Prideaux 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 because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Care plans and risk assessments had not been consistently reviewed. The reviews that had been completed showed ‘no change’ or boxes ticked with no commentary to suggest a meaningful process had been followed. The registered manager was aware for the need to review all the plans and assessments and this process had begun but it would take time for this process to be completed and then regular, ongoing reviews to follow. The registered manager did carry out pre-assessments with people wanting to move to the service. Support needs were assessed to make sure that the staff had the right skills and experience to support people safely. A relative told us, “The manager came and spoke with her and us before moving in.” Following a stay in hospital the relative of a person said, “They do reviews. She was in hospital recently with a damaged elbow. Manager came to hospital to see if she needed more support.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. People’s health and social care needs were met. The registered manager and their team made sure that people received the support they needed for example, dentist and opticians appointments were made and people were supported with visits form these professionals or to attend other sites. A relative said, “He has to go to the opticians every month for some treatment. They sort all of that out, they are very good.” Another relative told us that following a stay in hospital where their loved one’s mobility needs changed, a piece of support equipment was introduced to help. The registered manager attended the hospital to familiarise themselves with the equipment and made sure that the person would be able to use it, when they returned to the service. The relative told us, “They let them get used to it and the manager insisted that it was in place before returning.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Positive working relationships had been established with other health and social care professionals resulting in people’s needs being met in a timely way. Comments from relatives included, “They make appointments for him when he needs them” and “They do meet their needs, arrange appointments and the yearly vaccines, they get my consent first for that.” Regular visits to the service from the GP and district nurses meant that people’s health needs were monitored with any changes in support needed being identified and acted on. A professional told us, “Staff communicate in a timely and respectful manner and are usually well prepared‑ for visits. They provide relevant background information and are open to discussion about residents’ needs. The registered manager is accessible and responsive, which supports effective joint working.”

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. People’s experience when being supported to eat and drink varied. A relative told us they had witnessed staff walking away from people who needed more time and support when eating resulting in them not having a full meal. Comments from relatives also varied with some acknowledging that their loved ones did not seem to eat enough. One said, “They don’t eat much but does drink a lot of tea.” Another added, “The food is very good but they don’t eat much.” Others however told us about a positive experience, “We have full confidence in them. They keep checks on her. She is diabetic and that is managed well.” The service had recently employed a new head cook who was knowledgeable about people’s needs, was aware of people who required a diabetic diet and of people’s likes, dislikes and allergies.

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves. Clinically recognised tools were used to measure aspects of people’s care. For example, the Waterlow Score which indicated people’s likelihood of developing pressure sores and the Malnutrition Universal Screen Tool (MUST), which showed people’s risk of malnutrition. However, it was not clear whether results, trends or patterns were acted on by the service. We saw 2 examples of where people had lost significant weight during a short period of time and although recorded, no action had taken place. Reviews had not identified these trends, which had been highlighted using the MUST tool, with care plans being marked as ‘medium to low risk.’ Care plans also had some sections crossed out. These were previous entries that had been updated but the crossings out made it difficult to measure the continuity of care and support.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Several people lived with dementia and needed support with some day to day and longer-term decisions about their ongoing care and support. Decisions were made in people’s best interests, however discussions and or meetings to discuss these decisions were not fully documented so it was not clear who was involved and the rationale leading to some of the decisions made on people’s behalf. Staff were aware of the importance of gaining consent from people before carrying out a task or activity with them. A staff member said, “I explain each step at a time. Facial expressions can be important, if people look agitated, take a moment. You do get to know people.” A relative said, “They definitely ask her and get her permission before doing things.”