Chamberlaine Court

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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

Care plans were developed from assessing, monitoring and reviewing people’s needs. People were offered enough to eat and drink to maintain their health and there were effective processes to ensure people’s dietary needs were known by all staff. People received care that supported them to remain healthy and monitored to ensure positive outcomes. Where there were restrictions in people’s care plans, their capacity to consent to those restrictions was assessed. However, improvements were required to ensure conditions on approved Deprivation of Liberty Safeguard (DoLS) application were met.

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.

Relatives told us they were involved in planning people’s care when they moved to Chamberlaine Court. One relative told us, “I was involved with the original care plan.” Another relative said, “They asked me lots of questions.” A third relative commented, “We went through everything and gave all the information at the beginning. The care package has now changed. It was a bit confusing, but I came and sat down with [registered manager] and talked about it.”

The registered manager explained care plans were developed from assessing and monitoring people’s needs during their first weeks living in the home. They explained, “On arriving here they have their weight taken, they are on food and fluid charts for the first seven days and hourly checks during the day. It is then monitoring all that information to ensure we have the right package of care for them." Staff told us people’s care plans were updated when a change in their needs was identified.

Systems were in place to regularly assess and evaluate each person’s care plan to ensure it remained relevant to their needs.

People were offered enough to eat and drink to maintain their health. People were seen to enjoy their meals and were encouraged to eat and drink well. Staff monitored people and gently intervened when people were seen to be eating too quickly which put them at risk of choking. Where people did not eat well, they were offered an alternative meal option. One person told us, “On average the food is very good. They ask my choice of meal in the morning; I can’t fault it.” Other people commented, “I like the food generally, I always get drinks, they come every morning with drinks and in the afternoon” and “The food here suits me, there’s always two items. They come round an hour before to ask what I want.”

Staff understood the importance of good nutritional intake to keep people healthy and well. One staff member explained how they had recently reported concerns because a person’s appetite had decreased. Another staff member explained how they monitored food and fluid charts to identify when people were not eating and drinking enough. This was handed over to all staff, so they knew when people needed to be encouraged to eat and drink more to maintain their health. Staff told us they followed best practice guidance when people required a modified diet or needed thickener in their drinks.

The provider used recognised tools to assess and identify any risks associated with people’s health and wellbeing. This included tools to identify risks in relation to falls, skin damage and nutritional intake. There were effective processes to ensure people’s dietary needs were known by all staff. Where people were on a modified diet because of their risks of choking, there was accessible information to ensure their food was prepared in accordance with national guidelines. When people were at risk of not eating and drinking enough, their food and drink intake was monitored.

People and their relatives did not share any concerns about how information was shared between the staff supporting them or with other healthcare professionals involved in their care. One relative described the communication as being “fantastic”.

The registered manager and staff described the processes in place to ensure important information was shared. This included a handover between shifts and a daily meeting between senior staff to discuss any risks within the service. This ensured staff had up to date information about people and any emerging risks could be escalated through referrals to external healthcare professionals or increased monitoring and checks.

Other healthcare professionals spoke of processes to support good working relationships with staff at the home. One healthcare professional described a situation and said, “Chamberlaine Court worked closely with professionals such as me and the GP to ensure better outcomes.” Another healthcare professional told us, “Information is shared and easily accessible.”

Handover information was detailed and ensured important information was shared effectively throughout the staff team. Processes ensured effective communication with other healthcare professionals, so they had information about people to support their visits.

People and relatives described care that supported people to remain healthy. For example, repositioning people to prevent skin damage and ensuring they had enough to eat and drink. Staff supported people to attend healthcare appointments if needed.

Staff explained how they used information in people’s care plans to keep them healthy. For example, information about any allergies people may have or any medication that had specific risks. Staff told us they were encouraged to share any concerns about people’s health and wellbeing.

Care plans included information about people’s health conditions so staff could recognise any signs or symptoms which may indicate a deterioration in their condition. Where people needed support to maintain their health, this was recorded. For example, care plans detailed the support people needed to maintain their oral health.

Relatives felt their family members were well cared for and their needs were being met. One relative explained how staff monitored their family member’s emotional wellbeing. They told us, “Staff know what to look for when [Name] is starting to become agitated, they have brilliant de-escalation techniques.”

Staff described how they monitored people to ensure positive outcomes for them. For example, staff described how they monitored the fluid input and output for people with a catheter and regularly checked the blood sugar levels for people with diabetes. One member of staff gave an example of sharing a concern about a person not eating and drinking well. The registered manager had immediately implemented food and fluid charts to monitor how much the person had to eat and drink.

The provider had processes to monitor people to ensure positive outcomes. For example, there was a comprehensive senior care staff handover sheet which detailed any GP or other healthcare professional advice and what further observations need to be carried out. However, where people were prescribed medicines to support their emotional wellbeing, staff were not routinely completing behaviour monitoring charts when the medicine was given. Detailed records would enable healthcare professionals to make a clear judgement on the effectiveness of this medication. Other risks to people such as in relation to skin integrity or catheter care were monitored well.

We received mixed feedback from people as to whether their consent was sought before care interventions. One person told us, “They always ask my agreement to put cream on my legs.” Another person commented, “The ladies do ask my consent now and again.” A third person told us, “They don’t ask my consent, they know what to do and just do it.” However, people told us they were able to make their own choices and did not raise any concerns about having to do anything they did not want to do.

Staff told us they would respect people’s decision to decline any care or support offered. One staff member explained, “I would respect their wishes and go back 15 or 20 minutes later and see if they would accept it then." Where people were put at risk because of declining the care offered, staff said they would report it to senior staff so they could consider other options or whether a decision needed to be made in the person’s best interests.

Where there were restrictions in people’s care plans, their capacity to consent to those restrictions was assessed. New capacity assessments had been introduced which ensured people were given support to understand the decision to be made. Where there were restrictions that people did not have capacity to consent to, applications under the Deprivation of Liberty Safeguards (DoLS) were made to the authorising body as required. The registered manager maintained a DoLS tracker to ensure renewal applications were submitted in a timely way and any conditions on authorised DoLS were met. However, we identified the tracker was not up to date and the conditions on one person’s DoLS had not been recorded. The registered manager confirmed two of the conditions were no longer relevant. A meeting was immediately held with the person’s power of attorney to ensure the third condition was met and to review the person’s capacity assessments.