Clare Hall 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

People’s needs were assessed and related care plans and risk assessments were developed. These care plans were reviewed involving people and their relatives as appropriate. Staff worked with health and social care professionals to make sure people received the care, treatment and support they needed. We observed that staff were not ensuring people had a positive dining experience at the home. We discussed this with management who made significant changes following our site visit. The management team had systems and processes in place to meet people’s nutrition and hydration needs and improvements were being made to make fluid and diet intake more effective. Daily handover meetings were held and included discussions around people’s health and changing needs.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they had their care needs discussed with them. However, they did not always know what a care plan was. One relative told us, “He has a care plan, and it has been reviewed.” Another said, “My wife was involved with my care plan. I am happy.”

Staff regularly reviewed care plans involving people and their relatives as appropriate.

People’s needs were assessed and related care plans and risk assessments were developed. Care plans and risk assessments were then kept under review, to reflect people’s changing needs. Clinical assessment tools for monitoring, such as skin integrity and weight loss, were also in place and kept up to date. The provider employed 2 clinical support staff to monitor people’s care records to ensure they accurately reflected people’s care needs.

We did not receive any specific feedback from people about receiving evidenced based care and treatment. However, people were complimentary about the carers and nurse’s skills and knowledge and people told us relevant health care professionals were involved in their care. This ensured people received evidence-based care and treatment. One person told us, “It’s a good home, the staff look after me. I am hoisted with 2 carers.” We received mixed feedback about the food. Comments included, “I don’t care for the food, but it has improved slightly, the staff have the skills and are kind”; “The food is alright” and “There is not enough.” People had their meals in the dining room, lounge and in their bedrooms. There was no menu board in the dining area at the time of our site visit. We were told this was an oversight and menus were usually placed on each table. Staff were not seen interacting with people at the mealtime and not offering condiments.

Kitchen staff and those responsible for supporting people with their food had a good understanding of people’s assessed needs in relation to type and texture of food. However, they had no guidance about the appropriate meal portion sizes. Staff told us they helped people to make their meal choices. Improvements were needed in staffs recording of people’s dietary and fluid intakes as this was not always accurate. The nominated individual told us they had taken steps to only have food and fluid charts in place when there was a clinical need, to make recordings more meaningful.

The management team had systems and processes in place to meet people’s nutrition and hydration needs. Care plans and risk assessments clearly described what modified diet people were prescribed and the care plans followed. We observed that people who had been identified as losing weight were being offered fortified milkshakes twice a day. The timing of the morning milkshake was impacting on the amount of lunch they were then able to eat, and a lot of food was being thrown away. Following our initial feedback about the poor dining experience, to the management team, they made significant changes. They met with staff, started completing a weekly dining experience specific audit and monitored mealtimes, daily. They reinstated table menus, complemented by a menu board and removed routine milkshakes, only to be offered on a need’s basis. After our site visit the management team told us they had moved the dining room, to the lounge which was closer to the kitchen and the lounge to the larger dining area. They fed back to us that these changes had made a significant impact.

People and relatives told us that staff knew them well and were able to support them with appropriate care, which met their needs. People told us the service worked with GP’s and health professionals to meet their health needs. A person said, “The doctor will come if I need them.” A relative confirmed they were kept informed about changes in their loved one’s health needs. They said, “We were kept informed about the change in medication by telephone. The best thing about the home is that they are caring and understand dementia.”

Staff told us they worked with health professionals to ensure people got the care and support they needed.

A healthcare professional told us, “I have observed staff to respond to the call bell, in a timely manner, during my visits. Care records for the service user appear to be detailed and kept up to date, they encourage personal care and will leave and return if the service user declines.” Another told us, “They appeared keen to find a solution for the service user, they appeared willing to learn how to best support the person, all of which I would expect from a care home.”

The provider had a clear process in place to escalate health concerns within a timely manner. Staff worked with health and social care professionals to make sure people received the care, treatment and support they needed. Where specialist health care professionals were involved in people’s care, their input and advice was included in people’s care plans.

People and relatives told us staff supported them to manage their health and they received good care. Comments included, “Mum loves it here, they do look after her, when they changed her meds (medicines), they rang me. There seems to be a lot of staff around. Mum is always in the lounge, there is always someone around.” and “I can’t praise them enough, it’s really nice he’s really happy, he joins in with things, he has dementia and he is always clean, personal hygiene is good. The staff are friendly, and caring, there are plenty of staff around, the family are happy. We have nothing to complain about, we are really happy.”

Staff had a good understanding of meeting people’s changing needs. The management team were confident they had systems in place to make sure they gave people support to maintain or improve their health, wherever possible. Staff agreed with this and said they supported people in ways that didn’t take away their independence. The registered manager confirmed if people required a physiotherapist or occupational therapist these would be arranged through the GP.

There were systems in place to monitor people’s health. People’s needs were regularly reviewed, and referrals made to external healthcare professionals where required. Daily handover meetings were held and included discussions around people’s health and changing needs. Concerns were escalated where GP or hospital consultation was required.

People and their relatives felt all their care needs, including any clinical needs, were being met by the management team and staff.

Staff told us they had training and support to meet people’s care and health needs. The management team recognised the importance of learning lessons and continuous improvement to ensure they maintained high-quality, person-centred and safe care for people they supported at the home. They with the clinical support staff and nurses routinely monitored the quality and safety of the service people received.

Care plans were in place which detailed people’s care and support needs as well as their clinical needs in relation to health conditions. However, people’s care requirements which was no longer relevant, was still prominent on their care records and could advise staff to deliver support which was no longer appropriate. Improvements were made following our site visit to ensure people’s current healthcare needs were more easily accessed and not overshadowed by historic information.

People told us they were asked for their consent before care was provided. Where people were not able to be involved, due to lacking capacity and cognitive impairment, advocates were used where needed. We spoke to an advocate visiting the home. They told us, they were always made welcome. Their comments included, “Staff are gentle and kind.”

Staff told us they asked people for their agreement before providing care and support. Staff shared examples of where people had declined support, they had given people time and space and returned to them later in the day to see if they made a different choice.

Care plans contained information about the types of decisions that people could make for themselves and family members or friends that were involved. These were reviewed regularly to ensure any gaps relating to people’s ability to consent to care was identified and rectified.