Skylark House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People, and where appropriate their relatives, had been involved in developing their care plans. Records showed their views and preferences were included and consideration was given to people’s diverse needs. Care plans were holistic, detailed and provided staff with clear guidance. Staff were knowledgeable about people and their needs and had developed positive relationships with people and their relatives. People said they were supported to be as independent as possible. One person told us,“The staff let me get on and I do everything I can for myself.” People told us they were supported by staff who were responsive to their needs and spoke highly about the care their received. One person told us, "They (staff) are always cheerful and help, as if they really want to be there and care about us all.” People were encouraged to make choices about how to spend their time and described having access to a range of occupations and experiences that they enjoyed. One person said, “I really like colouring and TV and music and they help me with those.” A relative told us, "They like to go on outings and there is a farm they like to visit, also church services.”

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 told us staff knew them well and understood what was important to them. One person said, “They really do, just as family would.” Another person said, “They know me very well.” People said care was provided in the way they liked. One person said, “I couldn’t be happier,” another person said, “The outstanding things are their (staff) patience and happiness.” A relative told us staff were knowledgeable about people’s needs and said, “The cheerfulness (of staff) really brightens the day.”

The registered manager explained how improvements in staff deployment had led to better continuity and improved understanding of people’s needs and preferences. Staff told us they were deployed to work in specific areas of the home and this enabled them to provide more personalised care because they had opportunities to get to know people well. One staff member described how they would learn about a person, saying, “ I read care plans, talk to other staff and the resident and their family.” Staff were positive about improvements in maintaining consistent staffing in all areas of the service. One staff member told us, “It’s really good, we get to know the residents and families better… Families are happy with the connections and we are fully staffed”. Another staff member said, “Everyone is different, we are really getting to know the little things.”

We observed how staff were knowledgeable about people’s individual needs and knew their likes and dislikes. At lunchtime we observed how staff members where aware of people’s needs and supported them appropriately. We saw how one staff member encouraged a person to do as much as possible for themselves and provided gentle, discreet support when they needed it, showing a good understanding of their individual needs.

The provider’s systems for deployment of staff supported good continuity of care. Systems for monitoring incidents and accidents included checking that referrals were made to other services when appropriate, for example to the falls clinic following more than one fall.

Staff were positive in their views about changes to deployment of staff since the last inspection. They explained the benefits of working in one area of the home and how this had improved continuity for people and their relatives. They described how they had time to get to know people and to develop understanding of their needs and preferences. One staff member said, “I know the families and residents, I have had time to get to know them.” Another said, “I am getting to know individual preferences, although I haven’t worked here long, other staff know people well and can tell me.”

The local authority told us there were no concerns about the service.

People described being supported to access local health and care services. One person described how staff had supported a smooth transfer to hospital when they needed to be admitted for treatment. They said, “I have had to go to hospital and they sent a carer with me which was lovely.” A relative said they had confidence that staff would ensure medical appointments were made and kept. They told us, “They (staff) make all the arrangements for us.” A person told us staff would contact the GP or make appointments when needed, they said, “Nothing is easier, I say I need one and it is arranged.” People and relatives were positive about improved continuity of care and described the positive impact this had because staff knew people well and understood their needs and preferences. One person had recently come to live at Skylark House, their relative told us, “The staff are getting to know us both.”

The registered manager explained, “We have residents who are hard of hearing. We communicate with those residents using white board and pen, picture cards – as those are their preferable ways of communication. We also use the visual items to support residents’ making choices such as visual plates at mealtimes, cards with pictures of activities, items of clothing etc. In the past we had a resident on a respite stay who was profoundly deaf, we introduced him to use a tablet with the Google Transcribe app for communicating. This app translates the spoken word to text in real time. Since using the tablet with the Google Transcribe app the resident’s life changed completely. Even now, every now and then he contacts us and says thank you for making his life so much better."

The provider had a policy to meet the Accessible Information Standards. People’s communication needs were assessed prior to admission and care plans included measures and/or equipment that people needed to support their communication. Reviews of care plans included consideration of people’s communication needs and staff were aware and knowledgeable about how to support people.

Some people had sensory loss and needed support with information. A relative told us about their relation saying, “She is a bit deaf but she lip reads.” Staff were aware of the person’s needs and we observed how they spoke clearly and slowly to support communication with the person.

Staff demonstrated a good understanding of how to involve people in decisions about their care and support. One staff member told us, “I try to help discuss issues with residents.” Staff described how they got to know people’s individual needs and preferences. The registered manager spoke of the importance of involving people and where appropriate relatives in decisions about people’s care and support.

The provider’s Complaints policy identified how complaints could be raised and what people could expect to happen to address any concerns. There had been no recent complaints raised at Skylark House. Regular meetings were held with people and with relatives and this offered opportunities for people to express their ideas and raise any concerns about the service. Records showed these meetings were well attended. Issues raised were documented and the registered manager provided a response to each issue. Mechanisms for involving people in their individual care plans included regular reviews of their care. A Resident of the Day system was used to ensure people’s needs were reviewed and that their views, and those of their relatives, were sought where appropriate.

People and their relatives told us they were involved in planning care and support and could contribute their ideas to the service. One relative of a person with dementia told us, “The staff are doing their best to make life as near as possible to what he could want.” Relatives described having opportunities to be involved and felt they were encouraged to share their views and ideas. One relative told us, “They do treat us as family and know us really well.” People and their relatives told us they knew how to raise complaints and would speak to the manager or staff if they had any concerns or ideas about the service. One person said, “I haven’t raised any concerns but I would speak to care staff first and then the manager.” People said they knew who the manager was and they would feel confident that any concerns raised would be addressed.

Records showed that staff were proactive in accessing the support people needed. We noted examples in people’s care records of contact with health care professionals including GP, district nurse, SaLT,physiotherapist, hospital, auditory department, opticians, Parkinsons’ disease nurse and podiatrist. Consideration of people’s protected characteristics were evident in care plans and in the provider’s policies.

People spoke positively about being able to access services when they needed to. One person said, “If I want to see a GP they make an appointment for me, the system works well.” Everyone we spoke with said staff supported them to access health and care services. One person told us how staff would contact the podiatrist when they needed to, they said, “Anything I need in that line is organised for me.” Another person said, “I am sure they (staff) will get anything I need.”

Staff understood the importance of supporting people to access services in a timely way. One staff member gave an examples of involving SaLT and GP when a person showed signs of having difficulty with swallowing.

The local authority told us there were no concerns about the service.

Care plans were well personalised and supported good outcomes for people with diverse needs and preferences. Where barriers were identified through the provider’s systems for monitoring the service, appropriate actions were taken to remove or reduce barriers and to support people’s quality of life. For example, a person with dementia expressed an interest in going to visit a local historic site and staff arranged for this outing to be accommodated.

Staff were clear about their responsibilities to support people to achieve positive outcomes by removing barriers and making reasonable adjustments for people. Staff told us they had received additional training in dementia and this had improved their understanding of people’s needs. One staff member said, “Someone may struggle to choose one day but be able to do so the next. We have to keep offering, it’s important for people to feel independent.” A staff member described how they had tried different approaches to support a person with dementia to engage and be included in activities. They explained how they adapted their approach to support the person and had sourced a safe dart board from them to try. They told us, “We are giving this a try to see if it’s something they will enjoy.” The registered manager told us how additional training had made a difference to staff understanding of dementia and this meant they were better equipped to support people to achieve good outcomes.

People told us they were able to access all areas of the home and were invited to join activities and events. A person told us how they enjoyed musical events and said, “They (staff) always take me to it if I want to go.” People and their relatives spoke highly of the care they received and described how barriers were removed to ensure everyone was included. A person who used a wheelchair explained how they enjoyed access to the garden including using verandas with glass barriers. They told us, “The place is lovely and I love the verandas, they are very safe and at a good height.” A relative of a person with dementia spoke highly of the care provided by staff saying, “They recognise the turmoil my relative is going through and treat him very kindly and compassionately.” People described how their needs and preferences were considered and the care they received was well personalised. One person told us, “We are all treated as very important and special.“ Another person said, “I like my routine,” and another person said, “Really I do just what I want.”

Staff spoke positively about how end of life care was planned and provided to people. They told us how nursing staff have signed up for the Gold Standard Framework (GSF) which is a training and accreditation scheme aimed at improving end of life care. Nurses and care staff had received training in end of life care and staff described positive links with staff from a local hospice.

Care plans for end of life care were in place and included people’s views and preferences. There was clear guidance for staff including contact details for health care professionals involved with people’s end of life care. When appropriate, medicines were put in place in case they were needed if a person’s condition deteriorated quickly.

People and relatives told us they were supported to plan for the future. One person said, “I am going to spend the rest of my days here and I wouldn’t want to be anywhere else, I am very happy.” People and where appropriate their relatives were supported to be involved in making plans for care at the end of life.