Lotus Care Marmaduke Street

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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

We assessed 6 quality statements in the effective key question. The assessment of these areas indicated areas of good practice and improvements since the last inspection, our rating for the key question has changed to good. An assessment of people’s needs was completed in line with best practice guidance. People were involved in planning and reviewing their care along with those of importance. People were supported to maintain their nutrition and hydration needs and had choice over what they ate and drank. Staff worked effectively with other external bodies to help meet people’s individual needs and support them to live healthier lives. People’s care was regularly monitored in line with their care and risk management plans. People’s rights around their consent to care and treatment were respected and decisions were made in line with the principles of the Mental Capacity Act.

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.

Reponses from people were mixed in relation to involvement in care planning. One person told us he was not asked what support was needed before they moved into the service whilst another person told us, “Yes, I was asked what support was needed. My sister was involved in the whole process and speaks to the home.” Family members told us that communication with the home was always good, however some family members told us they were not involved in any planning or assessing needs before their relatives moved in.

Feedback from leaders confirmed the effectiveness of people’s care was maximised by assessing and reviewing people’s needs. We spoke with the clinical governance lead who confirmed that although people’s needs were assessed holistically, the most significant needs were prioritised. For example, the provider was in the process of transferring paper care plans onto an electronic system, the provider was also using this as an opportunity to add further detail to some care plans and the care plans deemed to be the highest risk were being rewritten first.

Processes, such as care plan reviews were in place to help ensure people and relevant others had been involved in the assessment of their care and support needs. Care plans evidenced people had been consulted about their care and support needs. Support was provided where needed to maximise peoples’ involvement and independence. Processes also helped to monitor whether people were receiving the right care and support for their needs, for example, by the use of assessment tools.

Most people and their families told us that staff discussed health needs with them and updated them if any referrals had been made to external services. In general, people felt that the care provided met their needs.

Feedback from leaders confirmed people’s care and treatment was planned and delivered in line with best practice standards and guidelines. We spoke with the clinical governance lead who shared an example of a care plan where the risk to the person was deemed as being high. The care plan contained references to best practice guidance which helped to ensure the person received the most up to date and appropriate care to meet their specific health care needs.

We were assured people received care, treatment and support that was evidence-based and in line with good practice standards. Processes supported this practice. Peoples’ care plans referred to best practice guidance, where appropriate. For example, one person’s care plan contained specific information about how their medicines should be taken, this helped ensure information and guidance for staff was accurate and consistent to ensure the person received their medicines in an effective way.

People told us that staff worked well with other services and each other. One person commented, "I do not need any support to get to appointments, but I just need help to get into the ambulance and to and from my appointments. The staff here arrange that with the ambulance service, and it always runs smoothly.”

Feedback from leaders confirmed staff worked effectively across teams and services to help support people. We spoke to the clinical lead who demonstrated how people’s care plans (to manage their individual health care needs) had been written in a way which best supported them.

Feedback from partners about the effectiveness of staff working well across teams was mixed. Some professionals felt staff didn't always act on advice that had been given to help manage people’s individual health care needs in the most effective way. However, managers had acted on this feedback and had put improvement measures in place to help address any shortfalls, such as, increased staff meetings and handovers.

Processes were in place to help ensure staff worked effectively to help support people. People’s care records demonstrated that staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Where referrals to external organisations were made, people’s individual needs and expected outcomes were considered. Information was shared with relevant agencies to ensure continuity of care, for example when clinical tasks were delegated. When people received care from a range of different services, it was co-ordinated effectively. Staff worked collaboratively to understand and meet people's needs.

Some family members felt their relative's personal care needs were not always met, for example 2 family members told us they did not think their relative was regularly showered.

Feedback from leaders confirmed people were supported to manage their health and well-being in a way which maximised their choice and control and helped to lead to healthier lives. The clinical manager explained how they worked with other organisations to help deliver good quality care. For example, they worked in conjunction with specialist nurses to ensure their practices to manage a person’s specific health care need was managed in a safe way and in line with best practice. This helped lead to a better outcome for the person.

Processes helped to ensure people were empowered and supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. Peoples’ care records evidenced they had been involved in reviewing their health and wellbeing needs where appropriate and necessary. People were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. Processes were in place to ensure that referrals to external organisations were made appropriately, for example, for people with changing dietary requirements.

People told us they were happy with the care they received. Family members told us their relatives needs were met, one family member told us their relatives health and wellbeing had improved since moving into the home.

Feedback from leaders demonstrated people’s care and treatment was routinely monitored to help improve it. The clinical manager explained practices were in place, such as weekly clinical meetings which identified people’s most high risk needs and involved a review of clinical and care practices. This evaluation helped ensure people’s outcomes were continually monitored for their effectiveness.

Processes were effective at ensuring people received consistently positive outcomes. Processes, such as frequent care reviews, ensured peoples’ care, and outcomes were monitored for effectiveness. Peoples’ care plans demonstrated that reviews of care had involved them as they should.

People provided examples of everyday choices they made such as what time to get out of bed or whether to go in the garden. People told us staff asked consent before delivering care and support and always explained what they are doing. One person commented, “They come in and ask, do you want changing.”

Managers and staff knew of people’s rights to consent to any care or support they provided, and they knew the legal process for making decisions on behalf of people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Systems and processes demonstrated people understood the care and treatment being offered or recommended. Processes supported people to make informed decisions about their care and treatment. People’s care records evidenced people had provided their consent. Processes were established and helped to ensure the provider acted in accordance with the principles of the Mental Capacity Act. For people who were not able to consent, processes and practices were in place to ensure the provider was acting legally in peoples’ best interests.