Kingsclear

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Whilst there were various engagement and activity opportunities for those who were mobile, people who were bed bound were often not catered for in this area. Information was provided to people in a way they could understand and communication needs of people were recorded and met. There was a joint up working approach with health professionals to ensure people received the specialist health care and support they required. People were involved in their care and were able to give suggestions on how to improve the service. People’s end of life wishes with gathered and respected.

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’s experience of personalised care differed depending on their mobility. There was a range of social activities offered to people who were able to mobilise to the communal areas. However, relatives with loved ones who were bed bound felt the same opportunities were not available for them, which led to a lack of meaningful activities and engagement. One relative said, “We like the range of activities provides. [Person] is active and participates and enjoys these."  However, another relative told us, “[Person] used to go to all the quizzes and lunches but she can’t go to them anyone as she’s bedbound. She tells me that she can’t have a cup of tea as its not teatime yet. I don’t feel like it’s her home at all.” A further relative said, “They had some animals come in the other day. I’ve never heard of them having entertainers going into her room. The only time she’s mentioned it is a school visited the other day and a child went into her room and gave her an Easter egg which she absolutely loved.” The feeling of care not always being personalised was exacerbated by people and their loved ones feeling agency staff did not know people and their likes and dislikes. One person told us, “The day staff know my individual needs and respect that but not sure the night staff do.” A relative said, “[Person] says she doesn’t trust the staff as they don’t make effort to talk to her or get to know her, but that she is safe. [Person] says she feels like a slab of meat sometimes. She said if they just spoke to her while doing embarrassing things to her like showering it would make her feel better.” Another relative told us, “Theres a box of photos in her room but they don’t use them to speak to her. Agency staff don’t know her at all. The more permanent staff know her.” A further relative told us, “The biographies, sometimes sent by email don't seem to filter down to the staff, eg food dislikes.  However face to face with care staff that seems work better.”

However, staff and leaders felt all people at the service received personlised care. One staff member said, “I think each resident is different and we know what each person needs. Some will be more mobile and independent, others more reserved so we may need to encourage them more.”

We observed kind and person centred care during our assessment. A person on the dementia floor was displaying anxiety and frustration. Staff were respectful and calm in supporting her wishes. There was a lot of conversation and laughter going on throughout lunchtime, and people genuinely seemed happy. The staff were attentive and ensured people had a good dining experience. Care plans were detailed and developed from the initial assessments. They contained people's life history which contained details about their childhood, family members, hobbies and interests. Care plans were regularly reviewed and updated according to people's changing needs. The staff carried handsets so they could record the care they provided in real time. They also had access to people’s care plans and risk assessments so they were able to have the information they needed to care for people and meet their needs. People's care plans contained a 'This is me' care passport. This stated information about the person in sections such as 'Things you must know to keep me safe', 'Things that are important to me' and 'My likes and dislikes'. This contained information which was specific to the person and helped the staff meet their needs according to their likes and dislikes. However, as detailed earlier in this report, staff did not always read or utilise this information.

People told us they could see the GP or other healthcare professionals when needed. They felt their health needs were met. One person said, “Oh yes I can see the doctor when I need to. He is coming to see me this afternoon.” Another told us, “I see the nurse when I don’t feel well and they call the doctor.” A relative said, “I believe they told the hospital everything they needed to know about mum. The GP comes in once a week.”

Staff told us there were strong working relationships with healthcare professionals. The registered manager told us, “We have a good relationship with the healthcare professionals. They know our residents’ needs and follow them.” Staff had good insight into people's needs. They were able to tell us each person’s health conditions, and the treatment and care they were receiving.

Equally, partners fed back that working relationships with the service were strong. One healthcare professional told us, “It is all very positive in terms of communication, responsiveness, safety and escalation."

People's health needs were recorded and met. People’s care plans clearly described their healthcare needs and how to meet these. We saw evidence people were visited by healthcare professionals and supported to attend health appointments as needed. Healthcare professionals involved in people's care recorded the outcome of their visits in people's records and any information or instructions for staff to follow. They included the GP, chiropodist and Speech and Language Therapist. The leadership team at the service established a good professional relationship with the local authority.

People felt they were provided with information on their care in a way they could understand. One person told us, “We get an activity sheet weekly so we can choose if we want to join.” Another person said, “I am usually informed of what is going on. We are also consulted about food. They asked us twice a day what we would like. It’s very good. Relatives felt there had been recent improvements in this area. One relative said, “A lot of relatives said communication was an issue, so after that they sent an email round with contact email addresses for the manager, housekeeping etc, which was helpful so we know who to contact.”

Staff felt the communication within the service was effective. A staff member told us, “[The registered manager] gives everyone an update on what's going on within the home for all areas, departments, any changes, anything new and always thanks everyone for their hard work and everything you do every time.”

People’s communication needs were recorded in their care plans and met. One person who was sight-impaired was listening to talking books when we visited. They told us, “I like listening to my talking books, I cannot use my eyes very much now.”

People told us they felt listened to and were able to voice their concerns as needed. They told us they were invited to regular meetings where they could raise concerns and ask questions. One person said, “There are residents’ meetings and we can talk to the manager. They do listen if we have concerns.” Another person told us, “They do ask our opinion, and we can say what we want. The staff do listen most of the time.” Complaints were taken seriously and responded to appropriately and in a timely manner. People who used the service knew how to make a complaint. One person told us, “I can talk to any of the staff. They do listen” and another said, “I let them know if I’m not happy about something.” Staff gave people choices of where they wanted to go, where to sit, what meals to eat and a choice of drinks. Staff listened to people and supported their preferences where possible. The staff showed understanding and patience in their communication with people living with dementia and had a good rapport with them.

The staff told us they felt listened to by the management team. There were regular meetings organised and surveys where they could raise concerns. One staff member told us, “Feedback is followed up and following meetings to ensure actions have been taken. We can then explore a barrier and how to overcome them if not achieved.”

The provider had systems in place for people to give their feedback about the service. These included a yearly survey, regular meetings and a suggestion box. People were supported to raise concerns and these were listened to. The provider had a ‘You said, we did’ system whereby they listed what people had raised and what they had done to improve this. There was a complaints policy and procedures in place and this was available to people who used the service. A relative had raised concerns in relation to their family member not being supported to sit up in bed when assisted with their meal. They also told us the person was meant to be on an air mattress but was not. At the time of our visit, an air mattress was in place. We saw evidence of regular checks and body map completed with photos. The provider kept a log of compliments they had received. Comments included, “Communication is always very good”, “very impressed with Kingsclear”, “We can’t thank you enough for the care and love towards our [family member].” “Thank you. Kind receptionist” and “Good activities and kind staff.”

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People’s end of life wishes were gathered and respected. A relative told us, “They’ve spoken to me about the subject. We did talk about it and a care plan was created.” Another told us, “I have been able to be involved in my [person]'s end of life wishes. We were listened to.”

Staff were knowledgeable in end of life care. The manager told us the service was supported by a local hospice in delivering this care to people, and the hospice also provided training in this topic. Staff confirmed they had received end of life training and had for example, learnt about Do Not Attempt Cardiopulmonary Resuscitation (DNARCPR) decisions.

People's end of life care needs were recorded in their care plans. These stated the person or people to contact in case of an emergency, what was important to the person in the event they became too unwell to voice their wishes, and where they wanted to be looked after at the end of their lives. Anticipatory medicines to help keep people comfortable at the end of their life were available and safely stored in preparation for residents who were being supported with palliative care. This meant there would not be a delay in obtaining the medicines should the person deteriorate quickly.