St Michaels Nursing Home

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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

At our last inspection we rated this question good, this rating remains unchanged. Staff assessed peoples needs on an individual basis and then planned their care, if appropriate families were fully involved too. When required staff worked together with other care professionals to share information and meet the holistic needs of people, this included access to other healthcare providers such as GP and dietitians. Care was planned in line with best practice and standards and was reviewed regularly. Staff ensured that people consented to their care and if they lacked capacity they carried out mental capacity assessments for specific interventions.

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.

We received no concerns about involving people or their relatives in assessing their needs. Positive comments included, “They [staff] keep in touch with us, and they involve us when anything changes, if he has an appointment, they inform us of everything”. “Yes [we feel involved in care planning]. [Manager’s name] has been brilliant, she has been open and honest and understands the issues”.

Leaders told us that they ensure that care plans are holistic, reviewed regularly and kept up to date when people’s needs change. Staff told us that the care plans are detailed and give them the information required to look after people’s needs.

We saw that people’s needs were assessed when they were first admitted to the home and were reviewed regularly, mostly once a month. Assessments considered people’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that has the best possible outcomes. We looked at 4 people’s care plans. The care plans were mostly up to date; however, we found a few gaps where information regarding people’s needs were not up to date. The manager addressed the gaps immediately. The manager explained that they were in the process of moving all the records from recorded on paper to be recorded electronically. We saw that the manager made a good progress in moving parts of the care plans to the new system that had been implemented a couple of months ago, however there was still work to be done.

People and their relatives told us that the care staff worked well together and coordinated support with other agencies, if this was required. One relative told us about how the team worked well together to try to resolve an issue around a person’s medication. Relatives told us they could access information about other health services, for example if a referral to an external agency was required.

Leaders and staff told us they worked well together as a team in the best interests of people. Managers told us they shared best practise guidance with staff, for example via memos and staff meetings. Managers often accessed up to date guidance from the Local Authority.

Managers and staff ensured they plan and delivered peoples care and treatment in line with current guidance. Referrals were made to the nutritionist, GP or speech and language therapist. People’s nutrition and hydration needs were met in line with current guidance. Updated guidance or legislation is made available by staff via memos and staff meetings.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People and relatives told us they were involved in review of their health and wellbeing needs. They were supported by staff with referrals to other agencies and with attending health appointments.

Managers and staff told us they supported people to manage their health and wellbeing, so they could maximise their independence and live healthier lives. Manager gave us an example of how they supported a person who was overweight with achieving healthier weight. For example, dietitian referral and supporting with healthier food choices. Staff gave us another example of how people’s mobility is encouraged “There is an area of the home (a long corridor) with a forest wallpaper on (to resemble the outdoors) and benches are placed along the corridor so people can take a break whilst they are walking and reduce the wheelchair use where possible”.

There were systems and process to identify risks to people’s health and wellbeing early and to support people to prevent deterioration. The service had links with other professionals to support people with access to healthcare, such as GP, optician, chiropodist, dentist. People were supported with maintaining healthy weight (loosing or gaining) by having their weight checked regularly referrals to SALT/ nutritionist and monitoring food and fluid intake when required.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People and their families confirmed that their rights around consent were respected, and their views and wishes were taken into account. Comments we heard included, “They [staff] always ask him for permission before coming in and doing anything”, “They [staff] always have a conversation with [name] before doing anything”; “I have seen them [staff] with other residents they [staff] always sit and talk and engage with them [people]”.

Leaders told us they had systems and process to ensure that consent to care and treatment is sought from people. They told us that mental capacity assessments take place if there are concerns about people’s ability to make certain decisions. Manager told us that she ensures that people's capacity and ability to consent is considered, and they, or a person lawfully acting on their behalf, are involved in planning, managing and reviewing their care and treatment. Care staff gave us examples of how they assess whether a person is able to give informed consent about their care. One staff said, “We ask for their [people] consent and the assumption is that they have capacity unless we’ve already been told specifically that they haven’t. It’s about communication, not just speech but facial expressions, movement”; another one said, “We do an MCA and best interest decision. Other than that, we ensure we ask and communicate with the resident”. Care staff also explained what happens if someone declines support from staff or refuses their planned treatment: “If they refuse, we talk to them about this and if still refusing we document it and may request professional advice if they continue to refuse”; “We try to explain why it’s necessary and we will leave them and come back later if they continue to refuse. Explaining the benefits usually work”.

Staff had assessed peoples capacity to consent and documented this fully within their care records. We reviewed 4 mental capacity assessments and found that each was decision specific and the relevant people had been involved in the assessment. For example, support with activity of daily living, family member had been involved. For convert medication the GP, pharmacist and family had been involved. There were people in the service who were on Deprivations of Liberty Safeguards. All the correct paperwork and assessments were in the patients care record. The manager had a tracker I place to ensure that the correct authorisation had been applied for, was in date, or another or a review of the authorisation needed to be applied for.