Service to the Aged

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 - we rated this key question as good. The service provided care that was effective so people could receive positive outcomes. People's needs were assessed so that they could receive the right level of care and treatment. People were supported to live healthier lives and maintain their health through regular checks with professionals. People's consent to care and treatment was sought. We have made a recommendation for the provider to look at best practice guidance on assessing people's equality and diversity needs. The service scored 75 (out of 100) for this area.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Assessments were carried out when a person was admitted to the home to determine if their needs could be supported by staff. Admission assessments included people’s health and support needs and their equality needs. People's care plans contained information about their wishes and preferences. The provider worked in partnership with people’s relatives and health professionals so that people were supported appropriately. Assessments of people’s diverse needs such as their equality characteristics were discussed prior to using the service. For example, assessments took into account people’s preferences around their religion, ethnicity, sexuality and culture. This meant people could receive a level of care that led to good outcomes for them both physically and mentally. Managers told us they complied with best practice guidance, in order to deliver evidence-based good practice to the required standards. The provider used a needs dependency system to help assess the necessary staffing measures that were needed for the home. At the time of our inspection, staffing levels according to their assessment was 2 nurses and 6 care staff on each floor during the day and 2 carers for the lounge to assist lounge manager. At night there were 2-3 care staff and 1 nurse on each floor. In addition, some people in the home had 1:1 care staff and there were extra staff available for escorting people in and out of the home for their appointments. We saw a full complement of staff on duty during our inspection in accordance with the day's rota.

People’s care and treatment was planned with them, including what is important and what matters to them. The provider followed legislation and current evidence-based good practice and standards. People were supported with eating and drinking and maintaining a balanced healthy diet. Where risks were identified with nutrition, a care plan was developed to manage and mitigate risks such as choking, weight loss or diabetes. Records showed referrals to healthcare professionals such as GPs, speech and language therapists and dieticians. People's fluid levels were assessed and checked to make sure they drank enough water or other liquids to maintain their hydration. At our last inspection we recommended that the home use and train staff in best practice on supporting people with dysphagia (swallowing difficulties). At this inspection we found the home was now using the International Dysphagia Diet Standardisation Initiative (IDDSI) used by the NHS which uses globally recognised descriptions such as; "LEVEL 4 - pureed" or LEVEL 5 – Minced and moist," to describe the recommended consistency of a person's food. The kitchen staff were provided this information where relevant for a person so that their meals were made and presented to them at the correct IDDSI level for their assessed needs. Most people told us they enjoyed their meals. A person said, “The food is good quality.” Another person described them as 'delicious' and other people made similar comments. A person felt the menu was repetitive and did not always enjoy the food. Records showed people were consulted and asked for their feedback and changes were made to suit people's preferences as much as possible. Staff understood the importance of good nutritional intake and hydration. We saw the mealtime experience was relaxed. It was noticeable that staff engaged in conversation with people informally and assist them when needed.

We found that staff, leaders and managers worked well together in the home to deliver safe care to people. A relative told us, “It’s easy to get in touch if I have any concerns. They’ll let me know if [family member] has not had a good day when I arrive." Another relative said, "I think the standards have definitely improved since the new manager took over. It is excellent and the staff are motivated and very caring. They have worked hard to improve the service." Staff told us they had positive and professional relationships with health and social care agencies and departments. A member of staff told us, “We work really well with GPs, district nurses and physios. The GP visits every week and is really supportive." A senior manager said, "The support from the GP is very good. There is good communication and they are a huge support to us." We received mostly positive feedback from health and social care professionals about the home. However one professional told us they found it difficult to get in touch with the manager to arrange some training for staff. We found that this issue was resolved and training was delivered.

People’s care plans contained important information about their personal backgrounds, needs and preferences. This enabled staff to deliver care and support in a person-centred way. Staff recorded information about people’s health and well-being on a daily basis and also recorded the dates of people's external health appointments. Outcomes or recommendations from appointments were recorded in people's care plans to ensure information about people's healthcare was current and relevant.

The provider supported people to manage their health and wellbeing so they could maximise their independence, choice and control of their care. People were supported by the service to maintain healthier lives. People were supported to see healthcare professionals when they needed, either through planned appointments or for more urgent treatment. A relative said, “[Family member] fell once after a trip. They called the doctor straight away and we were fully informed." The manager and staff felt assured they had positive relationships with external professionals and services to ensure people received continued care and support.

Staff worked together and communicated with one another either through verbal or written handovers and through automatic updates on electronic systems used within the service. This ensured staff were kept informed about and concerns or changes in people’s care needs. Care plans were regularly updated to reflect people’s current needs and risks.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. 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 MCA. In care homes, 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. People told us their decisions were respected by staff. They said staff asked them for their consent or permission at all times when they provided them with support. Staff understood people's rights and ensured no restrictions were placed on them which were not lawful. A person said, “Every staff member is lovely. There’s not a bad bone in their body. They talk to me and listen to me." A relative told us, “As as I can see, the carers are very respectful and always ask [family member] for their consent."

Staff understood the importance of ensuring people’s rights were respected. They understood people’s rights under the Mental Capacity Act (MCA) 2005. A member of staff said, “I always make sure I ask people for their consent. People must be assumed to have capacity to make their own decisions." Assessments of people’s mental capacity to consent to their care and treatment and to make certain decisions were carried out and in place in people's care plans. Decisions were made in people's best interests when required. Records showed Deprivation of Liberty (DoLS) authorisations were in place for people who required this level of support to keep them safe and meet their needs. Staff had been trained in the principles of the MCA and understood the importance of ensuring people's rights were respected.