NAViGO Health and Social Care CIC

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• 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

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. People’s feedback described it as excellent.

Staff assessed the physical and mental health of all patients on admission holistically. They developed robust individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients and their carers. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and ensured practice was safe.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 4. The evidence showed an exceptional standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them and their carers. We reviewed 13 care records across the three wards. Care records were consistently high in quality between the 3 wards, demonstrating that all domains of care had been addressed and risk assessments were updated to reflect current risks and these were all within date. Care planning was written in a person centered way and they were informative and demonstrated clarity around what was to be achieved and how this was to happen.

Carers told us that they were always involved in decision making, discussions and felt staff communicated their loved ones needs at all times. Feedback was overwhelmingly positive from carers who spoke with us, stating “I feel at ease they are looked after here”. All carers we spoke with noted they were central in MDT discussions.

We found evidence in care records that patients, carers and other professionals had been consulted regarding their care planning. Care plans evidenced support from other professionals such as podiatry, speech and language therapists, dieticians and occupational therapists as well as regular GP input. Care plans were collaborative and consulted people, where possible, with changing aspects of their care plans. This was initially done on admission and regularly reviewed. Care plans documented patients’ capacity to understand and where best interest decisions had been made with family members and other professionals.

Care planning meetings demonstrated that staff supported both patients and family engagement in the entire process. These included a detailed summary which involved family providing history, details around the admission, treatment that the ward provided, and what carers’ needs were. Care plans that were reviewed were individualised, person centered and focused on specific needs relating to each person. Care plans were reflective of risk assessments and needs-led, they acknowledged patient risk and mental health issues and detailed how these needs would be met. All mental health needs care plans showed a great degree of depth and clarity in being able to manage dementia and complex mental health.

Moving and handling risk assessments all contained needs specific to individual patients in terms of how many staff would be needed to assist and the role of the staff member. Each care plan advised on how to approach each resident and advised on any specific difficulties the resident may have including sensory concerns and how staff needed to communicate to ensure patients understood interventions.

Where required, patients had care plans for time specific medications, with clear links to concordance with NICE guidelines. Patients’ nutritional needs had been assessed, and patients’ preferences and weight were being recorded regularly. Any discrepancies in weight were being addressed proactively with involvement of other professionals where indicated. Most patients were on diet and fluid charts even if there was no clinical indication. This was discussed with the ward manager and the decision had been made to complete this documentation daily should anyone have any concerns rather than a clinical need. This ensured that any change was highlighted early without waiting for specific meetings to take place.

We scored the service as 4. The evidence showed an exceptional standard. The service always 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. They worked to develop evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and ensured patients’ rights were protected.

The service provided a range of care and treatment interventions suitable for the patient group, as well as purchasing specific equipment to meet individual needs. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. This included medication and psychological therapies and activities. Staff ensured that patients had responsive access to physical healthcare, including access to specialists when needed. Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration through collaborative working.

The service participated in clinical auditing, benchmarking and quality improvement initiatives. The service is currently participating in the ADAPT Trial (Alzheimer’s Diagnosis and Plasma pTau217) which aims to provide a reliable blood test meaning a faster, moreaccurate, and less invasive diagnostic process, allowing patients and their families to receive a definitive diagnosis and access to post-diagnostic support and future treatments much earlier. A more precise understanding of patients’ specific pathology (e.g. confirmed Alzheimer's) would help refine long-term medication andbehaviouralcare plans, ensuring they areoptimisedfor the individual.

The team included a full range of specialists required to meet the needs of patients in the service. As well as doctors, nurses and skilled support workers; the team consisted of occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists, dieticians and a peer support worker. Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group. We completed observations of staff interacting with patients using our Structured Observational Framework for Inspection (SOFI) and saw interactions in line with good, high level dementia care. Staff demonstrated knowledge and understanding of ways to interact and communicate with patients who could not verbalise their needs. Managers provided new staff with a robust induction using the care certificate standards as the benchmark for healthcare assistants.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance and ensured staff had access to team meetings or outcomes of these. The percentage of staff that had had an appraisal in the last 12 months prior to the inspection on Konar ward was over 80% in the months May, June and July and achieved over 90% at the time of inspection. Jane Lewington Suite and Janine Smith Suite had over 90% supervision compliance. Staff we spoke with confirmed that supervision was regular and supportive. Any learning or development needs were addressed and revisited.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge and staff we spoke with highlighted numerous learning and development opportunities they had been offered. Managers ensured that staff received the necessary specialist training for their roles and additional training to mandatory training such as best interests’ assessors, dysphagia training, non-medical prescribing and advanced practitioner training, end of life training, leadership qualifications and preceptorship training were all available to staff.

Mental Health Act

98.78% of staff across the three wards had received training in the Mental Health Act. Staff were trained in and had a strong understanding of the Mental Health Act, the Code of Practice and the guiding principles as well as how this was embedded in patient care. Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice and knew who their Mental Health Act administrators were and how to contact them.

The service had relevant policies and procedures that reflected the most recent guidance and this was easily accessible to all staff. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. Patients had access and were referred by staff to an independent mental health advocate during admission. The advocate visited the wards regularly. Care documentation evidenced that staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it and supported carers to understand their loved ones’ rights.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted and care records evidenced leave being in place. Reviews of medication records showed that staff requested an opinion from a second opinion appointed doctor when necessary and that Mental Health Act documentation was in place, with action being taken if necessary to ensure patients’ rights were upheld. Mental Health Act documentation was stored safely, and copies of patients' detention papers and associated records (for example, Section 17 leave forms) were available to all staff that needed access to them.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to Section 3 or equivalent Part 3 powers authorising admission to hospital for treatment where applicable, and staff completed regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

We scored the service as 3. The evidence showed a good standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once. Comprehensive assessments ensured that all relevant information was captured on admission and care plans, assessments and discharge plans were continuously updated through regular and effective multidisciplinary meetings. Staff shared information about patients at effective handover meetings within the team which we observed on the wards.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation such as care co-ordinators, social workers and commissioners. These meetings always included family, and this was evidenced in our carer feedback.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future need for care and support.

Staff supported patients to live healthier lives through a range of activities and initiatives. For example, the service offered healthy eating and hydration advice, with posters evident to promote this. The service also had ‘Move it Monday’ and ‘Walking Wednesday’, which encouraged movement, physical stimulation to help patients maintain mobility. The service offered seasonal flu vaccinations.

Ward activities helped promote a healthy lifestyle for patients by ensuring people had the right care and treatment to maintain personal hygiene needs, dietary and fluid requirements and mental stimulation through service appropriate activities. The wards all had access to outdoor space which provided fresh air and an outdoor gym that had been developed with the patient group in mind. This enabled staff to help people maintain their physical health whilst in hospital.

Staff supported patients with all physical health needs and appointments, ensuring any identified needs were addressed and met in a responsive manner to maintain both physical and psychological wellbeing.

We scored the service as 3. The evidence showed a good standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Staff used audits to monitor and improve outcomes for patients. Audits were in place to review the number of incidents and any use of restraint, which also was monitored by the services patient safety group and discussed at operational level. Blanket restrictions were regularly reviewed to ensure least restrictive practice was being used and restrictions were discussed with the older persons management team.

Staff encouraged the completion of patient surveys. We reviewed surveys which had been completed and found the responses were all positive. Staff also attended monthly ‘lessons learned’ meetings in order to look at what actions could be taken to improve outcomes.

Staff used recognised national rating skills such as Pool Activity Level (a tool for tailoring activities to match the cognitive and functional abilities of each person, fostering meaningful engagement), Abbey Pain Scale, Geriatric Depression Scale, Cornel Scale, Waterlow, Adenbrookes, and therapy outcome tools. Risk assessments were all within date and evidenced regular reviews to recognise changing risks which were reflected in care plans and risk assessment plans. The wards regularly discussed the outcomes of audits with staff teams to improve services and outcomes for patients.

Staff utilised technology to help support patients and minimise any distress. Staff were able to use technology to record risks, assessments and care records.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Care records identified that staff took all practical steps to enable patients to make their own decisions and helped them understand their care and treatment. For patients who had impaired mental capacity, staff assessed and recorded capacity to consent appropriately as well as training more staff as best interest assessors. Care plans that where in place for patients lacking capacity were created on a decision-specific basis with regard to significant decisions and involved family where possible. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Records we reviewed evidenced discussions around personal preference and staff made attempts to meet the patient and families wishes.