Andover 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.

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 62 (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 support needs were assessed prior to moving into the service. However, the provider did not always make sure people’s care and treatment was effective. This was because care plan information was not always sufficient to ensure people’s needs would be fully understood by all staff.

Some care plans for people living with dementia needed more information to ensure staff had all of the information available to them to keep people safe. For example, situations that might trigger people to feel anxious, had not always been documented. When staff had been unable to identify any triggers, this was not always recorded. In 1 person’s care plan, it stated staff should use “distraction techniques” but there was nothing written to describe what this meant. We spoke with the registered manager about this who told us they would include information on triggers and distraction techniques to care plans going forward.

Autistic people and people who had a learning disability had care plans in place which described how they may present when distressed. For these people care plans guided staff how to recognise this and action they could take to help improve the situation.

Staff told us any changes to care plans were discussed during handover and records confirmed this. People, and where agreed, relatives, participated in people’s assessments to ensure their views and opinions were captured.

Where some people had a learning disability or were autistic, records did not always demonstrate how they had been involved in their assessments and reviews when people were not able to verbally communicate their views and opinions. However, staff clearly knew people well and were able to demonstrate how they respected, listened to and implemented people’s preferences as part of their day-to-day support.

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 provider used nationally recognised tools to assess and monitored people’s needs and risks, including the risk of malnutrition and skin damage. People had access to an in-house physiotherapist. Some people had contractures, and the care plans provided staff with information on how to maintain hygiene and improve joint positioning.

Staff ensured people had enough to eat and drink and where there was a concern in this area, staff had put safeguards in place to help people manage these.

Some risk assessments were completed using scoring to assess people’s risk; however, all prompts had not been considered to ensure the assessed risk levels used to plan care were accurate. The risk of this was mitigated because staff knew people well. We spoke with the registered manager about this who told us they were in the process of reviewing all care plans and risk assessments.

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 had access to people’s care and support plans to understand people’s needs and deliver their care. The service used an electronic care planning system and staff used handheld devices to write notes in real time and to view people’s care plans.

A multi-disciplinary team of health professionals supported the service. Records showed staff consulted with external teams such as the tissue viability nurse, speech and language therapy (SALT), a learning disability team, and the older people’s mental health team. When advice was sought, this was documented, and when people were reviewed, this was included within care plans. This meant all staff were aware of the most up to date recommendations.

Where people had a learning disability or were autistic, their choices about how they wanted to be supported were communicated so a consistent approach was maintained between services.

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.

Staff monitored people’s health and escalated concerns appropriately. The service used the National Early Warning Score tools to assess when people’s health had deteriorated and when they needed to escalate their concerns.

Some people had diabetes. The care plans for these people informed staff how to support people to make healthy choices around their food intake to promote a stable blood sugar level.

People were supported to access prompt care and treatment and where additional support was required, the staff made referrals to relevant health care professionals.

The information the provider relied on to monitor people’s care and treatment to continuously improve it was not always reliable. Therefore, both clinical expectations and the expectations of people themselves might not be met.

There was oversight of people’s care and treatment. Records showed wounds, weight loss and falls for example, were monitored. Appropriate referrals had been made for people who required additional clinical support, such as the tissue viability nurse, the older people’s mental health team and speech and language therapy (SALT).

We reviewed the care plans of some people who had wounds. Although the wound care plans detailed the frequency of dressing changes and the type of dressing required, we observed the photographs taken of wounds did not always make it easy for nurses to assess if wounds were deteriorating or improving. This was because wound measurement tools were used inconsistently; some of the photographs we looked at included a measuring tool, others did not. Record keeping in relation to the size of wounds was also inconsistent. Some staff had documented wound dimensions, but not all. The registered manager told us they had discussed this with the nursing team and started making improvements. For autistic people and people who had a learning disability there was some detail to evidence how people’s skills, life experience and strengths were discussed with them and those involved in their care, to understand how their life choices, goals, ambitions and outcomes could be planned and achieved.

The provider told people about their rights around consent and did conduct mental capacity assessments when required. However, records relating to mental capacity assessments and best interest decisions were not always detailed and sufficiently comprehensive to show how decisions had been made in accordance with the principles of the Mental Capacity Act 2005 (MCA). Where relatives participated in these assessments best interest meeting records did not always detail what the relative’s opinion was or if they agreed with the decision being made. The registered manager told us they would review the mental capacity assessments.

All legal applications had been made in accordance with Deprivation of Liberty Safeguards (DoLS). This meant people’s rights were fully respected. When a DoLS application or authorisation was made, this was included within care plans. Care plans we looked at informed staff there were no conditions attached.

We observed and heard staff asking people’s consent before they supported them. For example, we observed staff knocking on bedroom doors and waiting for a response before entering.

Records included information about how autistic people and people who had a learning disability demonstrated they did not consent to specific interactions.