The Spires

On this page

• 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.  

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.  

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider assessed people’s care and treatment with them to ensure this was effective. There was a robust pre-admission assessment process which helped to identify people’s needs, wishes and preferences and identify if the service was able to meet these prior to any admission. People, their relatives and relevant agencies were involved and consulted as part of the assessment processes. Staff were provided with information and guidance through handovers and digital care plans. Some people and relatives felt improvements could be made to ensure staff had more detailed, personalised information. Comments included, “I’ve only been here a short time. The staff in my previous care home knew me very well. The staff here don’t yet. They do things their way. I am teaching them my way. I am very particular but find I have to keep reminding them of basic things,” and “We found communication isn’t the best, so we have written out a very specific daily routine so all staff should get to know [Name’s] routine.”

The provider had systems and processes in place to monitor the weight, food and fluid intake of people and take action where required. However, we found staff did not always follow robust monitoring to ensure, where people had been assessed as at risk from dehydration, they had consumed sufficient fluids each day. Monitoring records were not completed consistently which meant there could not be effective oversight of the risk of dehydration, though there was no evidence people had been harmed as a result of this. The registered manager and provider’s representative took immediate action to review care records and arrange training for all relevant staff. Referrals have been made where needed and immediate action taken to change the consistency of people's food in response to recent decline in swallowing abilities. A relative told us, “[Name of family member’s] diet is now liquidised and they require the assistance of a carer to be fed. They have not lost any weight that I am aware of and staff have responded well to changes in their needs.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. We spoke with a visiting health professional who told us, “The staff take advice and act on it. There is good training and equipment available. I’ve never had to raise a concern.” The provider had effective systems and processes in place which staff followed and ensured effective communication and working with other agencies. Staff described positive, supportive teamwork within the staff team and new staff told us they were made to feel welcome from their first day.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support. People and relatives described how staff supported them to maintain their health and wellbeing, including timely referrals to health professionals and responding to changes in people’s needs. People were able to access a range of activities which provided stimulation in addition to access to outdoors spaces and group trips within the local community. Some people and relatives felt people who were unable to participate in scheduled or group activities were at risk of feeling isolated. They had discussed this with staff responsible for activities but were still waiting for concerns to be acted on.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.  We found inconsistent information in some people’s care plans. For example, one person was described as eating independently, whilst other areas of the care plan identified them as having swallowing difficulties and needing staff support during meals. We also identified care plans did not always provide sufficient information around the impact of people’s health condition on their outcomes and monitoring needs. The registered manager told us they would undertake an immediate review of care plans and ensure accurate information was available on digital care plans. Some people wanted access to regular bathing as part of their outcomes but felt unable to request this. Comments included, “You can have a bath occasionally; I’ve had 2 since I got here and that’s over 12 months ago. I would like more, but usually there’s not enough staff to just ask for one; you have to book a bath time.” and “I have been here a couple of weeks or so and haven’t been offered a bath yet; but I expect if I ask, I will get one.” The registered manager told us they would explore why people felt unable to ask for baths and improve access for people following our site visit.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. People and relatives told us staff sought consent before providing care, were supported to make choices and staff respected their decisions. We observed staff respected people’s choices and were receptive when people shared their views and wishes. Care plans contained evidence of consent from people or their representatives where appropriate and best interest processes were followed. Care plans did not always include conditions attached with DoLS authorisations; the registered manager told us they would update records to include these following our site visit.