Thames 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 inspection we rated this key question good. At this inspection 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 54 (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. Staff were not always reviewing assessments on a regular basis and some care plans we reviewed required improvement.

The provider did not always have up to date information to help tailor people’s support needs accordingly. For example, we found 2 people’s care plans in which the depression assessment tool had only been completed once within the previous 6 months. From reviewing activity records, we noted both people often refused to participate. Hygiene records also indicated a reluctance to participate and accept support. As no formal monitoring was being completed, it was unclear whether this resistance was mood related. Assessments should be reviewed regularly and whenever required throughout a person’s care and treatment.

The quality of the care plans we reviewed was variable. One persons’ care plan was detailed, accurate and contained clear guidance for staff to follow, to ensure they provided care and support in line with the person’s needs and wishes. However, 2 other people’s care plans contained a mix of detailed guidance, along with some inconsistent, inaccurate and contradictory information. For example, repositioning guidance for 1 person outlined they did this independently in 1 section of the care plan, but in another section stated staff needed to do this every 2 hours. For another person, information about their mobility was unclear. Evacuation guidance stated they could mobilise using a walking frame, then later stated they would need to be hoisted into a wheelchair and assisted to a safe zone. Care records relating to the care and treatment of people should be accurate and up to date to fully ensure people’s needs are met.

Feedback from relatives was mixed; 1 relative told us, “The care plan is updated every so often and there are best interest meetings when required,” whilst another relative said, ‘There has been no reviews for ages, no one has talked to us, and I write [person’s] care plans.” Most relatives felt staff did not follow care plans effectively. For example, a relative said, “They’re [staff] supposed to regularly reposition [person] but it’s not happening,” whilst another relative told us they reviewed care notes every week and did not believe everything was being recorded accurately.

Leaders told us nursing staff were allocated time to review care plans. Nursing staff confirmed this was the case. Minutes from the nurses meeting held on 30 January 2025 highlighted how care plan reviews needed to be completed more thoroughly by staff as assessments and risk assessments had been found not to be up to date.

Care staff told us care plans were updated by nurses and any updates were communicated to them.

Staff knew how to access policies and procedures. However, some of the provider’s policies needed to be renewed and some had not been reviewed since 2018. One of the policies which was out of date was the sepsis policy, therefore we were not assured staff would recognise and respond in a timely way to the signs of sepsis. It is a provider’s responsibility to maintain up-to-date records including policies and procedures as part of effective governance.

Staff had access to a sexuality, sexual expressions and relationships policy which had not been updated since 2023.

Nursing staff said they were updated regularly about the latest good and best practice. However, most healthcare assistants did not feel they were updated about best practice updates in the same way.

Staff assessed people’s nutritional needs and ensured they had a care plan aimed to meet their nutritional requirements. From our review of care plans and daily records, we found staff checked peoples’ weights regularly. Staff had clear guidance to follow on how to support people with diet and nutrition and on the whole people were receiving their daily recommended intake of fluids and nutrition.

Staff, including kitchen staff, were aware of any special dietary requirements for people and had instructions on how to make up the correct diet type. We observed staff supporting people who required assistance with eating and drinking. People who required assessments with the speech and language therapy service were referred appropriately.

People’s relatives provided differing opinions on the food and drink provided. One relative said, “I’ve been there [at mealtimes] and there aren’t any issues,” whilst another relative told us a person had been admitted to hospital as they had not been provided with the appropriate levels of fluid. We reviewed this person’s care plan in relation to fluid intake and found since their hospital admission, and following a lessons learned exercise, compliance with providing and recording fluid intake had improved.

The provider did not always work well across teams and services to ensure people’s needs were assessed in a timely manner where there was a need for a new assessment.

Care plans showed mixed results in relation to people being referred to other relevant services in a timely manner to support their needs. For example, in the week prior to this inspection, a person had regularly declined to have a shave, clean their teeth or have their nails checked or cleaned. They had also refused to get out of bed on 6 out of 7 occasions. There were no records documented to state staff had referred the person to their GP or that mental health services who were currently involved, had been contacted based on their presentation. However, we also observed concerns raised regarding the loss of weight for another person had resulted in a timely referral to a medic.

Feedback from relatives regarding how the provider worked with other teams and services was mixed, for example 1 relative said staff had not booked an appointment with a service in a timely manner which had exasperated their symptoms, whilst a further relative said the service kept them updated and made appropriate referrals to the hospital.

Staff felt they had good relationships with healthcare services and external professionals.

Staff completed handover meetings twice a day. We attended these and found information provided was accurate and up to date. Notes from daily meetings with the leads from the service were also shared with healthcare assistants.

Care plans were shared with hospital staff when people were admitted.

The provider did not always support people to manage their health and wellbeing. A person had been clear within their initial assessment they wanted to access a gym, but we did not see evidence of this. Leaders told us this was impacted on by factors such as the person’s sleep routine, however, we identified gyms nearby which offered 24-hour memberships.

During our review of care plans we identified people were not always signposted to services in a timely manner, nor did they always have access to meaningful activities and wider community engagement.

A relative told us how they were concerned by how much weight a person had put on since starting at the service and felt their health had deteriorated.

A further relative had concerns about oral care support not always been accessed for the person in a timely manner which had led to a deterioration of symptoms.

Relatives did not consistently feel they were provided with accessible and timely information to help them make choices about their relative’s future health and wellbeing.

However, we did identify instances where people had been supported to access services to help them live a healthier life.

The provider empowered staff to act as advocates for people when engaging with healthcare professionals, support organisations and other agencies.

The provider supported people’s food and nutritional needs and ensured foods were in line with cultural and dietary requirements and preferences.

The provider actively engaged with healthcare services such as speech and language therapy, dieticians and specialist nurses.

The care plans reviewed showed people received oral healthcare and this was documented in their care plan.

Staff told us people were supported to live healthier lives, but did outline how some people were resistant to making changes.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider ensured people and their relatives understood their rights and care records explained whether people had capacity to consent to care. However, in discussions about care and support, although best interest decision making was referenced, we did not see examples of these records within care records.

Care records included a DoLS assessment, which detailed whether staff had applied for a DoLS and if these had been granted by the local authority. We found where conditions had been included as part of the DoLS authorisation, these were not always listed within people’s care records. As such, we were unable to evidence conditions had been actioned or incorporated into people’s care. According to the DoLS code of practice (part of the MCA framework), providers have a responsibility to ensure conditions are integrated into the persons care plans and records to ensure they are observed by staff on a regular basis.

We observed staff routinely asking for consent from people before proceeding with a task. One example of this was a member of staff who requested consent from a person to straighten their hair.

Staff supported people to make decisions by requesting support from relatives and advocates where necessary.

The provider kept a file which contained all DoLS applications and a DoLS tracker which showed all people who required a DoLS in place had it, and applications for renewed DoLS had been completed in a timely manner.

Staff had a 90% training compliance rate in relation to MCA and DoLS.