Blackburn (Florence House)

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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

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. For this key question we assessed the quality statements relating to; assessing needs, delivering evidence based care and treatment, supporting people to live healthier lives, monitoring and improving outcomes and consent to care and treatment. Care plans reflected changes in people’s needs and the involvement of professionals, as well as information about end-of-life care needs, where this was relevant. Assessments were undertaken but not all people and relatives could confirm they had been involved in them. A number of people had lived in the service for a long time. Staff told us they had access to information to provide up to date care to people. One person said, “Care plans are done by managers in the nourish [electronic system]. We have access to care plan and you can update the records.” The provider was working within the principles of the MCA. Staff understood the importance of seeking consent before undertaking any care or activity. People were offered choices including care and meals. People’s individual needs were considered in relation to their meals. A good arrangement was in place to provide meals, considering cultural and religious practices. Professionals were usually involved with people’s needs where this was required. Information, guidance and policy was available to support staff.

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.

A number of people living in the service had lived there for a number of years. People could not confirm they had been involved in assessments or the development of their care plans and risk assessments, meaning we could not be assured their individual needs and preferences had been considered. However, a relative told us they had been involved in the development of their care plan. They said, “They had [persons] file already straight away, they really went to town in the 1st few days.” A person living at the home confirmed they were offered choices.

Staff and management told us people’s needs were assessed and reviewed and the information was available in their care records. They told us, “We use Nourish [an electronic recording system] to record and review care plans, this is a lot better and we are able to access information we need to look after people” and, “Care plans are done by managers in Nourish. We have access to care plans, and you can update the records.”

Preadmission and transition assessments had been completed for people, to support them in moving into the service. Evidence of reviews were seen, providing up to date information about people’s needs. Care plans were in place with evidence of risk assessments according to people’s needs. Handover records contained a range of daily information including the care provided, activities and interactions.

People told us they were provided choices in their meals and they were happy with the food provided. One person said, “I get choices over the food I want.” We observed the meal time experience on both days we attended the service. Staff were seen engaging with people regarding meal choices and where they would like to sit.

Staff knew about people’s dietary needs and how to support healthy choices. Where people had special dietary needs, they understood how to ensure these were managed safely. Staff were seen encouraging people to make decisions and choices in the service. Information and guidance was available to support people with important information.

We saw evidence of professionals involved in the care, assessment and reviews. Care records included information in line with guidance and evidence-based care. Policy and guidance was available to support staff in the delivery of care to people. Assessments, such as oral health assessments had been completed. A range of mandatory and specific training was ongoing for the staff team. The nutritional needs of people had been assessed, with relevant professionals involved where required. Weights were being monitored and referrals to GP’s had been made when the findings required. Meals were provided in line with their requirements. The registered manager confirmed they would ensure all care records, including hospital passports reflected the up to date needs of people. A good system had been implemented in the kitchen to ensure food was prepared in line with religious and cultural needs. A range of meals were offered to people and weekly menus had been developed with the input from people who used the service. The registered manager told us all staff made the meals in the service and had access to information in relation to the individual needs and preferences of people. Menus on display in the dining room were not up to date. The registered manager took action to address this. We suggested some consideration was made in relation to encouraging more healthy options for people, and ensuring arrangements were in place during public holidays to ensure plentiful supplies of food were in the building. We noted no record in the kitchen of people’s individual dietary needs.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People were offered choices. People told us staff supported them. They said, “The staff treat me well here and I get on with everybody.” Relatives said, “I think communication from staff is good [person who used the service] I was informed straight away [of an incident with a person].” Another relative told us reviews into people’s medical needs with professionals were taking place.

Staff knew where to access information and guidance about people’s needs and encouraging healthy choices and lifestyle. One told us, “We always try to obtain low fat food and encourage walks.” Staff and managers knew people’s needs well and discussed when referrals and review with relevant professionals were required. The registered manager demonstrated they understood people’s needs and spoke about the action taken where these had changed.

Records directed staff about people’s needs and how to support them with healthy options and lifestyle. They included information about the involvement of professionals such as the GP, consultant specialist and chiropody. Where people’s needs changed, referrals were made. Hospital passports had been completed for all people. This would ensure relevant information was shared with professionals should an admission to hospital be required. The registered manager gave assurances that they would ensure these records were fully reviewed so they reflected all the current needs of the people. Relevant policies and guidance was available to support staff in the delivery of care. Professionals were complimentary about the service and the care they provided. One professional told us, “I have always found both the staff and management to be welcoming and helpful each time I have visited” and, “Staff are welcoming and friendly to myself and I feel that they have good professional relationships with the service users [people who used the service.]”

We saw people being included in decisions about their care. Staff encouraged and supported people in a kind, caring empathic manner with the people that uses the service, always ensuring that the person was ok. A relative told us their family member had been supported in reviews of medical needs where this was required. However, one person discussed the action a professional had taken to address a change in their family member which had not been acted upon by the management.

The registered manager told us about the action taken to address and investigate concerns in relation to one person who required a review which had not been identified by the service. Staff knew how to report changed in people’s condition to improve outcomes for them. One said, “I would report [changes] to the manager and team leader. They would act on it.” Staff knew how to access updated information via the electronic system and spoke about how changes were made.

Assessments had been undertaken that reflected people’s needs and supporting them to improve outcomes. Where professionals were involved, information supported the care provided to people and improved their outcomes. Assessments of people by professionals were ongoing and in line with guidance and practice. Information, policies and guidance was available to support staff in care delivery for people. People’s quality of life was improved because policy and guidance was available for staff. Care plans supported staff in providing individual communication needs to people. Staff understood how to communicate with people and we saw staff engaging positively with people. Records included information about end of life wishes, where this was relevant. This would support decisions for end of life care. The service undertook audits on observations of quality and the care provided to people in line with their assessed needs. This would support monitoring and improving outcomes for people.

During our observations we saw staff engaging with people, seeking consent for care, undertaking activities and promoting choices in their day. Staff were seen knocking on people’s doors and waiting to be invited in. Most people told us they were happy with the care provided to them. One person told us, “The staff treat me well.” Another told us they were happy in the service. A relative said, “I think communication from staff is good.”

The staff team understood the importance of ensuring they sought consent from people before undertaking any care or activity. One said, “I always ask consent if people said no, I wouldn’t do it. If they refused, I would document it and advise team leader.” We discussed the care of one person with the registered manager and the actions taken as a result of the feedback they had received from the family. The management team had an understanding of MCA, capacity assessments and best interest decisions undertaken for people living at the service.

The provider was working in line with the MCA principles. Best interest decisions and capacity assessments had been completed where relevant. DoLS applications had been submitted to the assessing authority and a system was in place to follow up authorised DoLS. Where applications had been approved, records were completed including, how to support people if conditions had been applied to their DoLS. An easy read guide in relation to the service and the support the provider offers was in place. This included the importance of engaging, offering choices and supporting people. Good information was available in relation to advocacy services and how to access them.