and improving outcomes. An external healthcare professional informed us that when they visited the service, they often observed residents participating in chair exercises as part of the home’s activity plan. This was further supported by another health care professional who advised that when exercise plans were left for people, the staff were prompt in implementing them.

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

People’s rights were respected. Staff had received training on the Mental Capacity Act (MCA) and the MCA principles. However, staff responses to questions showed some lacked confidence in the MCA and Deprivation of Liberty Safeguards (DoLS). Staff we spoke with understood the need to gain people’s consent prior to any care intervention. A person when asked if they were involved in decisions about their every day care told us, “I decide what time I like to go to be and get up, staff are respectful.”

Best interest decisions were in place for complex decisions where people had been assessed as lacking capacity to make an informed decision. People’s records included information where people had a Lasting Powers of Attorney (LPA) in place for care and welfare, this ensured the appointed person was involved in decisions relating to care and welfare, where the person was unable to make an informed decision.

People’s records stated if people had a DNACPR (do not attempt cardiopulmonary resuscitation) or a ReSPECT form (Recommended Summary Plan for Emergency Care and Treatment) which recorded their wishes.