Aster Grove 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

The overall rating for this key question is good. People’s needs were assessed prior to them living at the service. Staff used nationally recognised tools to identify risks and planned care and support to address and mitigate the risks. People experienced good outcomes of care by receiving joined up care from staff and health and social care professionals. Professional advice was included and updated in people care records; staff followed the advice, monitored the effectiveness, and provided feedback with to professionals. Staff worked in line with the 5 principles of the Mental Capacity Act 2005. People were asked consent for all support interactions. People and/or their legal representatives were asked to read and sign consent forms to enable staff to offer support. Staff respected people’s wishes and right to decline care.

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.

People and their relatives were involved in initial care assessments which formed the basis of their care plans. Assessments were designed to ascertain people’s individual needs and preferences. A relative told us about the assessment process and said, “I remember filling in forms about [person’s] interests and foods they liked and didn’t like. I said about gardening and the banjo and a toy dog, it goes around with [person], it got lost a few times but staff know its [person’s] and it is important to them.”

The registered manager told us they and other members of the management team assessed people and would provide feedback to the local authority. They requested input from health or social care professionals to help the assessment and admission process to run smoothly for the person.

Assessments were completed before people moved to the home. This included consultation with professionals, the person and their relatives. People and their relatives were welcomed into the service before admission to help make an informed decision on whether the service was appropriate to them.

People’s health risks were assessed by staff using evidence based tools to ensure their care records and risk assessments were accurate. For example, the malnutrition universal screening tool (MUST) was used to ascertain people’s risk of malnutrition and the Waterlow tool was used to assess people’s risk of damage to their skin. Care plans were written up to address risks, for example, for people with vulnerable skin integrity, they would have planned repositioning and airflow mattresses amongst other measures to reduce the risk of pressure damage to the skin.

Members of the management team told us about the evidence-based care and treatment tools they used. They said, “We use the FRASE (Fall Risk Assessment Scale for the Elderly), Brandon scale, Abbey scale for pain. A lot of assessments, there is a post falls assessment too.” We saw these tools were used and outcomes recorded to inform people’s care and support.

Care records reflected legislation and best practice. For example, people were assessed and specific care plans were written for health needs and equipment such as, catheters. A member of the management team told us how they were effective and said, “Daily catheter checks are a prompt for the nurse in charge to check and update the finding and follow up on previous shift. This has helped monitor colour, concentration etc, then means we can pre-empt there is a potential infection, if we notice darker urine, we start pushing fluid rather than wait for an infection.”

People received joined up support as staff worked effectively with health and social care professionals. People’s health and support needs were understood, information was communicated effectively between services to ensure a continuity of care. People and their relatives were involved in reviews. A relative told us, “If [person] ever had any problems, the trained nurses were so easy to speak to, they would soon report back to me. They would consult me and ring me in the evening with feedback from the GP. They always kept me well informed.”

Staff gave examples of how they worked with teams and professionals to ensure people received appropriate and timely care and treatment. A staff member said, “The speech and language therapy (SaLT) team will come and will say if any residents need thickener or if anyone is going for the different levels of foods. They will tell the nurse; they (nurses) tell us in handovers and what level it needs to be. This information will be put in the care plans. I read the care plans; whatever we need to know we can get the information from there. We immediately tell the nurses for any changes, no matter how small and they update.”

Health and social care professionals provided feedback about how staff and management have listened to suggestions and improved people’s experiences. One visiting social care professional told us, “Referrals sent to Aster Grove are typically met with a swift response confirming acknowledgement and assessment of the individual person’s needs. Any declines are accompanied by needs-based rationale whereby it is clear that they consider the potential risks alongside the existing dependency profile of the home.” Another health professional said, “They are a home that contact regularly to check on processes and request advice for clarity on situations or concerns regarding individual residents or training available.”

People’s care records were up to date and accessible should a person need to move to another service or hospital. People had a ‘this is me’ document which detailed their needs, likes and dislikes, this helped staff, teams and services to work towards a good outcome for the person.

People were supported to live healthier lives, staff ensured people always had drinks available to them and people were able to choose from them menu what they liked to eat. We received mixed feedback about the food on offer, a relative told us their loved one did not like the food so the registered manager gave a catalogue of various foods for them to choose from. Where staff identified concerns about a person’s nutrition, referrals were made to the SaLT team or dieticians.

Staff supported people to attend appointments at hospital or within the service. Any actions or follow ups would be documented in people’s care records. Staff monitored people and escalated any concerns to relevant health care professionals. A staff member told us, “[Person] a few days back, was getting red under the eye, we informed the nurse, we documented this too. It is getting better. We are applying ointment which was provided.”

People’s care records included professional involvement and any advice or instructions for staff to follow. The management team monitored to ensure staff were following the advice and provided feedback to professionals. A professional told us, “When I have offered advice, they demonstrate they will trial recommendations suggested to see if this is appropriate for the individual and will then contact me again if some suggestions have not been successful. When I am involved, they are happy to work as a wider team to optimise the outcome.”

Outcomes of people’s health and well-being were monitored by staff and where improvements could be made or where support needed reviewing this was actioned. A relative told us, “There have been some changes to try and get [person] off the medication.”

Staff told us how they monitored people’s health needs and escalated any concerns they had if the planned support was not providing good outcomes for people. Where needed care records would be updated to reflect people’s changing needs. A staff member told us, “We are the ones who write the care plans, we review them monthly, we get more and more knowledge about the resident we ask them what they like, such as, time to go to bed and what time they like breakfast and update. I ask the carers about the residents and we can add to the care plans. For mobility, for personal care, if they are eating, how much fluids.”

People had current and person-centred care plans which reflected best practice guidance. Daily care notes and charts evidenced people received the support as identified in their care records. Quality monitoring processes included monitoring care records which helped ensure these remained current and relevant for people.

People were consistently asked for permission and consent from staff before they were supported. Staff provided people with choices in relation to where they spent their time, what they wanted to do and what they wished to eat and drink. A person told us, “I can eat in the dining room but I prefer eating in my room, it’s a lot quieter.” People's right to decline care was understood and their wishes were respected.

Staff received training in the Mental Capacity Act 2005 (MCA) and worked within the principles. Staff gave examples of how they helped people understand their rights, choices and how they gained consent from people. A staff member said, “We ask for consent, some residents can’t say yes or no, or do not respond. When I am offering medicines, I look to see if they are willing to take it such as opening their mouths. If they don’t take it we keep it a side and I try to leave and return.”

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. MCA assessments were carried out with people, they were decision specific and detailed the involvement of people, their relatives, relevant legal representatives and professionals. MCAs were person-centred and contained Best Interest decisions where needed. Consent forms were completed by people or their legal representatives. Where people had lasting power of attorneys in place, documentation was checked by the management team to ensure decisions made on people’s behalf were done legally.