Archived: College House

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 45 (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 treat people with kindness and respect or uphold their dignity. While some interactions were caring, we observed one person being told they could only have their money if they cleaned their room, which undermined dignity.

People told us they generally felt comfortable and some described staff as kind, but these positive experiences were inconsistent. Relatives said staff were approachable and caring, and we saw examples of staff supporting people to attend health appointments. However, the lack of consistent professional behaviour and oversight meant people were not always treated with compassion. While some staff described working together and supporting people as a “family”. We observed staff interacting with people in a way that was not underpinned by professional standards.

The provider did not always treat people as individuals or ensure care reflected their preferences. Care plans lacked detail about people’s cultural, communication and personal needs, and were not regularly reviewed. While some staff knew people well and adapted support, this was based on familiarity rather than documented guidance.

Relatives told us people could personalise their rooms and choose clothes, and we saw evidence of some outings and activities. However, opportunities for meaningful engagement were limited, and records did not show how people’s aspirations, such as going to the zoo or visiting family, were being met.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Some people told us they could spend their day as they wished, but staffing shortages often restricted opportunities to go out. For example, relatives said 1 person who needed 2 staff for outings had only been out twice in 6 months, despite funding for community access. Activities were inconsistent, and there was no structured planner.

Staff said they tried to support people to make choices, but records did not consistently evidence this. We saw people had personalised their rooms, but overall independence was limited by rota constraints and lack of proactive planning.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

We observed call bells being answered quickly, and staff escalated health concerns to GPs and district nurses when people’s conditions deteriorated. However, one person receiving end-of-life care was left overnight without regular checks, despite being doubly incontinent and unable to use a call bell. This meant the person was not receiving consistent reassurance and comfort throughout this period, putting the person at risk of suffering a painful and traumatic death alone, which may not have been identified for a number of hours.

Communication with relatives about hospital admissions and injuries was poor, causing distress and uncertainty. Care plans lacked clear protocols for urgent needs, such as pain management.

The provider did not always support staff wellbeing or provide effective systems for training and development. They did not always support or enable staff to deliver person-centred care.

Training was mainly online, with gaps in key areas such as autism awareness and end-of-life care. We discussed this with the registered manager, who told us she did follow up with staff to ensure training is completed, however there continued to be gaps. This did not evidence effective management, leadership or oversight and exposed people to poor care outcomes or the risk of harm.

Staff told us they worked well together and pulled together during difficult times but also reported low staffing levels and rota issues affecting morale and people’s opportunities. While some staff felt able to raise concerns, others said communication with the management team was poor and meetings were irregular.