Scholars Mews Care 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 and preferences were assessed before they moved into the home. This ensured the provider could meet their health and social well-being needs. Improvements had been made to this process since our last inspection and the Operations Director described how the home was now admitting new residents very gradually to ensure a safe transition. Referrals were made to specialist healthcare professionals when required. People had access to a GP who would review any emerging healthcare needs regularly. Some further improvements were required in how staff worked effectively across teams with other healthcare professionals. Effective monitoring of people's health after changes were made by healthcare professionals was not always always clear to enable an effective review. Staff understood the importance of seeking people's consent before providing care during their day to day interactions with people. However, where staff had taken clinical photographs of people's wounds or injuries, records did not show their consent had been always been sought. Records also required further information to show people's capacity to make decisions had been fully assessed.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The Operations Director told us changes had been made to the pre-assessment process to ensure the home could fully meet people's needs. The Operations Director explained the process staff went through when completing their first assessment since their voluntary placement stop had been lifted. They said, “We met the person and completed our pre assessment questions and then when the deputy manager returned to the home the assessment was discussed with me as the Director of Operations, the Quality Director and the Regional Manager would be part of that process as well. We all discuss whether we feel we can meet their needs. This is done very gradually and carefully.” The Operations Director explained that this was the only person that had been admitted to the home since the last inspection and talked through how they had continually reviewed how well the person had settled into the home. They told us, “We are monitoring admissions to the home very carefully. We will only be taking in low level needs at the moment.” Staff were positive about the way information was shared to ensure peoples assessed needs were identified and communicated across staff teams. One staff member gave us examples of how information relating to the needs of new people moving into the home was communicated effectively. This included during handover and through other discussion with senior staff, and information provided on the initial care plan.

The Operations Director told us changes had been made to the pre-assessment process to ensure the home could fully meet people's needs. The Operations Director explained the process staff went through when completing their first assessment since their voluntary placement stop had been lifted. They said, “We met the person and completed our pre assessment questions and then when the deputy manager returned to the home the assessment was discussed with me as the Director of Operations, the Quality Director and the Regional Manager would be part of that process as well. We all discuss whether we feel we can meet their needs. This is done very gradually and carefully.” The Operations Director explained that this was the only person that had been admitted to the home since the last inspection and talked through how they had continually reviewed how well the person had settled into the home. They told us, “We are monitoring admissions to the home very carefully. We will only be taking in low level needs at the moment.” Staff were positive about the way information was shared to ensure peoples assessed needs were identified and communicated across staff teams. One staff member gave us examples of how information relating to the needs of new people moving into the home was communicated effectively. This included during handover and through other discussion with senior staff, and information provided on the initial care plan.

Records showed people's needs had been assessed before moving into the home. The pre-assessment document contained enough information about the person’s needs to enable the home to make a judgement about whether they could provide support to them. For example, medication, medical history, infection control risk, continence, falls history communication, psychological health as well as their previous working life, social interests and hobbies. When people had been admitted to the home from hospital, staff also ensured a discharge letter was available. On-going assessment continued as people moved into the home. A variety of assessment tools were used to identify changes in levels of risk in areas such as nutrition, falls, skin damage, oral health etc. Assessments were reviewed monthly or as required and show changes being factored into the assessment when things change. Care plans were updated to reflect advice from professionals.

People did not raise any concerns to suggest they were delivered care against good practice guidance. A relative commented how food had been adapted in line with a persons change in health and told us, “[Person] was diagnosed with pre-diabetes and had their diet changed. This was managed well. I was involved, and so were the kitchen staff.” People spoke positively of the food and told us their nutrition and hydration needs were met. One person said, “There are healthy food options available if you want them. The food here is very nice." Another person said, "The food is very nice, I always enjoy my lunch.”

Staff told us they had access to national best practice guidance such as the British National Formulary (BNF) which detailed pharmacology advice. Staff told us they were informed of best practice through training and staff meetings. One staff member told us access to training had now improved and included face to face training for night staff. For example, in relation to basic life support training. Staff understood people’s nutrition and hydration risks. The chef who did not work at the home regularly knew people's nutritional risks and preferences and knew where to find important information about people. Care staff also told us information about whether people were eating and drinking well was shared with them during the handover. One staff member described the importance of ensuring people ate and drank well to maintain their health. Staff were able to describe the process for the safe storage of thickener for people who needed them. Thickener is a powder which is added to liquids to create a thicker and more stable texture.

Records showed people’s eating and drinking needs were assessed when they moved to the home and monitored through regular reviews. Where risks were identified, a plan of care was in place to manage and mitigate known risks. A variety of best practice screening tools were used. We saw (MUST) nutritional screening tools in use and evidence of staff supporting people at nutritional risk. Records showed people’s weights were reviewed at weekly clinical risk meetings to ensure appropriate actions taken where needed and referrals were made to other healthcare professionals where required.

Overall, people and relatives felt staff teams worked together to ensure people received the care they needed. One relative told us, “Yes, the staff work well together. The kitchen staff and care staff worked well with [person] when their diet changed."

Staff told us they worked across teams through handovers, discussions with colleagues and staff meetings. This helped to ensure people’s care needs were identified and addressed. Day staff spoke of good information sharing between the staff team through handovers between shifts. However, 1 staff member told us, “Yes we have handovers where we share concerns, but it doesn't mean things are always done.” This staff member gave an example where a person had been prescribed a medicine which had not been actioned in a timely way. The Regional Director told us regular daily meetings took place where all departments met to discuss current issues with people's health and social care needs.

Healthcare professionals reflected on the improvements since the last inspection and had more confidence staff were working effectively with other teams to ensure better care outcomes for people. One healthcare professional told us, “They have followed appropriate steps in referring to other agencies, including social services, physiotherapy, occupational therapy, dieticians and raising safeguarding concerns where appropriate over the last few months.” However, improvements were still required to ensure effective practices were embedded and they went on to say, "We have recently discussed improving documentation for ward rounds in the GP / Frailty nurse communication." Another healthcare professional gave some examples of where care outcomes for people could have been better if internal recording and monitoring had been more effective in being able to give an accurate picture of a person’s health to healthcare professionals. They told us, “This still needs to be improved. I think some staff are better than others at acting on things.”

Overall, records showed the outcome of visits from external professionals had been documented. However, effective monitoring of changes made by healthcare professionals was not always clear to enable an effective review. For example, the monitoring of a new medication to support people's sleep was not being monitored well. The monitoring of changes to people's health is important to ensure the home worked effectively with other healthcare teams. Records showed details of internal 'clinical risk meetings' and 'ten at ten meetings' which ensured all staff had up to date information about people’s changing needs.

Some people or their relatives chose to arrange their own healthcare appointments such as dentists. One relative told us, “I take [person] to all their appointments and deal with everything as I have power of attorney.” Where people needed support to make appointments or arrange transport, this was provided. One person told us, “The home or my daughters take me to the GP, dentist and opticians. They are very quick in sorting things out.” Another person told us, “The doctor, dentist and optician are organised on a regular basis, it works very well.” A relative explained, “[Person] has not had any changes in their condition. I feel they do get the right treatment."

Staff told us they supported people to see a variety of external health professionals. This included GPs, the frailty nurse, Parkinson’s nurse and the optician. Staff gave us an example where staff had noticed a person’s needs were changing in the morning. The staff organised a review of the person’s medicines via the specialist nurse and GP, so they would be sure the person’s progressive illness was being appropriately managed. Staff told us the GP visited every Thursday. Staff told us there was a GP book which the GP checked when they arrived at the home. This covered which people were a priority to review. Staff also told us the optician visited the home every 2 years for NHS patients. One staff member told us about the importance of supporting good oral health care. They explained, “We need to look after the oral hygiene because their mouth needs to be cleaned every day so they don’t get gum disease which may mean they don't eat well or swallow well."

Records showed people were supported to see healthcare professionals when they needed. Records showed the GP and frailty nurse visited the home weekly and we saw evidence of referrals to other healthcare professionals such as SALT, dietician and optician. Care plans were regularly updated to reflect people’s current needs. Although we found evidence of some annual health reviews, records were not always clear if people and their relatives had been involved in reviewing their care plans and health needs.

People and relatives confirmed the care provided to people had improved since our last inspection. On relative commented, “It has massively improved from before”, whilst another commented, “Things have gotten better, but there is still room for improvement.” One relative described how their parent had undergone a medication change and said, “The staff kept me informed on how it was going and adjusted the dose. [Person] has been better since.”

Staff told us they continually monitored people’s care to ensure they remained well. For example, staff told us they monitored people’s weights and recorded their fluid intake to ensure people were well nourished and hydrated. One staff member gave us an example of improved health outcomes for 1 person. The staff member explained the person had previously been designated for end-of-life care. The staff member said as a result of careful monitoring and support their end-of-life status had been withdrawn as their health had improved. One staff member told us about improvements in the way people’s health was now monitored. The staff member said, “The food and fluid charts make it easier [to monitor people’s needs]. It gives you more time with the residents”

Processes to monitor people’s clinical outcomes could be improved. One person had recently had a medication change to aid their sleep pattern at night. However, this was not being monitored effectively to enable a co-ordinated approach to managing this need. Another person had an increase in medicines due to their levels of distress. Staff did not routinely complete behaviour monitoring charts to enable an healthcare professionals to make a clear judgement on the effectiveness of this medication. Records showed some monitoring, but this was not easy to navigate. Without having clear information, it was not always clear if people were receiving care that was joined up and co-ordinated. Despite this, other day to day monitoring of people's risks such as those related to eating and drinking, skin integrity or catheter care were monitored well.

People told us staff asked their consent when delivering care. Comments included, “They (staff) always ask my permission for everything, when they shower me, everything” and, “I did consent to come here, a very good decision. All the staff are respectful and get my permission like when to get me up” and, “I’m as independent as I can be and can make my own decisions where possible.” During our visit we saw occasions when people declined support, and this was respected by staff. However, during our visit we found staff had taken clinical photographs and it was not clear if people had given their consent for this. The Operations Director told us that a review of the providers policy would be undertaken to ensure staff had a clear process to follow when taking these photographs.

Staff told us they understood the importance of offering people choices and seeking consent before providing care or support. Staff told us they respected people’s right to make their own choices and decisions where possible. One staff member told us, “It is important people make their own choices, like picking clothes from wardrobe and asking which they would like. People choose what time they go to bed and get up. [Person] likes to go to bed after lunch then comes for supper and stays up late which is their choice. There is no pressure to go to bed. It is their choice. When I come in we have early risers but sometimes they want to sleep longer so night staff will leave them and that is absolutely fine.” Staff told us if people declined care and support, they would respect that decision and offer support later in the day. One staff member told us, “If they (people) want to sleep, then they will sleep. If they want to stay in bed, then they will stay in bed. I will not force people to get up if that is not what they want.” Staff understood the need to report any refusal of support which could place people at risk to senior staff. Senior staff would consider what action, if any, needed to be taken in the person’s best interests. One staff member told us, “If the person is capable and can make their own decision, I would leave the person for a while. I would still try to convince them but if they insist, there is nothing I can do. I can't force a person. I need to get the manager involved if they still refuse personal care” and, “We change our face. If they don’t want me then we will swop with a colleague."

Mental capacity assessments were in place for a range of specific decisions but some of these lacked detail to show staff had taken all practicable steps to support people to make these decisions. Where people lacked capacity to make a decision, records showed decisions had been made in people's best interest decisions such as to have sensor mat next to their bed to support their falls management. However, where clinical photographs had been taken, records did not show people had consented to these or that the decision had been made in their best interests. The Operations Director told us, “Staff should absolutely be seeking people's permission before taking photos and records should support this.” The Regional Director confirmed the providers 'Standard Operating Procedure Avery Guidance for Clinical Photography' had been reviewed and updated to ensure there were clear protocols around the importance of consent for such photographs.