Fosse Healthcare - Lincoln

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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. We found people’s outcomes were consistently good, and people’s care records and feedback around health supported this. People’s needs were assessed in line with current best practice, people were fully involved in this assessment and all subsequent reviews of their care and had given their consent. The staff worked with external professionals to ensure people had access to all health professionals and equipment they required to keep them safe.

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 were fully involved in their assessments but they did not always feel the assessments were implemented effectively in practice. People felt the assessment process was, “Slow going.” Or, lacked attention to detail, resulting in people feeling staff did not know their preferences for meals or leaving tasks incomplete.

Staff were able to demonstrate a good knowledge of people and explained how they ensured the care was person centred. One staff member told us, “I ask the [people] themselves what they prefer and how they like things done while also following the care plan and risk assessments. I treat them as individuals.”

Systems were in place to ensure a robust assessment of people’s needs, likes and dislikes. This took a holistic approach to the person’s life and the information was then transferred to care plans and risks were assessed. The registered manager used best practice tools to determine risk levels for people at risk of pressure damage to their skin and for risks related to eating and drinking. The registered manager and staff team ensured they consulted with external health and social care professionals where required to ensure best practice was being followed.

People had mixed feedback about the support they received to ensure good nutrition. One person told us, “[Staff] are supposed to cook for me but it’s very hit and miss. Some don’t know how to cook it or present it and will just put everything in the microwave whether it needs to be cooked or not." Another person said, “Caring is pretty good for the ones who actually get it and have had a bit of training."

Staff understood how and when to refer to external professionals when people required additional support or equipment. A staff member told us how the provider had supported a person to gain a new Zimmer frame with wheels that better enabled them to maintain their independence by accessing the kitchen to make their own drinks with less risk of falls.

The provider worked with external professionals to ensure people had access to all health professionals and equipment they required to keep them safe. They monitored people’s health and dietary needs and implemented additional training for staff in relation to food preparation and awareness as a result of people’s feedback.

Despite the provider ensuring teams worked well together and involving people in transitions, people and relatives had concerns about the lack of continuity of care, particularly for people living with conditions such as dementia. A relative told us how this impacted on people’s ability to build trust with the staff, which made the relationship more difficult. Another relative told us about how care was rearranged without proper communication, causing distress and inconvenience.

Staff understood the importance of sharing information with each other, people, their relatives and relevant external professionals such as GP’s. They understood the need for consent and how to work together to get the best outcomes for people.

Staff understood the importance of sharing information with each other, people, their relatives and relevant external professionals such as GP’s. They understood the need for consent and how to work together to get the best outcomes for people.

The provider used electronic care records which enabled sharing of information with consent, via the use of QR codes. This meant external professionals, people and their relatives could easily access the information they needed. The registered manager implemented plans, referrals and needs assessments as required. All information was recorded in people’s care plans.

People did not all require support with their health needs as they were able to do this themselves or with the support of their relatives. When this was required, people felt the care was not always well co-ordinated or did not support their personal preferences. Some people told us their mental health had deteriorated as result of the stress caused by inconsistent care.

Staff understood how to look out for deteriorating health in people and how to promote positive well-being. One staff member told us, “You do like a quick risk assessment and look around to see if there is anything to trip over or if people are not well and spot early signs of a bed sore or if someone needs a nurse or GP or [their relative].”

There were policies and procedures in place to identify and report health concerns to the relevant professionals. Referrals were made within a reasonable time frame and regular reviews of people’s health took place. Risk assessments were detailed and regularly reviewed.

People were fully involved in reviews of their care and had opportunities to provide feedback. However, people’s views about this were mixed. Some people agreed they were aware of and supported to monitor and review their care and other people told us they were not aware of review outcomes.

Staff understood how best to gather information from people and those important to them about their care needs and how to use this information to review the quality of care. One staff member told us, “To Listen, Ask and Do. We get to know them, speak to their families to see what is usual for them and work out how best to support them and their needs.”

The registered manager had systems in place to review and monitor people’s care. The information gathered was analysed by the registered manager and senior managers to determine any improvements to be made.

People had consented to their care in their care plan. However, not everyone agreed that staff sought consent or worked with them to ensure they continued to consent to their care. For example, a person told us, “[Staff] don’t always ask if I mind them doing something; they just come in like a bull in a china shop." However, another person said, "I give consent for my care and [staff] respect me. They do ask my permission if they are going to help with anything too personal.”

Most staff understood the importance of seeking people’s consent before providing care and had an understanding of how to assess if a person had the mental capacity to make their own decisions safely. For example, one staff member told us, “[People] can make wise or unwise decisions and have to be able to retain information. We never assume someone lacks [mental] capacity. You always ask the person for permission before doing anything. Talk them through what you are going to do and why. Consent can be verbal, written or communicated in another way such as gestures. A nod of the head. Thumbs up, signing words.” However, not all staff had a good understanding of what to do if people no longer had the mental capacity to make safe decisions for themselves. Staff told us they felt they would benefit from additional training in this area.

The provider had processes in place to seek people’s consent to provide care at the point of assessment and reviews. The registered manager ensured care plans were accessible for people to review and offered opportunity for feedback. Where required the best interest process had been followed to support people’s decision making where it was deemed they no longer had the mental capacity to make a specific decision.