The Poets

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

People were involved in planning their care. Care and treatment plans’ reflected people’s preferences and promoted effective outcomes. People’s needs were regularly assessed and reviewed. People had access to health and social care professionals and medical treatment. Effective processes monitored people’s health and outcomes. People’s rights were respected, and care and treatment provided in line with the requirements of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

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 were involved in their needs assessments. They told us this enabled them to plan their care with staff. A person new to the service told us, “Even after being here such a short time. I feel comfortable. I’m quite at home.”

Assessment processes enabled staff to understand people’s current and changing needs. Staff used different assessment tools to monitor people’s health and wellbeing. Information gathered from assessments was used to identify the type and level of support people needed to support them well.

Assessments were carried prior to people joining the service to ensure their needs could be met. Multidisciplinary assessments provided information for targeted care planning. Assessment processes were person centred and encouraged partnership working.

People had opportunities to discuss their health and support needs. Some people felt this was an area staff could improve upon. Most people we spoke with said they were kept well informed, and their care plans were discussed with them. A person said, “They go along with the little things I like done. They’re little things, but they’re important when you can’t do them for yourself.’

Staff regularly reviewed people’s care. This enabled them to identify what was working well and where people may need more support or treatment. Staff followed best practice guidelines to ensure people received effective care in a personalised and non-discriminatory way. A staff member said, “We have many residents here. There is no discrimination.”

Processes were in line with legislation and good practice standards. Accurate records were kept about people’s care. There were effective systems in place to assess and monitor people’s health, care, and outcomes. Training was available to ensure staff had up to date skills and knowledge to support people well.

People told us the staff worked well together. A family member told us their loved one felt unwell, they said, “Staff put aside what they were doing straightaway and dealt with it. They said they would call 111 or get a doctor, they saw to it at once.” People told us they were able to access other services such as GP, physiotherapy, and hospital treatment. A person said, “I am amazed how they look after me.”

Staff worked together to support people well. Staff told us changes to people’s care and treatment plans were communicated effectively through hand over, team meetings and care records. Clinical staff co-ordinated people’s treatment. They worked collaboratively with staff and other healthcare professionals, such as the community matron and tissue viability nurses to ensure people received continuity of care.

Professionals working with the service shared positive experiences about partnership working. They told us there was effective management and clinical leadership. Nurses triaged clinical concerns and recognised those that required more urgent intervention. Staff were described as ‘kind, calm and engaging with residents.

The service worked in partnership with other organisations. Treatment plans showed staff sought advice and guidance appropriately. Referrals were made for specialist support. Care records reflected people’s needs and circumstances were considered when they were referred to the service and when they left.

People said they were provided with advice and support to maintain their health and wellbeing. People were aware of their health needs and treatment plans, and told us they were supported to manage pain, specific health conditions and dietary needs well. People told us the food was good, and they had plenty to eat and drink, with snacks and beverages always being readily available.

Staff were knowledgeable about the support each person needed to achieve good health. They discussed test results with people and created treatment plans. Staff were knowledgeable about the signs to indicate a person’s health may be deteriorating. For example, recent sepsis training had provided them with an awareness of the early signs of sepsis and action to take.

Staff liaised effectively with each other and specialist health care professionals and teams. Care records showed that people had access to routine and specialist health care treatment and appointments. Records were kept about people’s health including outcomes from health appointments and consultations. Staff ensured any guidance provided was implemented.

People told us their health and wellbeing were constantly monitored. A person said, “They are always doing checks.” Another person said, “They keep a good eye on me, they are always checking what I have eaten, how much I have drunk, my blood pressure and how I am.” A person told us staff checked on them 2-3 times during the night. They said, “It’s not intrusive and it doesn’t wake me up.”

Staff told us effective monitoring led to better outcomes for people. They explained the vast range of processes and tools in place to monitor people’s health and well-being. For example, repositioning plans and fluid monitoring supported good skin integrity, and clinical observations provided information about people’s physical health. Staff outlined the importance of taking time to talk with people which they said supported better mental health and provided an opportunity to monitor people’s well-being.

Governance processes regularly monitored people’s care to ensure better outcomes. Clinical processes were robust to ensure people’s health needs were monitored and managed well. Early warning processes were in place to detect and respond to clinical deterioration in people, including sepsis. This enabled early intervention and treatment and better outcomes for people.

People told us and we observed, staff sought people’s consent before providing support. A person told us about a regular medical intervention they needed. They said, “They explain what they’re doing when they do it. I’m kept well informed.” People said their decisions and choices were discussed and they felt informed and listened to by staff and medical professionals. This enabled them to make decisions about their health, care, and treatment.

Staff worked collaboratively with people, families, and professionals to ensure people’s rights and freedoms were respected. Staff had regard for people’s feelings and wishes and ensured these were considered in all decisions about their care and treatment. Staff and managers understood the principles of the Mental Capacity Act 2005(MCA). They knew how to support people safely ensuring any restrictions necessary were lawful and proportionate to the risk and seriousness of harm to that person.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Mental capacity assessments had been completed where necessary. Where restrictions had been placed on a person’s liberty to keep them safe, these were lawful and authorised by the local authority.