Cross House

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had not always ensured people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Whilst care plans had been updated to ensure they were detailed and provided staff with clear guidance on peoples care needs, wellbeing and communication needs; the provider had not always assessed people’s health care needs to ensure effective care. This meant people were at risk not having their health care needs met. This did not meet right support, right care and right culture guidance; policies and the approach to care and treatment did not support people’s rights to access health care services.

There was a care plan review system in place, however this was yet to be embedded due to updating all care plans since our last assessment.

The provider did not always ensure good practice guidance was followed to ensure people received effective care. For example, National Institute for Health and Care Excellence (NICE) guidance was not always followed in relation to medicine management or annual health reviews for people living with a learning disability. We found medicines were not always managed safely. In addition, people had not been offered an opportunity to have their annual health review with a GP. This meant people were at risk of not having their health conditions identified at the earliest stages to prevent further health conditions. A professional told us the provider did not always work in line with best practice. They told us, “I have to say that care is not always provided in a way that meets best practice guidelines. For example, concerns raised with the manager are not always followed up, I had to ask several times for [person] to be registered with a [city] GP. This has now been done but it took several months.”

People were supported to eat a balanced diet and staff ensured they were having enough to drink. People were able to choose what they would like to eat and drink. This meant people’s nutritional needs were met.

The provider did not always work well across teams and services to support people. We received mix feedback from professionals; most professionals told us the provider did not always follow their guidance and raised concerns regarding the lack of working together to meet people’s needs. One professional told us, “Our concerns relate to restrictive care, lack of reporting of incidents, skills and training of staff in appropriate support when individuals display aggressive behaviour/self-harm.” This meant services could not always work together to ensure people received effective care.

Staff told us they all worked well together. One staff member told us. “We work well together. We communicate clearly, help each other out, and all put the people we support first.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. Whilst health care plans had been implemented since our last assessment, they lacked detail and evidence of supporting people to access health services. This meant the provider failed to ensure health checks were completed in line with NICE guidance for people living with learning disability. The guidance stated: ‘An annual health check can identify health concerns at an early stage and promote actions to address identified health needs such as vaccinations, blood tests, breast and testicular screening, dental review and vision and hearing assessment’. We found the provider lacked understanding of ensuring this practice was in place, we found people had not had checks such as dental, vision or hearing. This placed people at risk of not identifying health concerns at the earliest stages to live healthier lives. People did see a GP if they showed signs of being unwell.

People who were at risk of developing further health concerns due to their BMI being in a risk category had risk management plans in place. People had been encouraged to make healthy food swaps and participated in more movement. One person had lost 8kg. One relative told us, “My [family member] certainly gets enough to eat and drink, their medications can result in weight gain however [family member] is now on a good diet, he is encouraged to walk every day, and their food is cooked from scratch.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. There were ineffective systems in place. Where people had declined to complete personal care tasks, such as brushing their teeth, the provider did not always have effective mechanisms in place such as oral health assessment to monitor risks and improve outcomes. Whilst there was a care plan review process in place it was not embedded, and staff had not identified concerns such as the lack of dental appointments, therefore staff could not improve people’s outcomes.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. The provider did not always follow the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA 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 make decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Mental capacity assessments had been completed; however, we found they did not always follow the five 5 key principles to prove someone lacks capacity. We found these were not always clear on how decisions were reached including how other less restrictive options were considered. This meant people were at risk of having decisions made unlawfully. The manager told us all the management team had attended external Mental Capacity Act training since our last assessment but recognised further work was needed.

Where people could consent to their support, staff were able to explain that consent should be obtained before supporting people.