Russell 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.

The service was in breach of legal regulation in relation to people’s consent.

This service scored 62 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service had a ‘welcome to your new home’ pack in place for new people coming to the service. People were assessed for the provider to assure themselves they could meet their needs. People visited the service prior to coming to live at the service and the service worked closely with the person and relatives in getting to know the person.

A relative told us the transition to the service for their family member was positive. They commented, “They made it so much easier for us. I was really stressed about the transition. They arranged lots of visits and lunch too. The transition took about 6 months. I was really impressed, and the process was really, really good”.

The provider had recently completed a quality-of-life tool to enable them to assess any shortfalls in their assessment and care of people. The outcome of the assessment was to involve people in realistic goal setting to improve their quality of life. In care plans viewed we saw this had commenced.

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 who had a diagnosis of epilepsy had their health overseen and regularly monitored by a Consultant Neurologist to ensure that people received evidence-based care and treatment.

Staff and leaders were aware of new and innovative approaches that evidence shows can improve the way their service delivers care. The service had introduced acoustic monitoring of people’s seizures which provided accurate information on the time of the seizure. This enabled the service to be proactive in responding to seizures to safeguard people.

People’s nutrition and hydration needs were identified and met in line with current guidance. Malnutrition screening tools (MUST) and waterlow assessments (used to assess pressure ulcer risk) were in use and kept under review. Staff were informed of people’s dietary requirements, and this was incorporated into meal planning.

Relatives were generally happy with the meals provided. They told us their family member got food choices, meals were homemade and there was fruit and snacks available. A relative commented, “[Person’s] weight is checked, they have put weight on, have really improved and has healthy food available”. Another relative commented, ‘I see too much processed food and little evidence of fresh food”. This was fed back to the registered manager to monitor.

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.

All relevant staff, teams and services were involved in assessing, planning and delivering people's care and treatment and staff worked collaboratively to understand and meet people's needs. People had access to a range of health professionals on site which promoted a prompt response to referrals, and people were actively involved in treatment plans and reviews. The health professionals liaised closely with the service. They attended health review meetings to monitor people’s progress and were proactive in responding to changes in people’s health and well-being, as well as supporting the staff to refer on to external health professionals where required.

Professionals involved with the service confirmed their involvement with the meetings. They commented, “Over the last year with [registered managers’ name] stepping in to the role of Manager we have seen a real improvement in the organisation and efficiency of these meetings. Each team leader has come prepared and share good quality feedback about the people from their flat. They are open to suggestions and proactive at managing the health and wellbeing of the people they support”.

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

People’s care plans outlined their medical conditions and treatment plans. People were registered at a local GP service and had access to a dietician, Speech and language therapist, dentist, chiropodist, an onsite registered nurse and a senior house officer (SHO) for epilepsy related concerns.

The service worked closely with a consultant psychiatrist and learning disability team, including a clinical psychologist and positive partnership team to promote a holistic approach to people’s care.

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.

Daily handover records and people’s daily records outlined how individuals presented daily with changes in people noted and acted on in a timely manner.

Staff completed monthly key workers reports which identified any changes in individuals needs. It also highlighted outcomes of health appointments and noted forthcoming health appointments. We observed for some people the ‘outstanding actions’ from the previous keyworker meeting all stated “ongoing” and repeat themselves at the next keyworker meeting without a rationale as to why not actioned. This was fed back to the provider to follow up on.

The service had worked closely with a physiotherapist in promoting a person’s standing and mobility following an admission to hospital. This resulted in a positive outcome for the person.

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

Whilst staff involved in completing Mental Capacity Assessment (MCA’s) and best interest decisions were trained in the Mental Capacity Act 2005, we found some of the Mental Capacity Assessments viewed were not decision specific. For example, a person had a Mental Capacity Assessment for both personal care and 1:1 support and another for bed rails and lap belt. Another person had a Mental Capacity Assessment for living at the service and included the need for the use of acoustic epilepsy monitoring equipment.

Mental Capacity Assessments were not in place in relation to restrictions on people. For example, Mental Capacity Assessments were not in place for people on 1:1 or 2:1 care and none of the Mental Capacity Assessment for living at the service referred to the doors being locked.

Mental Capacity Assessments for medicines did not include the medicine that the Mental Capacity Assessment related too and did not include how medicines were to be administered for example, with thickener, in food or via percutaneous endoscopic gastrostomy (PEG) which allows a person to receive their food and medicine via a tube into the stomach.

We saw an example of a best interest meeting for covert medicines that took place in 2016 for a person, but it stated that only rescue medicines were to be given covertly. It was not clear what the rescue medicines were or if the person was still taking the same medicines at the time of inspection. A more recent best interest meeting had taken place for this person. However, this was not medicine specific and did not provide details of who was present in the meeting. This did not give us assurances that people were receiving medicines in line with their assessed needs, preferences, and legal safeguards under the Mental Capacity Act.

A media consent form was signed by a person’s next of kin and not completed as a mental capacity assessment and best interest decision.

The service had obtained consent from families to people having the flu vaccinations. However, mental capacity assessments and best interest decisions were not completed. This is not in line with the principles of the Mental Capacity Act 2005.