Heartlands

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 requires improvement. At this assessment the rating has changed to 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 had their needs assessed prior to moving into the service. Some relatives told us this had taken place in hospital or at home. Staff told us they were provided with information about people who were moving to the service before they arrived. Staff told us they got to know people’s support needs by reading the information on the provider’s electronic care recording system and speaking with people and their families.

Where people required assistance with communication of their needs, this had been clearly documented in a personalised manner. These records outlined the nature of the person’s communication needs and explained the approaches to be used by staff when offering support.

One person had a cultural care plan in place which had been developed in conjunction with the person and their family which supported the individual’s cultural requirements with food and religious events.

The provider had a dependency tool to assess and review the level of individuals’ care needs. This tool was then used to help determine the staffing levels required to meet people's needs.

People’s relatives told us they had been involved during the pre-assessment process, and they had been invited to take part in care plan reviews. One relative said, “They [staff] came to the centre and did an assessment. There is a care plan and it’s on the system. It’s checked every six months. We go through it together and change what’s needed at these reviews.”

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.

Care plans detailed people on modified diets. However, we found that implementation of GP recommendations regarding nutritional supplements for a person that had lost weight was inconsistent and not clearly recorded or understood by staff. For example, we found no food intake records were available to guide staff on when additional supplements were required. This lack of documentation hindered effective monitoring and timely administration. Care plans for people on fortified diets lacked detail. Although a ‘fortification register’ was provided to the kitchen manager, there was a lack of evidence of how people’s diets had been fortified. Once this was raised with the management team, they immediately implemented updated guidance for the kitchen manager and staff. Care plans were updated for the people on fortified diets with ongoing monitoring implemented.

The provider used recognised tools to assess and identify risks to providing people’s care and support. This included the International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI is a standard for describing food textures and drink thicknesses for people with swallowing difficulties. Using the IDDSI, care plans clearly identified how people needed their food prepared or to what consistency they needed their drinks thickened to reduce their risks of choking.

We found that people’s care and support needs had been assessed with the involvement of people and their relatives. The provider had systems and process in place to evidence they were working with other health professionals and that this was managed effectively for example referrals to the local speech and language team (SALT) had been recorded. The provider had received a complimentary email from the SALT team on how they had handled a choking incident at the service.

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. There were virtual weekly ward rounds from the local GP with limited face to face contact which had caused some concerns for people and their relatives. One person told us, “The GP only comes if needed and then it’s difficult to get him in or he comes to give injections.” The registered manager had taken on board the concerns and met with the GP to voice her concerns and had now arranged face to face meetings. For example, the paramedic attached to the GP practice now visited on Tuesdays and the GP on Thursdays of each week. This was a positive step taken by the registered manager in direct response from people living at the service and their families.

The service was also supported by district nurses and other health professionals. Health professionals we spoke with told us the staff were proactive in making contact for advice and followed any recommendations. One health professional said, “[I] love the staff team. They all work so well together [and are] willing to help.”

Clinical and care staff described the processes in place to ensure important information was shared. This included daily flash meetings for handovers between shifts to ensure staff had up to date information about peoples care and support needs and any changes to health.

People’s relatives told us the staff team always kept them informed about any healthcare appointments.

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 told us they saw healthcare professionals to maintain their health and wellbeing. For example, staff had supported people to make appointments for eye tests, and visits to the chiropodist, audiologist, and the dentist.

There was regular access to GP although this was not always face to face at the time of the inspection. Staff had identified when people were not feeling well or there had been a change in their care needs resulting in calls to health professionals or 111/999.

Nursing staff could tell us how they would access additional support from healthcare professionals to help people manage people’s health, should this be required.

Staff supported people’s emotional health and physical well-being. People were encouraged to take gentle exercise and spend time outside in the garden.

The catering team were aware of people’s dietary needs, for example a kosher diet which was strictly followed. Modified meals were provided to the same standard as other meals on the menu. Meals were very well presented, hot and people were complimentary about these. The mealtimes were a pleasant experience, and the dining room was laid appropriately prior to meals being served.

We observed lunch on both days of the inspection. We saw people eating their lunch were treated with respect by staff who were talking with them and checking they had what they needed and enjoying their food. Staff were polite when serving meals. We observed that people were offered a visual choice of 2 meal options and told what the food was as it was placed in front of them.

Overall, people and their relatives raised no concerns about the availability of drinks and the quality of the meals served within the home. One relative said, “The food is really good, and [Name] has enough to eat. They do encourage her [to eat]. The drinks trolley comes around all the time, and they also give her fruit and biscuits.” Another relative told us “The food looks good. [Name] is on a puree diet. It is well presented.”

There was active encouragement from staff to support people to exercise and retain their mobility. There was an activity scheduled for each day of the week and people were observed taking part and seemed to be enjoying the interactions. People were accompanied into the community, for example visiting the local garden centres and places of worship.

People were encouraged to join ‘resident’s meetings’, which were held regularly.

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.

Pressure relieving equipment we looked at was set correctly and nationally recognised tools were used to assess people’s risk of skin damage. Repositioning charts were in place and had been completed for most people requiring support in line with care plan guidance. However, discrepancies were identified in the repositioning records for 2 people who required repositioning every 4 hours. Although there were gaps in the records, we found there was no evidence of harm to people. Management advised that repositioning had been carried out during responses to call bells, but staff had failed to record these interventions on the repositioning charts. This had been acknowledged and addressed with staff to ensure future compliance.

The provider had systems to monitor the quality of people's care and ensure their care plans accurately reflected their current support needs. This included monitoring records for people at risk of skin damage, malnutrition and dehydration. However, there were gaps and inconsistent recording of people's food and drink intake, which was not always completed. We found people had not been impacted by the lack of consistent recording. When this was bought to the provider’s attention, they acted immediately to put measures in place to record, review and monitor people’s fluids and food intake.

Monitoring activities undertaken demonstrated people affected by incidents such as falls and pressure injuries experienced positive outcomes. For example, fall logs were used to identify the frequency and timing of falls, and records confirmed that post-fall checks were consistently carried out. Where individuals’ risk assessments had been reviewed, their care plans were updated to include additional instructions. These updates also included the implementation of equipment such as floor sensor mats to help prevent further incidents. One relative told us “[Name] is constantly at risk of falls recently had 2 falls. The home has lowered her bed, and [Name] has a sensor mat by it.”

In one case, a person admitted with a grade 4 pressure injury was under the care of the tissue viability nurse. Their records showed dressings were regularly changed, and assessments along with photographs were taken to monitor the progress of wound healing.

Relatives also shared positive feedback regarding the care provided to their family member following a fall. They expressed satisfaction with the responsiveness and quality of care delivered.

One person’s PEG [Percutaneous Endoscopic Gastrostomy] feeding care plan was found to be detailed and comprehensive, outlining clear instructions for setting up and administering the feed. PEG feeding means the person has food and drink through a tube that goes straight into the stomach. Nurses were able to confidently explain the routines for both preparation and monitoring, in accordance with established protocols. A copy of the feeding regime was visibly displayed in both the person’s room and the medicines room. Reviews of PEG feeding were documented by nutrition nurses, indicating ongoing oversight and support.

For people with diabetes, blood glucose levels were routinely checked before breakfast, lunch, and dinner, ensuring consistent monitoring and management of their condition.

Care plan reviews related to behaviour and emotional wellbeing were well-written and demonstrated a person-centred approach. These plans reflected individual needs and preferences, supporting tailored care delivery.

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

Mental capacity assessments had been carried out in line with legislation. For example, people had their mental capacity assessed in relation to consenting to live at the service, to have bed rails in use. People who were at risk of falls had sensor mats in place to alert staff if they tried to stand up unaided and for staff to support them with their care.

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 Mental Capacity Act 2005 (MCA). In care services, 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, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The registered manager kept a record and tracker of DoLS applications and authorisations.

Where best interest decisions had been made on people’s behalf, these were recorded in people’s support plans. Representation from advocates and family next of kin were recorded where required. One relative who had Power of Attorney said, “I am informed and consulted on any changes in medication, such as following infections, new medicines or reducing existing dosages.”

Not all the people we spoke with were able to tell us if staff asked for their consent before providing support. However, we observed staff throughout both days of our inspection offering people choices and asking for their consent. For example, we saw staff knock on people’s doors seeking consent before entering, asking people if they wanted to take part in activities.

People’s relatives told us they saw staff ask people for their consent and offer choices to their loved ones.