Cassandra 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. The last time this was assessed we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were good, and people’s feedback confirmed this. We did though identify some areas which could be more consistently applied.

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 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. People's holistic needs were not always appropriately assessed. Care plans and risk assessments contained conflicting information. For example, One person's mobility care plan stated they required equipment when transferring. Another area of the care plan did not reference this. This meant that staff did not have consistent and up to date information about people's mobility needs. People and their relatives were not always involved in the care planning process; however, relatives told us that staff would contact them regarding any changes in their loved ones' care requirements. Staff understood their responsibility to report any changes to the management team who updated people's care records. However, whilst regular reviews of care plans tookplace, we could not be assured that changes were appropriately recorded.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care records for people did not always include guidance for staff in line with best practice. For example, where people displayed behaviours associated with distress there was a lack of detailed information for staff to follow on how these behaviours may present or how staff should respond to avoid escalation. Behavioural monitoring records were not in place to support the service to identify any triggers or potential factors that may increase people’s distress.

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. Staff shared information with each other verbally at handovers. This was recorded appropriately. Where staff identified concerns regarding people's care and support appropriate advice was sought. However, this was not always followed up in a timely way. Information was available to share with healthcare services when needed.

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 were supported to access external services, for example physiotherapy, to improve their independence. Staff told us they encouraged people to do the things they could but would assist if people needed this. People were supported to maintain a healthy balanced diet and enjoyed the food at the service. People’s care plans reflected their choices, including dietary preferences. One person told us, "The food is nice and if you want something else that can be provided, or they [staff] will make something you request".

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 and consistent, or that they met both clinical expectations and the expectations of people themselves. Monitoring records to support people's everyday needs were not always consistently completed or followed up. For example, people who required monitoring records to be completed in relation to theircontinence needs did not have these in place. Where they were in place, we identified staff did not always take appropriate action to ensure people's continence care was maintained to promote their health and wellbeing and reduce the risk of infection.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. The provider worked within the principles of the Mental Capacity Act. Capacity assessments and records in relation to decisions made in people’s bestinterests were available. Staff showed understanding of the need for consent and would document any refusal of care. Staff encouraged people to make their own decisions and had completed training about the Mental Capacity Act.