Home of Comfort 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 changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s wellbeing and communication needs with them. However, health needs were well managed.

People’s healthcare needs were assessed and reviewed well. Regular meetings were held with a multi-disciplinary team to support effective care and treatment for people. Partner agencies were positive about the approach from Home of Comfort.

However, this structured approach was not consistently reflected across all aspects of care planning. While assessments included some information about people’s communication and social needs, staff were not always supported to promote engagement or reduce isolation. Observations showed some people experienced limited stimulation throughout the day and 1 person was not communicated with effectively; however, this had not been identified through assessments or addressed within care planning. This increased the risk of people’s needs not being met.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always do this in line with legislation and current evidence-based good practice and standards.

The documentation and delivery of people’s care was mostly clear, consistent and in-line with evidence-based good practice guidance to support people’s health conditions. For example, the use of nationally recognised assessment tools was in place regarding people’s pressure area care and mobility needs. The care provided to people reflected this evidence-based approach. However, it was not clear people were fully involved in their care planning, and some told us this did not always meet their needs or preferences. For example, in relation to their social and emotional needs.

People’s nutrition needs were met. Where people had swallowing difficulties, appropriate assessments and advice were sought, and this information was incorporated into their care records. Where people were at risk of losing weight, action was taken to reduce this risk. People said they had enough to eat and the quality of the food was good. Although people were offered a choice of food, they described it as sometimes repetitive. We observed the dining experience and saw people remained sitting in their armchairs rather than be offered the choice of being supported to the dining room. There was no interaction between people and no support from staff to ensure this was a social experience.

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 service worked collaboratively with local partners to ensure people’s health needs were understood and consistently met. Professionals external to the service confirmed the service was responsive to their advice and engaged positively during joint reviews. They reported that leaders acted on recommendations, which contributed to improved continuity of care and safer decision‑making. For example, 1 said, “They [staff] contact us when needed, they’re proactive and are always good at following any guidance we give them.”

People werealsopositive about how staff in the home worked withpartner agencies. One person told us, “They organise all that. They take you [to appointments] and they bring you back. It’s well organised.”

Within the staff team, communication took place through a range of channels, including handovers and communication books. Staff told us these ensured they kept up to date with people’s changing needs.

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 were supported to access health services when required. A relative told us, “They [health professionals] have to come to her. The optician comes and the GP. Her [health conditions] are all well managed.” A health professional told us, “Staff are very proactive if they have concerns about people and contact us appropriately.”

Staff used evidence-based tools tomonitorpeople’s health toanticipateanddetermineif peoplerequiredclinical support. Appropriate escalation of incidents andtimelyreferrals helped support people with immediate needs.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

Peoples’ care was not always being delivered to meet the needs of the whole person, including the planning and provision of social and stimulating activities to meet an individual’s needs.

People had their fluid intake recorded to monitor they were getting enough to drink. The target amount people should be drinking had not been individualised for the person, nor was there any guidance for staff as to what action they should take if people had not reached the target. Records demonstrated on some occasions people had not reached the target fluid intake. This increased the risk of dehydration for people. Following the inspection, the registered manager told us of how they made some improvements to fluid monitoring.Other areas of people’s care were monitored well such as food intake and health conditions.

The provider did not always tell people about their rights around consent or respect these when delivering person-centred care and treatment.

Consent was mostly sought prior to care being delivered. There were some systems in place to promote choice in relation to areas such as dining, personal care and visitors, however, we saw from feedback surveys and some people told us they could not make choices about their daily routine.Where people lacked capacity to make specific decisions, capacity assessments had been completed and best-interest decisions made in consultation with those involved in the person’s care.

Staff completed training in the Mental Capacity Act (MCA) 2005. Some staff had a good understanding of what this meant and how to apply the principles in their day-to-day work whilst others did not, this increased the risk of people’s choices not being met in line with the MCA framework.