The Shrubbery 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

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 inspection we rated this key question good. At this assessment we did not assess all quality statements within this key question. The overall rating for this key question remains good based on the findings at the last inspection.

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 mixed reviews regarding people and relatives having involvement in people's care planning. One relative told us, "They always involve me in updating the care plan". Another said, “I am not involved in any care plans". However, people and relatives said this had not had an impact on them and they were informed of any changes to support their care needs. We shared this with the registered manager, who told us they were in the process of improving this process to fully ensure that people and relatives were fully consulted. Where people required additional support and guidance with more complex needs, for example, epilepsy or diabetes, specific plans were in place and had been reviewed by the relevant external professionals.

Staff knew people well and were able to describe their current needs and how best to support them. Staff told us they had enough information about people and were kept up to date with any changes in people’s needs. For example, during daily meetings, so that the personal care they supplied always met peoples’ needs.

We looked at 3 peoples’ care records. For the person with a diabetes care plan, this care plan had been recently reviewed. This showed that diabetes appeared well controlled with no concerns. The plan contained clear information and guidance for staff to follow. The falls risk assessment had also been recently reviewed. Staff supported with all moving and handling requirements. No concerns raised had been raised. The person stated in the care plan: “I am unable to weight bear and required full body hoist and medium sling for all transfers.” The person was receiving nursing care in a specialist profile bed. The nutrition and hydration risk assessment stated the person was supported to choose from the daily menu. They continued to have supplementary drinks and fortified meals. Weight had been gained. Information regarding the need to ensure food was not a choking risk was in place. We saw fluid records. Fluid intake was monitored to prevent dehydration.

People and relatives told us that the care received from staff met the assessed needs.

Staff demonstrated good knowledge of peoples’ needs. There were detailed care plans which specified peoples’ care needs, preferences and choices. Staff, including the chef and kitchen assistant, understood the international dysphagia diet standardisation initiative (IDDSI) standards. This had information to describe texture modified foods and thickened liquids for people with dysphagia [which is, difficulty in swallowing], to prevent choking. They knew which people required specialised diets, and how to prepare foods and fluids to the correct consistency. Staff knew how to support people who had difficulties swallowing and at risk of choking.

Care plans provided clear information and guidance and were updated to inform staff if people’s care and treatment needs had changed. The management team and staff were working with a wide range of health professionals, such as occupational therapists and social workers to ensure people were receiving appropriate care and support.

Staff told us team morale was good and staff worked well together as a team. Staff told us they were provided with the information they needed to ensure they can carry out their roles effectively. Relevant information concerning peoples’ needs and the running of the service is shared following 11am daily meetings. This is attended by the manager, nurse in charge, senior carer, housekeeper and kitchen staff. Any updates and or concerns are discussed then shared with the rest of the staff team. Staff told us and showed us the information they can access on the electronic app which contained relevant information on peoples’ care needs. This included key risks for important issues such as for falls, choking, tissue viability needs and moving and handling requirements.

Partners had told us the registered manager had made contact with them to ensure people living at the service were receiving coordinated care and that everyone was working together to achieve the best outcomes for the people living at the service. Care plans showed that relevant staff, teams, and services are contacted to be involved in assessing and planning care, to ensure the delivery of care meets people's needs.

The Registered Manager had made contact with all professionals involved in people’s care and support if they have not had the information they needed to appropriately assess, plan, and deliver people’s care and support.

Observations showed staff had good interactions with people and they were respectful. People were prompted to drink where needed and reminded they had food to eat if they chose to have it.

People we spoke with said staff were good and gave them the support they needed to live well. We saw that staff were monitoring people to ensure that they ate and drank well, in order to protect their health needs.

People had regular reviews with external medical professionals. Appropriate referrals had been made for people who required additional clinical support. The GP also visited every 4 weeks to review people. Relatives were included in reviews. We also observed family members supporting people to attend appointments on the day of our onsite assessment.

Staff had knowledge of people's changing needs, and were able to tell us how these were shared with the rest of the staff team through daily meetings and updates on the services digital system. People's care records had been reviewed regularly. Where people required additional documentation to support more complex clinical needs, such as Parkinson’s disease [a condition that affects the brain. It causes problems like shaking and stiffness] and epilepsy [a common condition where sudden bursts of electrical activity in the brain cause seizures or fits]. They were in place and had been reviewed by external professionals. For example, where people were on end of life care, the GP had reviewed medicines.

The Registered Manager had implemented systems and processes to have an oversight of people’s care and support. Care plan audits were completed to review and monitor people’s outcomes. Where risks, concerns or errors had been identified action was taken. For example, people who required monitoring of their fluid intake to ensure they had enough to drink, had goals set on what they should have in a 24-hour period.

A person told us that staff talked to her and let her know what support they were going to provide during personal care. We saw a person’s care plan which had been reviewed recently which covered health, wellbeing and care needs. Staff supported the person to make simple day to day decisions or care was provided in the person’s best interests.

Staff understood the importance of gaining consent from people before they deliver care. One staff member told us, “During training we learnt how we must always ask and involve the person. For example, ask them what they would like to wear, what they would like to eat and drink. We encourage people to make their own choices.” Another staff member explained how they consulted others such as families, where appropriate, where a person lacked capacity to make decisions about their care and support.

Systems were in place to follow decision making principles on behalf of people who lacked capacity. Staff had received training in the mental capacity act. They supported people to make their own decisions wherever possible, and staff respected people’s choices, which was recorded