Fosse Healthcare - Nottingham

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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

Peoples needs and rights were supported. Peoples care and treatment was effective due to their health, care, well-being, and communication needs being assessed with them. Peoples care plans were kept up to date with any assessments completed in a timely manner. Staff were aware of people’s preferences and respected these in a person-centred way. People were aware of their rights around care and treatment. Staff had good knowledge of the mental capacity act, including capacity and consent. Staff were aware of how to support someone with fluctuating capacity.

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 relatives told us that the provider carried out an assessment of needs with them and they were involved with planning their care. People were generally confident that their needs were understood by the staff team, but one person said they sometimes had to tell staff what they needed done even though the information was in their care plan.

Staff told us that they had time to review care planning documents, so they could keep up to date with people’s changing needs Staff had good knowledge of how to support people’s needs, and what action to take if the person’s needs appeared to have changed.

Staff had access to documents on how to support people. Where people’s needs changed, these care planning documents were updated so staff understood people’s changes in needs. People’s communication needs were recorded and understood by staff. For example, we saw a care plan which explained how best to speak to the person to ensure they understand, and that the person sometimes used a magnifying glass to read. This allowed staff to communicate with people, to have a clear understanding of the persons needs and wishes.

People felt the support they received met their needs and preferences so what was important for them as well as what mattered to them was considered. One relative spoke with us about the support their loved one required with a swallowing difficulty which affects what food they can eat. They said, “I liaise with [registered manager] and said give [relative] what they want within the limits of swallowing, which they do.”

Staff understood how to work with external health and social care providers, to provide support in the most effective way. The registered manager spoke with us about ensuring what was important for someone and what mattered to them was considered through care planning and review, through staff observation about people’s health and wellbeing and included the importance of promoting people’s independence. They said, “It’s easy sometimes for staff to go in and take over so we remind them what people can do for themselves.”

Care plans contained clear information regarding what was important for people to ensure their care met their needs and preferences. This included a section on “what’s normal for the service user” which was a useful tool to help staff identify when people’s needs may have changed and prompt a review. People’s nutrition and hydration needs were supported in line with current standards. People with specific conditions, for example: diabetes, contained good, clear information regarding the persons condition including signs and symptoms for staff to be aware of and contact details for the district nurse who supported the person’s care.

People we spoke with and relatives, said that staff work effectively with family and where relevant, professionals, and share information with them appropriately.

The registered manager talked with us about how the team worked collaboratively with external professionals and other stakeholders to improve the service people received. They provided positive examples of communication by phone and email with other stakeholders which had supported with positive outcomes for people including emailing a social worker to increase a persons care package who required additional support with shopping.

One external partner we spoke with explained how the provider worked with them and how important it was for the team to provide feedback on the person’s care. They told us, “We rely on care provider to be our ‘eyes on the ground’ and Fosse do this well, they are also excellent at alerting workers who they know to be involved or alerting our contact centre so that a worker can be allocated perhaps in the case of a care package needing adjustment.”

We reviewed evidence of collaborative working practice through people’s daily records which detailed conversations with visiting professionals and emails between the team and external professionals. This positive team working approach involving the person, staff, family and professionals ensured people received care that met their holistic care needs.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

People and their relatives told us that their care was monitored, and changes were made to improve outcomes. Most people did recall having a recent review. People who could not recall having a recent review of their care felt confident communicating any changes to the staff and also felt care staff would notice any changes to their health and wellbeing and would address this. One person spoke with us about a recent care review as “things had changed and needed added to.” They said, “The care plan is constantly being tweaked and added to, so I know what’s in it.” A family member told us, “Over time things have changed, they’ve [provider] responded well and changed things.”

We spoke with the management about how they monitor and improve people’s care outcomes. The quality manager spoke with us about how they monitored people’s care outcomes through regular review of care plans to ensure they were up to date and relevant as well as reviewing any accidents and incidents to identify any causes which may point towards a need to change the person’s care package to better support them, as well as considering people’s feedback about care. They told us, “Every month we do a care plan and risk assessment audit and check to see nothing is missed.” Ensuring people have a complete and current care plan supports to improve people’s care outcomes.

The provider carried out regular reviews of people’s care and staff were encouraged to provide feedback on people’s care as well to identify any concerns and also improvements where people’s independence had improved. Identified outcomes were recorded in people’s care records to ensure that they were progressed. We saw they were reviewed and updated accordingly. Where feedback was received that people were not receiving the care required to ensure they experienced positive outcomes from their care, we saw that these were investigated and responded to appropriately.

People and relatives told us people’s rights were respected and consent to care was sought before providing care. One person told us, “Yes, they [staff] will always ask [before providing personal care.” Another person described how staff respected their rights and independence. They told us, “They [staff] leave me to it and I feel like I’m respected, otherwise I’d say something.”

Staff understood the importance of seeking consent before providing care and respecting people’s right. We spoke with the registered manager who told us, “We always ask people for consent when giving care and people sign their care plan to give consent to the agreed care. If the person lacks capacity, we will go to the next of kin. The person might not have capacity but there is usually a way to ask for consent when providing care.” Seeking people’s consent when providing care and support demonstrates people’s rights are considered and respected.

We saw that people had signed consent forms which included consenting to being supported with the care recorded in their care plan as well as what information can be shared and with whom. Where relatives had given consent on a loved one’s behalf, we saw that the appropriate legal documentation was in place. For example, the relative had power of attorney which meant they could legally consent on their loved ones behalf. Staff had clear guidance on what to do if someone declined care for example, if someone declined to consent to be supported with personal care.