Dalkeith

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 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 did not always ensure people’s care and treatment were effective because people’s health needs were not consistently reflected in their records, which meant staff did not always have clear guidance on how to meet these needs.

The provider used an electronic care records system that included assessment tools to support staff in assessing people’s physical and mental health needs. However, these records were not always completed accurately or updated in response to changes in people’s health needs. As a result, care plans did not always reflect people’s current needs.

People’s needs were assessed prior to admission to ensure these could be met by staff. Staff told us care plans were created from the assessment with input from staff, residents, and families. They also had access to updates about changes in health care needs and people’s communication needs, through care records and staff handover meetings.

People’s health needs were assessed by visiting healthcare professionals to ensure care and treatment were appropriate and to support timely referrals to specialist services when required. Some elements of healthcare, including the assessment and management of pressure ulcers and wounds, were provided by community nursing services.

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.

Staff used nationally recognised assessment tools to assess people’s health needs, including the Malnutrition Universal Screening Tool (MUST) for nutritional needs and the Waterlow assessment for skin integrity. Staff had received training to support their understanding of best practice and how to use these tools effectively. However, in one care plan we reviewed, the MUST score recorded later in the plan differed from an earlier score, indicating the assessment had not been consistently or accurately recorded. This placed the person at risk of not receiving appropriate nutritional support, as inaccurate scoring could lead to unmet needs, delayed intervention, and deterioration in their health and wellbeing. Inconsistent records may also result in confusion for staff, increasing the likelihood of inconsistent care and reducing the effectiveness of monitoring changes over time. Despite this, staff and managers were able to describe the signs and symptoms of infections and pressure ulcers and were confident in reporting concerns and recording information appropriately, including the use of body charts in preparation for community nurse reviews.

People with identified swallowing or eating needs had their risk of choking assessed. Where risks were identified, appropriate changes were made to the texture of food and drink. When required, people were referred to a speech and language therapist for further assessment and guidance. One staff member said “SALT (Speech and Language Therapy): For people with swallowing difficulties, I follow the guidance from SALT, such as providing food of the correct texture pureed, soft, or thickened liquids and supervising mealtimes to reduce the risk of choking”

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 the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. They worked with various healthcare professionals to ensure continuity of care. Staff were aware how to refer people to other services such has mental health teams and community nurses. Care records demonstrated that health care professionals were involved in providing clinical support to people. One professional told us “Dalkeith staff are always friendly, and they are willing to ask for support from other services in an appropriate and timely manner. Support and suggestions are taken on and acted on promptly and appropriately.”

Information about people’s health and communication needs was available and ready to be shared with paramedics and hospital staff in cases where people could not provide this information independently.

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 helped people to attend healthcare appointments. A GP and other health care professionals involved in people’s care and wellbeing visited the care home on a regular basis and were able to speak with people individually about their health needs or any concerns highlighted by staff.

Activities were designed to promote physical and mental stimulation and included art and craft sessions, chair fitness and community outings. On one occasion, a Festival of Stars show was delivered by an external theatre company held in the garden. One person living at the service told us “The activity co-ordinator takes us to the cinema in their car quite a lot. Three or four of us. She’s really nice”. Another person told us “I go down to the garden and sit for a while in the summer. It’s ever so quiet down there”.

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.

Systems to monitor people’s care and treatment were not always effective in identifying opportunities for continuous improvement. Audits and reviews were not consistently identifying or addressing gaps in care planning and delivery. For example, we found shortfalls in the monitoring and management of repositioning for one person. Following our feedback, the registered manager took immediate action and assured us that these issues were being addressed.

Daily handovers were completed to share information and ensured staff remained informed about people’s health, wellbeing and any changes to their care needs.

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

Staff had received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and consistently sought consent before providing care and support. We observed staff explaining what they were going to do before supporting or moving people.

Where people declined refreshments, staff respected their choice and returned at a later time. These practices demonstrated respect for people’s rights and supported person-centred care by ensuring people remained involved in decisions about their care.