Albany House - Bognor Regis

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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

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. The service was in breach of legal regulation in relation to person-centred care.

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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Assessments and reviews of people’s health, care and wellbeing needs were not completed consistently. Some were detailed in some areas but were not always holistic. The provider had failed to complete a functional assessment for people with learning disabilities. This meant there was not a planned approach that was relevant to their individual needs to support skills and enhance their quality of life.

Staff were not consistently including people in reviewing their assessments and care plans. The registered manager said people sometimes chose not to be involved but not all staff were offering people the opportunity. One person told us how they discussed their needs, preferences and aspirations with their key worker. A key worker is a member of staff who has a special interest in a person and supports their communication, develops a strong relationship and supports them with planning their care. We sampled notes from some key worker meetings with people. We could see that people discussed a variety of topics with the key worker including individual interests, concerns and aspirations. However, not all discussions led to changes in care plans. For example, a person had expressed an interest in seeking paid work but there were no plans in place to identify how they could be supported with this aspiration.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always follow current evidence based good practice and standards.

People’s care and support was not always planned and delivered in a person-centred way. People with learning disabilities and /or autism had not received a comprehensive functional assessment to support evidence-based care planning. This meant staff did not have the guidance they needed to support people in a structured way to improve skills, increase levels of independence and develop their interests. People were living with enduring mental health conditions, this meant there was a risk that their mental health could deteriorate. However, care plans did not always include personalised identifying signs and symptoms that might indicate a relapse in their mental health condition.

Some evidence based assessments were being used, for example, staff used a Waterlow assessment tool to evaluate risks to people’s skin integrity. This supported staff to identify the level of risk and to plan support to ensure the risk was managed appropriately.

The provider worked well across teams and services to support people.

Staff described communication systems that supported effective teamwork. One staff member told us, “We have a meeting every morning called “the huddle”, where we all come together and discuss plans for the day, including any appointments and what support people might need. It’s really helped us to have a clear plan for the day.” A health care professional told us they had regular contact with staff about their patients who lived at the service. They said, “Staff there have always communicated any queries or concerns to me in an appropriate and timely manner.” Records showed how staff made appropriate and timely referrals to health and social care professionals when concerns arose. One person said, “The staff contact my doctor and the mental health team if I need them.”

The provider supported people to manage their health and wellbeing. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People told us staff supported them to remain well. One person told us, “If there are signs that I am going to be ill again, (staff member) will notify the manager or deputy manager (Head of Care) who can contact the doctor.” Another person said, “I have a Community Psychiatric Nurse (CPN) and a doctor in charge of my medication, the staff make sure I am taking my medicines and that’s keeping me well.” Records showed staff had made appropriate referrals to health care professionals including a chiropodist, CPN and district nurse.

People said staff encouraged them to eat healthily and to exercise. One person said, “I go for a walk every day if I can.” Staff told us another person had joined a local walking group. One person described having a goal to reduce their weight and improve their fitness, they described how they had been supported saying, “I have more salads and I’m eating smaller portions, and I have lost weight.”

People said they enjoyed the food at Albany House and described it as “Really good home cooking,” “Lovely food,” and “Really healthy diet.” The chef was knowledgeable about people’s needs and preferences, and we saw there was plenty of fresh food available. People told us there were choices available. We observed one person was having home-made soup which they told us the chef had made specially for them as it was their favourite.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider had systems for monitoring people’s needs and treatment. For example, people’s weight was regularly checked. A staff member told us when there were concerns about unexpected weight loss staff monitored food intake and encouraged the person to eat to improve their weight.

A health care professional spoke highly of the service and described working with staff to monitor outcomes for people. They said, “I have always found the communication with staff to be open and honest and open to suggestions if required.”

People were consistently positive in their views of the service. One person told us, “I like living here, I’m very happy.” Another person said, “I love being here, this is my home.” The registered manager told us they regularly monitored people’s views and some people had chosen to write about their experiences at the service. One person’s comments included, “The staff look after us and we feel safe here, it’s a nice environment, it’s warm and welcoming.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff were not consistent in their understanding and approach to issues of consent. Some staff demonstrated a firm understanding of their responsibilities with regard to the Mental Capacity Act (MCA) however this was not consistent for all staff. Staff told us they had received training in MCA and explained they would always seek consent before supporting a person. The people we spoke with confirmed this happened. However, not all staff were clear about how they would determine when a person might lack capacity to make a specific decision, and what to do in such circumstances. For example, staff were not always clear about how they would support someone who they considered to be making an unwise decision.

Some records included contradictory information which did not provide assurance that the requirements of the MCA were always met. For example, some care records described people as having full capacity to make decisions, however this was not accurate and did not take account of fluctuations in people’s mental health that could affect their capacity to make decisions at specific times.