Richard House Care Home

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 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were not always assessed or reviewed accurately or promptly to ensure care remained safe and appropriate. Assessments and care plans did not always reflect people’s current needs, abilities or risks. Changes in people’s health or support needs were not always assessed promptly or clearly recorded. This meant staff did not always have up‑to‑date information to guide safe care and support.

In some cases, care plans contained information that did not match observed care or feedback from those supporting the person. This included inconsistencies in areas such as support with eating, mobility, falls risk and personal care.

Assessments made before people started using the service and ongoing assessments were not always used effectively to plan care. Important risks were sometimes identified after admission rather than anticipated and assessed in advance which was not in line with the provider's own policy. This increased the risk that people’s needs were not fully understood or addressed from the outset of their care.

Although some assessments were updated following feedback during the inspection, there was limited assurance that assessment processes were consistently used to identify changing needs and review risks proactively.

Care and treatment were not always delivered in line with evidence‑based guidance or recognised good practice. Care records and observations showed that changes in people’s health were not always identified, assessed or responded to promptly.

Where people became unwell or their condition changed, records did not always demonstrate that staff had carried out timely assessment or monitoring to understand the cause or escalate concerns appropriately. For example, a person became unwell however, the change in the person’s condition was identified by a family member rather than through routine staff observation and assessment. A relative told us, “If I hadn’t gone in, I don’t know if they would have noticed that [they were] unwell.”

Although some reviews and updates were completed following feedback, there was limited assurance that assessments and monitoring were consistently embedded into everyday practice.

Joint working between staff, teams and external professionals was not consistently effective in ensuring coordinated and safe care. Communication between staff and teams was not always effective. Information about people’s needs, risks and required actions was not consistently shared across shifts or between roles. This meant staff did not always have a shared understanding of how care should be delivered or followed up.

Professionals involved in people’s care told us that agreed actions were not always completed as planned. They also raised concerns about poor communication, including a lack of clarity about who was responsible for actions and whether these had been carried out. This increased the risk that changes in people’s needs were not responded to in a timely or coordinated way.

Staff feedback indicated that teamwork was inconsistent, particularly during periods of staffing pressure. Staff described occasions where coordination between team members was limited, especially when care required more than one member of staff or when responding to changes in people’s condition.

Support to help people maintain and improve their health and wellbeing was not always timely, proactive or effective. People were not always supported to access timely assessment or intervention when their health needs changed. Changes in people’s physical health or general wellbeing were not consistently recognised or acted on promptly, which increased the risk that opportunities to prevent deterioration or support recovery were missed.

Care records did not consistently show a proactive approach to supporting healthier lives. When people experienced changes in appetite, weight or overall health, actions were not always clearly planned, monitored or reviewed. This reduced assurance that preventative support was in place to help people remain as healthy and independent as possible.

Although some people received appropriate support, this was not consistent across the service. As a result, there was not always clear assurance that people were supported to live healthier lives through timely intervention and coordinated care.

Information about people’s care and outcomes was not always used effectively to support improvement over time. Care records did not always show that changes in people’s health or care needs were routinely reviewed to understand whether outcomes were improving or deteriorating. Inconsistencies between care plans, risk assessments and care delivered limited assurance that outcomes such as safety, nutrition, mobility and skin integrity were being effectively monitored.

There was evidence that changes in people’s health were not always linked to improved outcomes over time. Some people experienced deterioration, including increased falls, reduced mobility, weight loss or infections, without clear evidence that care was adjusted effectively to stabilise or improve their outcomes.

Relatives expressed concerns that outcomes did not improve despite issues being identified. One relative told us they lacked confidence that concerns raised led to meaningful change. This indicated feedback was not always used effectively to improve people’s experiences.

Some positive outcomes were observed, for example where fluid intake was regularly recorded, and people were encouraged to drink. However, this was not consistently reviewed alongside other aspects of care to assess overall wellbeing or identify deterioration.

The service generally understood the Mental Capacity Act 2005 (MCA), and capacity assessments were completed for specific decisions. Where people were assessed as lacking capacity, records showed that relevant people had been consulted as part of decision‑making. However, documentation did not always clearly show how different options had been considered or why certain options were ruled out. Records did not consistently explain whether less restrictive options had been explored and discounted or what support had been provided to help people understand information or express their views before decisions were made. This made it difficult to understand how decisions met the requirement to act in the person’s best interests in the least restrictive way.

Consent for day‑to‑day care was not always clearly recorded. Where people’s capacity may have fluctuated, records did not consistently show how consent was sought or how staff responded when people declined or were uncertain about care. This affected assurance that people’s consent was respected and reviewed in line with their circumstances.