Archived: Holly Lodge

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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

We reviewed 6 quality statements for this key question relating to assessment of needs and the delivery of care. Care plans were detailed and regularly reviewed. We found staff supported people to live healthier lives, this included seeking appropriate specialist advise and nutritional management. Staff and visiting professionals worked well together. However, although people had been assessed for their capacity to consent to some aspects of their care, not all aspects of care had been considered. This was acted upon by the management team following feedback.

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’s relatives told us the staff knew their family member well. They knew their likes and dislikes, and how to support them individually.

One staff member said, “We [staff] read the support plans regularly. We see people and notice their changing needs. If someone is struggling with cutlery for example, we can get them reviewed by a therapist so that they can be as independent as possible.” Staff told us they ensured people had at least twice daily oral care. One staff member said, “We do oral care twice a day, every morning and before they go to bed. One person refuses but we try our best, we encourage people.” The management team told us they had re-aligned staff to be named nurses for individuals, with a lead clinical standards nurse having oversight of the support plans and documentation.

People’s needs had been assessed and were detailed and provided clear guidance for staff on how to meet people’s needs. However, one person had a nutrition plan in place which referred to a textured diet and thickened fluids. The same person also had a plan in place for a recently inserted percutaneous endoscopic gastrostomy tube (PEG). The nutrition plan was no longer in use but had not been archived. This was addressed at the time of the inspection. People had access to dental services and were supported to attend dental appointments. Oral health plans were in place.

People’s relatives told us Holly Lodge provided the right support for their family member according to their individual needs. Relatives told us they were kept informed when specialist guidance was sought.

One staff member said, “We have a care home nurse practitioner who has visited and is coming to start with the annual reviews. The surgery has specialist paramedics who come as well. There is a triage system so if we need support we call and [the surgery staff] call back, sometimes they visit or we take people to the surgery for review.”

Records showed staff responded to people’s changing needs. When people became unwell for example, staff monitored people’s vital signs and sought medical advice when necessary. Records demonstrated staff responded to people’s deteriorating health and staff were proactive at seeking medical advice when required. Other specialist advice and support was sought when required, such as occupational therapy, physiotherapy, speech and language therapy and tissue viability support.

Relatives told us the staff team worked well together.

Support staff told us nurses gave a handover to them each morning. Staff said they had access to the daily care notes and care plans on their hand-held devices and could keep up to date by reading the previous days records. One staff member said, “Nurses do handover first and then come and give us handover. If I've been off, I will always read back and ask questions.” Management told us they have very good working relationships with Holly Lodge staff, visiting professionals and new colleagues supporting with the transition of new people to the service.

We observed handover between the nurses when the shifts changed. They discussed people’s clinical needs and any changes to people’s conditions. There were regular reviews conducted, including an annual health check.

Relatives told us their family member had regular dental checks and oral health care. One relative told us staff were supportive of their family member improving their diet.

Staff gave examples of how they promoted healthy living. One staff member said, “We try to encourage [person] to have enough vegetables and fruit and fluids. We encourage [them] to go for a walk. Another said, “We help [person] to make healthier choices with gentle encouragement” and “We get people to do armchair exercise. One person uses weights and goes to the gym.” The management team told us their digital recording system had helped to monitor people’s health more accurately.

People had their weight monitored to ensure they had their nutritional needs met.

Relatives told us there were regular checks on their family member’s health and care needs. Some relatives told us they had not seen the person’s care plan. This was discussed with the management team at the time of the inspection. It was confirmed care plans were shared on request, however plans would be shared with relatives routinely instead.

One staff member said, “Our outcomes are good. We rarely have pressure sores for example” and, “We have a communication, action development meeting monthly with nurses, team leaders, and managers. We have minutes, and I share information with that group and action points.” The management team told us they have oversight of outcomes and can easily access the information from their regular audits of the service.

People’s clinical needs were discussed at regular nurse clinical meetings. People were supported to attend hospital appointments and had annual reviews. Medicines were reviewed in line with Stopping Over Medication of People with a learning disability (STOMP) principles.

Relatives told us the staff always talk to the person and tell them what they were going to do and how they were going to support them.

Staff understood the need to gain people’s consent. Staff comments included, “I use gestures to ask people things if they can't speak. Most people here on this unit can give consent” and, “If someone refuses [personal care], we might swap and try another member of staff. If people can’t give consent, we can see how people react.” Staff described people’s body language and verbal sounds that indicated they were giving their consent.

People’s consent to care was not always sought in line with legislation and guidance. Although people had been assessed for their capacity to consent to some aspects of their care, not all aspects of care had been considered. For example, some people had bed rails in place to help keep them safe when in bed. Of 13 people with bed rails in place, nine did not have mental capacity assessments in place or documentation of best interest decision meetings. We discussed this with the management team during the inspection and they addressed the shortfall immediately. They introduced a bed rail risk assessment with a mental capacity and best interests decision embedded within it.