Haldane House Nursing Home

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 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 were in place to support this practice. The registered manager worked with staff to ensure care plans and related documents had specific information about people, their needs and how to manage any conditions they had. Relatives were involved in planning their care and were informed of any changes in health or wellbeing. Relatives were positive about the staff and the service. People were able to access healthcare professionals such as their GP and other services specific to their needs. The service worked well with other health and social care professionals to provide care for people. Professionals noted to us a clear positive change and improvements in the service. Staff supported people to make decisions following best practice in decision-making and respected their rights to refuse support. People and relatives told us staff were caring, friendly and kind, and we observed this. Staff understood how to treat people with care, respect, and consideration.

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 their families were involved in the assessment of their needs, and support was provided where needed to maximise their involvement. People’s individual needs have been appropriately assessed and were fully understood by the service. Relatives told us people’s needs were met and understood by the staff team, and they were regularly informed of any changes. Professionals said, “I think [the registered manager] and her team have grown in confidence and will reach out for support, to achieve the best outcome [for people]” and “Yes, I think they do an amazing job with [assessing and monitoring people’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that has the best possible outcomes]”.

The registered manager worked with the team to maximise the effectiveness of people’s care and treatment by regularly assessing and reviewing their health, care, wellbeing and communication needs with them. They communicated daily to ensure any information or changes about people’s needs had been noted and actioned. The registered manager said, “Reviews are done monthly. We involve families in any decisions about the person. Best interest decisions are always done with family and professionals…I always ensure families know they can talk to me, they are welcomed”. The registered manager reviewed and considered the needs of staff so it could be met according to their diverse needs. This supported their health and wellbeing in their roles and helped them to provide safe and effective care to the people they support. Staff told us people’s needs and risks were assessed and reviewed regularly using a range of assessment tools to ensure their needs were reflected and understood. Staff also told us their views were sought and considered to support people’s reviews and assessments. They agreed people and families were always involved in those processes. Staff told us information was shared during meetings, handovers and daily communications to ensure all staff were aware of any changes. Staff added, “I don’t do assessments myself but can give my view. Assessments are undertaken to prevent weight loss, sore skin and moving and handling. All staff are made aware of these. People are included at all times; we like them to feel involved” and “Nurses and the registered manager are mainly responsible now [for assessments]. I have done assessments, and my views are known. Residents are encouraged to be involved or their relative”. Staff told us they felt supported and they were encouraged to share any issues or concerns with the registered manager.

We reviewed 5 care plans for people and noted to the registered manager they were much improved, ensuring the person receiving care was respected, considered and at the heart of staff’s work. Assessments and reviews considered the people’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that would have the best possible outcomes. Care plans for support with oral care varied and some had more detailed information than others. For example, records did not always contain clear guidance for staff on how to manage people's oral health and support they would need with it. However, daily notes indicated people received regular oral care and support. People’s communication needs were assessed, recorded in the care plans and met to maximise the effectiveness of their care and treatment. Assessments were up-to-date and staff understood people’s current needs. We spoke to the registered manager about adding a few details or examples specific to the person such as if something worked well for a person, or if they responded to something well, to include as part of plans of care.

People received care, treatment and support that was in line with good practice standards and achieved good outcomes for people. Relatives were kept up-to-date with people’s care and support and informed about any changes.

The registered manager told us they sought support from other stakeholders to ensure the care was in line with legislation and current evidence-based good practice and standards. Staff told us they received training, attended staff meetings, reviewed relevant guidance to ensure they were up-to-date with required standards to help them care for people in this service. People’s nutrition and hydration needs were met in line with current guidance. The registered manager explained how they supported, monitored and reviewed people’s nutrition and hydration needs including seeking support from professionals if they identified any risks or issues. One professional added, “They go above and beyond with their care around this [area]”. Staff said people had choices at meals times and if anyone did not like the choices, they were able to have an alternative of their choice. Kitchen staff were able to support variety of people’s dietary needs and worked with the rest of the team together to ensure they had all the information needed. Staff said, “It is my job to ensure meals, food and drinks are offered at all times. Staff monitor the weights and the meals provided are appropriate” and “The chef and staff talk to people to help make the menus…Staff know people well and care plans are in place. Staff are aware of any food risks, and they encourage food and drink. If people lose weight, we may monitor them more and we also weigh them monthly”.

The registered manager and staff communicated with people, their relatives and partners about their care and treatment that supported current good practice that was relevant to people’s care and was reflected in their care plan. Staff and the registered manager were encouraged to learn about new and innovative approaches that evidence shows can improve the way their service delivers care. For example, the service had been using a specific system for remote monitoring in their care. This was to help support the complex care required by people. The staff would collect people’s health readings and use the remote system to share this with the dedicated health team. Depending on symptoms and care needs the team were able also escalate to the local GP practice for further support. This helped reduce waiting times on the phone and the staff were able to support and address people’s health needs promptly. The remote system worked well with the service’s own scheme to record observations. The registered manager and the staff member told us they have won a Docobo Innovation Award for their implementation of the remote system. Kitchen staff communicated with the staff team on a regular basis to ensure they had the right information on what people’s diets, preferences and any specific requirements were. People could have a drink or snack at any time. We observed people always had drinks available to them and were encouraged to have those. People received support where needed with meals and drinks to maintain a balanced diet. During mealtimes, we observed people were not rushed to have meals but also were encouraged to maintain their independence with having meals.

Relatives told us the service and other professionals worked well together to look after the people. The information was shared between teams and services to ensure continuity of care and when people were referred between services.

The registered manager shared information and examples how they worked in collaboration and effectively across teams and services to support people as they moved between different parts of the system. For example, the registered manager ensured people were able to use the dental and optician services without needing to leave the service. This way, everyone was reviewed and provided with any further treatment if needed. The registered manager and staff had access to and used the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. The registered manager had clear lines of communication and records kept to ensure care was co-ordinated effectively. The registered manager said, “I keep a track of all the communications. Professionals will call and advise us what is needed. Social services regularly visit us, and they were fantastic. If we need support, we contact different professionals when needed. They supported really well me, it is wonderful”. Staff said the service and other professionals worked well together to look the people. The information was shared between teams and services to ensure continuity of care and when people were referred between services. Staff said, “Everyone works well together…On [shifts] we all work together, we are a ‘little positive team”. The nurses on [shifts] summon GP, 111, if we needed to” and “Staff communicate and work well with other professionals, for example GP and social services staff, SALT, tissue viability physio, pharmacist”. Staff told us they had enough support, knowledge and skills to provide specific care to people with different needs.

Professionals agreed the service worked well in collaboration to ensure continuity of care and good outcomes for people. They said, “The staff worked tirelessly with the person who had not been able to mobilise or weight bear for months and worked with professionals from other teams to get the person up and walking again” and “Yes, [The registered manager] and the team communicate effectively and will reach out for guidance and support”.

The registered manager had a process in place to support people and their relatives as they moved between using different services. When people transferred from other services, the registered manager ensured initial assessments were done and plans were compiled to ensure they considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. All relevant staff, teams and services would be involved in assessing, planning and delivering people's care and treatment and staff would work collaboratively to understand and meet people's needs.

People were supported to remain as healthy as possible. Relatives told us they were informed what was going on with people, any changes in their health or wellbeing. People were referred to various health professionals to address any health issues or changing needs in a timely manner. Professionals agreed the service supported people to maintain good health, have access to healthcare services and receive ongoing healthcare support. One professional noted when the registered manager started at the service, they identified people were using the same incontinence product of the same size. The registered manager recognised this was not person centred and could have negative effects for people’s skin. Therefore, they completed continence assessments on all the people and ordered individualised products for people. this supported people’s independence, choice and control.

The registered manager told us how people were supported to manage their health and wellbeing, but also to ensure people maintained their independence, choice and control as much as possible. The registered manager worked with staff to understand people’s needs and preferences and look after their health, care and wellbeing needs. People were involved as much as possible in reviewing their health and wellbeing needs where appropriate and necessary. Staff told us they worked together to help people look after their health and respond to any concerns or deterioration related to their health. They said, “All staff, whatever their job, keeps an eye on any changes to [people’s] condition for example [infections], behaviours and we would report it to nurses. Care plans are in place and shift handovers, so all staff know of any changes… if any changes, the nurses/manager would refer to GP or 111 quickly and let staff know of any concerns” and “Oh yes definitely [staff team respond to health changes]. If staff see a change in a person, they will report this. A nurse is on duty at all times. If residents are unwell, the nurses report to the GP”.

There were processes in place that help identify risks to people’s health and wellbeing early and on how to support people to prevent deterioration. The registered manager and staff used computerised system to improve the care and treatment of people using the service. It also supported the service to contact professionals quicker for early interventions when a person was deteriorating. This system supported prevention of hospital admissions and people would be looked after at the service. People’s health was regularly monitored including any health assessments and checks where appropriate and necessary with health and care professionals.

People were valued by the registered manager and staff who showed genuine interest in their well-being and quality of life. Relatives agreed staff were knowledgeable to provide specific care to people. People had care and support that was co-ordinated, and everyone worked well together and with people. Staff supported people so they were enabled to live as they wanted to, seeing them as a unique person with skills, strengths and goals. Staff were patient and used appropriate styles of interaction with people. They were calm and attentive to people’s emotions and support needs, such as sensory sensitivities.

The registered manager told us they and staff routinely monitored people’s care and treatment to continuously sustain it and improve it where possible. They ensured that outcomes for people were positive and consistent. The registered manager felt the teamwork, low staff turnover and staff’s knowledge of each person supported effective approaches to monitor people’s care and treatment and their outcomes. Staff said, “All staff monitor residents continually. Any needs changes, it is referred to GP, 111 or social services. Trained nurses are on every shift to provide care and support. Things have been implemented since new manager came in, for example, audits are undertaken more now, lots of monitoring to ensure good quality of care” and “Assessments and audits of records and care plans are undertaken. [People] do have a good life experience here. The staff are caring and diligent”.

Care plans reflected a good understanding of people’s needs, including relevant assessments of people’s communication support and sensory needs. Staff ensured people had up-to-date care and support assessments, including medical, psychological, functional, communication, and preferences. This way staff were able to support people receive the care, support and treatment they needed and wanted. Staff provided people with personalised, proactive, and co-ordinated support in line with their communication plans, sensory assessment and care plans.

People's rights to make their own decisions, where possible, were protected and respected. Staff sought people's consent before providing care or support. We observed staff were polite, kind and respectful towards people and respected their decisions. If people did not want to do something or take part in an activity, the staff responded appropriately. Relatives were complimentary about staff’s support and the way they treated people.

The registered manager told us how they communicated and encouraged staff to assume capacity, support people with their choices and wishes, even the small details of what they liked. The registered manager told us they signed up for further training of MCA to ensure they continued managing this aspect of care and support for people. The registered manager also told us they involved and consulted people, relatives, and any other relevant party to ensure the decisions made were in the best interest of the person. The registered manager and staff worked together to ensure people received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. Staff told us about people’s capacity to make decisions through verbal or non-verbal means. Staff explained how people would express themselves, what it meant and how staff would support them appropriately. Staff empowered people to make their own decisions about their care and support and respected their rights including right to refuse. Staff explained they would respect this but try again to support people later. Staff understand the importance of ensuring people understood and were able to make decisions without any restrictions. Staff said, “When people [come to the service], their ability to make decisions is looked at…staff encourage people on a daily basis to make decisions where possible, if they want to get up, what they want to wear and what they want to do” and “Staff spend time with residents talking to them and ensuring all their rights are upheld. All staff have done MCA training and know they must, wherever possible, obtain consent before undertaking tasks such as taking medicines, personal care and so on”. Staff told us people, their relatives or others that matter, professionals were involved in supporting people to make decisions when planning, reviewing or managing care and support.

The registered manager worked with people, staff, and others to ensure people’s rights around consent were respected when delivering person-centred care and treatment. Within people’s care plans, it documented about people’s capacity and support they required with making decisions. We noted to the registered manager that some consent forms were signed by others who may not have the legal right to do it. The registered manager said they would remove those forms. There was no negative impact on people. The registered manager followed the process when people needed support to make decisions to ensure it was in their best interests with the right parties and professionals involved. Staff helped people make choices and decisions, using their preferred method of communication and this was done in a respectful manner. People's capacity and ability to consent was taken into account, and they, or a person lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment. People’s views and wishes were taken into account when their care was planned.