Handsale Limited - Silver Trees Also known as Laurel 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

The overall rating for this key question is good. People were supported to experience joined up working with health and social care professionals to achieve good outcomes. We received positive feedback from professionals who felt the service was well managed and the care provided was good. The service sought best practice guidance and nationally recognised tools to manage people’s health and care needs. People were asked for consent and all support and care plans contained important information about people’s capacity. Mental Capacity Assessments and Best Interest decisions were in place for most decisions for care and support, although not where people had acoustic monitoring in place. The registered manager confirmed action taken following our assessment. Staff had received Mental Capacity Act 2005 training, although when asked who lacked capacity and who had a deprivation of Liberty Safeguard in place, staff were not able to provide this information. Care plans contained important information such as people’s medical histories and if people had a religion or if they wore glasses or a hearing aid.

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 felt involved in assessing the care and care plans were individualised to people’s individual needs. Where people’s needs changed, a personalised approach was undertaken and the person and their families were part of any assessment. One relative told us they had been made aware when the person’s needs had changed. They said, “They were moved to the nursing floor of the home, when they had become unwell”.

The registered manager and other members of the management team were responsible for undertaking assessments and for reviewing people’s care needs. Referrals were made to health and social care professionals when required. This included the GP, district nurse and the social care professionals.

Assessments were undertaken prior to the person moving into the home. This formed the person’s care plan. People and relatives were part of reviewing this care plan which was undertaken once a month.

People felt part of their care and treatment and people’s health risks were assessed using evidence based tools such as malnutrition universal screening tool (MUST). However, not all care plans had risk assessments, for example, where people had vulnerable skin and needed to be re-positioned. The registered manager had taken action to address risk assessments being in place by the second day of our inspection. Air mattresses and how these needed to be correctly set were recorded in people’s care plans and were observed to be accurately set for people. Where people needed their diet modified, care plans contained important information and assessments had been undertaken. We observed people getting their meals as per their assessed needs. One person who was being monitored with their hydration had electronic and paper records completed. However, these records did not contain the same information as we found the person’s electronic record had more entries completed. We raised this with the deputy manager so they could review the recording of this person’s hydration. Most people told us the food was good and there was choice. Some people however felt they would like more variety and access to more fruit and hot drinks.

The registered manager and management team told us where they had engaged with external projects to improve outcomes for people. This project had been an opportunity to review people’s health and medicines and make recommendations to reduce the person’s medicines.

Initial assessments were undertaken by the service when people were identified as being at risk of choking. Referrals were then made to health professionals. Clinical meetings were an opportunity to review any changes to people’s health needs. People’s dining experience could be improved by having a daily menu available. The registered manager, following our inspection, confirmed they had updated people’s care plans to contain important information about people’s wishes around their dining experience and they were looking to implement menus back onto tables. Dining areas had tablecloths, napkins and condiments.

People and their relatives were happy with the care and support provided and all felt involved in people’s care and support. Health and social care professionals were updated by the staff team when any changes occurred.

The registered manager and staff confirmed they worked as a team to ensure people got the care and support they needed. All staff felt able to raise concerns with the management if needed. Staff had hand over meetings and clinical meetings which were an opportunity to discuss any changes to people’s individual needs and referrals required.

Health care professionals provided positive feedback about how staff and the management of the service kept them up to date with important information. Comments included, “Staff are knowledgeable about the residents. They know important information and residents are happy and well cared for”. They also felt that the home was well managed, and staff were friendly and important issues were raised when needed.

People’s care plans were individual and personalised. They contained important information such as people’s likes and dislikes and personal information such as hobbies, interests, health conditions and any medical allergies.

People were supported to manage their health and wellbeing to maximise their independence, choice and control. One person told us how they undertook an exercise class in the local community. People told us they were given choice with their personal care and if they had a bath or a shower. One person told us, “I have a bath. This is my choice”.

Staff promoted people’s independence and encouraged people to do things themselves. They told us how they promoted choice by asking people what they would like to wear and what their preference was about washing. One member of staff told us, we give people, “Choices about their care and how they would it provided”.

People’s care was delivered by the service whilst liaising with professionals as required. Clinical meetings, handovers and the GP round was an opportunity to ensure any changes were being raised so advice could be sought and referrals made. All professionals felt the service provided was good and any changes to people’s needs were communicated by the service.

People’s care and treatment was monitored so that their health and well-being was the best it could be. One relative told us the service had made a referral when the person had recently had an infection. All people and relatives we spoke with were happy with the care and support provided by the staff.

The registered manager and staff escalated any changes to people’s health needs to ensure they got the best care and treatment. The registered manager confirmed this included reviewing the nutritional outcome of the menu, reviewing people’s medical needs through clinical and GP reviews and ensuring referrals were made to speech and language therapists, dentists and opticians when needed.

People had person-centred care plans although important information such as people’s repositioning information and risks were not always accurate and up to date. Daily records and charts were not always up to date and accurate for people on fluid monitoring and daily repositioning.

Staff sought consent from people on aspects of their care. Staff gave people choice with how to spend their time, how they wanted their care provided and what they wanted to eat and drink. Staff were not always familiar with who had a Deprivation of Liberty safeguarding in place and who lacked capacity although staff confirmed people had choice and they respected this.

Staff received training in the Mental Capacity Act 2005 (MCA) and they worked within the principles of people have choices. One member of staff confirmed people had, “Choices about their care and how it is provided”. MCA assessments and Best Interest decisions were in place for people. These involved people, their relatives and other representatives. Although MCA and Best Interest decisions were not evident where acoustic monitoring was used. The registered manager undertook action to address this following our assessment.

People’s care plans contained whether people had capacity to make specific decisions about their care. Where people lacked capacity, people had a Mental Capacity Assessment (MCA) and Best Interest decisions were made for individual’s specific decisions such as personal care and vaccinations. Information was recorded in people’s care plans if they had lasting power of attorney.