Abbeyfield Lear 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 58 (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 did not always make sure people’s care and treatment were effective. We identified issues with the accurate assessment and recording of people’s daily care needs and although staff confirmed risk assessments were informative and updated monthly or when changes occurred, we found some risk assessments, incomplete or inconsistent.
We found a person had experienced a choking episode, but this had not been followed up with a risk assessment to review or adapt their support. This meant there was the risk of a similar incident occurring again. We observed one person was left to eat their meal alone in their bedroom, despite their care plan clearly stating they required observation during mealtimes.
Although some people did have a preadmission assessment, this wasn’t always done consistently. Care records did not consistently demonstrate individuals had been actively involved in the planning of their care.
Family members felt informed and involved in care reviews. Their comments included, “We get invited to reviews and are kept up to date.” People told us they were not involved in the planning of their care and responded, “But I am very happy here. Everyone is very kind."
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People's nutritional and hydration needs were assessed using recognised clinical tools, including the Malnutrition Universal Screening Tool (MUST) and the Waterlow score, which help identify risks such as malnutrition and pressure ulcers. However, we observed that fluid intake records were not consistently completed with sufficient accuracy or detail. In some cases, daily care notes were written before midday, with general comments like “good day and good fluid intake,” raising concerns about whether care was being delivered and recorded in real time.
The registered manager acknowledged ongoing challenges with consistent documentation and told us they were taking steps to strengthen record-keeping and improve oversight.
We saw people had access to a variety of nutritious meals that reflected their personal preferences and dietary needs. Mealtimes were calm, and staff supported people in a way that promoted their dignity and independence.
 

The provider did not always work well together to support people. Staff knew the people they were supporting well. For example, there were communication procedures in place using daily handovers however, we found these to be inconsistent in the recordings. In one instance, information handed over between staff stated ‘no concerns’ for a person who was in hospital at the time. One person’s fall had been recorded for a date prior to the fall so there was uncertainty regarding which day the fall happened. We found information recorded in one person’s care review was inaccurate. Staff had documented the person was unable to retain information. However, the registered manager advised this was not correct and did not reflect the person's actual cognitive abilities
Family members confirmed a positive collaboration. Comments from family members included, “Staff seem to work well as a team” and “Happy to speak to managers or staff if I need to. They are very helpful.” Feedback from professionals and stakeholders confirmed positive working relationships.
We found the provider and registered manager engaged with other professionals, such as the speech and language therapy team and the falls prevention service. However, advice and recommendations from these professionals were not always followed or implemented in practice.
 

The provider supported people to manage their health and wellbeing, so people could maximise their independence, choice and control.
We saw people were supported to attend both routine and specialist healthcare and wellbeing appointments, with these documented in the care notes.
Some people benefited from personalised outings and activities that supported their wellbeing and connection with the wider community. Family members told us, “We can take [Relative] out whenever we want to, we don't need to arrange it, we just let them know” and “The things that stick out are the kindness of care staff, activities are excellent, activities are intellectual as well as physical. It is always a nice warm atmosphere.”
 

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 they met both clinical expectations and the expectations of people themselves. Peoples assessed needs were not always evaluated or completed and care records including daily care notes were not monitored or evaluated.However, family members expressed confidence in staff responsiveness. They told us, “If something happens, they [staff] inform me.” and "[Relative] had a couple of falls, but I always knew it was dealt with properly by staff at the home. Communication was good. I was always informed if incidents occurred.”
 

The provider did not always tell people about their rights around consent and respect these when delivering person-centred care and treatment. For example, some people’s care records did not always show their consent had been sought or documented.
The Mental Capacity Act (MCA) 2005 provides a legal framework for supporting people who may lack the ability to make certain decisions for themselves. Best interest decisions had been made following significant changes in people’s health and care needs. However, there was no evidence these decisions involved family members or relevant professionals, as required by the MCA. This meant the principles of the Act were not always fully followed.
One person was subject to a Deprivation of Liberty Safeguards (DoLS) authorisation, which is part of the Mental Capacity Act (MCA) and is designed to protect individuals who are deprived of their liberty in care settings. In some cases, specific conditions are attached to DoLS authorisations to help ensure the person's safety and promote their wellbeing. Although the registered manager had a system in place to monitor DoLS, it was not effective. The system did not capture all the required information, including any conditions attached to the authorisation. Staff we spoke with were unaware of these conditions—such as the need to notify the supervisory body of changes to the person’s care plan or to carry out regular medication reviews. These conditions were also not documented in the person’s care records. This posed a risk that legal safeguards were not being consistently followed.
However, staff understood their responsibilities around gaining consent. We observed them taking time to explain care tasks and seeking verbal agreement before providing support.