Alban House Residential 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 requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of the legal regulation relating to people’s need for consent.

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.

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 care and support plans were not always personalised, holistic, strengths-based or reflected their needs and aspirations, including their physical and mental health needs.

Care plans did not always reflect a good understanding of people’s needs, including relevant assessments of people’s communication support and sensory needs.

Assessments were not always up to date or reflect people’s current health and social care needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s specific nutrition and hydration needs were not always met in line with current guidance. For example, when asking a member of staff who had modified diets, they initially stated no-one currently. However, on further discussion, they went on to say, there were people requiring soft foods. When asked if they knew which level of International Dysphagia Diet Standardisation Initiative (IDDSI) they required, they were unable to tell us the levels required. TheIDDSI frameworkin the UK provides standardised terminology and definitions for food and drink textures for individuals withdysphagia.It consists ofeight levels, numbered 0-7, with drinks measured from 0-4 and foods from 3-7.These levels help ensure consistency in the assessment and management of dysphagia.Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others cannot swallow at all.

The provider had identified, on purchasing the home in October 2024, staff knowledge and competency needed to be improved to ensure they were up to date with national legislation, evidence-based good practice and required standards.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Records did not always demonstrate health and social care professionals being contacted in a timely manner in response to changes in people’s needs or to encourage health promotion. For example, in relation to wound management.

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.

The service did not always identify risks to people, such as in relation to skin integrity, to prevent a deterioration in their health and wellbeing.

People’s care plans and risk assessments were not detailed, contained contradictory information and did not accurately reflect current needs. This exposed people to risk of harm as staff maybe unable to recognise changes in people’s physical or mental health and act accordingly.

Care record reviews were out of date, which did not ensure people’s current and changing needs were understood and being met.

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.

The service did not always focus on identifying risks to people’s health and well-being early nor on how to support people to prevent deterioration. For example, injuries had not been accurately documented and prompt referrals for support from health care professionals had not been made.

There were ineffective approaches to monitor people’s care and treatment and their outcomes alongside health and social care professionals. This meant continuous improvements were not always made to people’s care and treatment.

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

The service was not always working within the principles of the Mental Capacity Act (2005) MCA. We found a lack of evidence of mental capacity assessments and best interest decisions being completed. For example, one person’s care plan stated they had full capacity to make their own decisions. However, it was documented there had been a ‘rapid cognitive decline in the last 2 months’ and their capacity to make certain decisions had not been reviewed. Another person had no mental capacity assessments in place, despite their care plan indicating a review was required. A further person had no mental capacity assessments in place since 17 June 2022. This means the provider could not be assured people had consented to care or that decisions were being made in their best interests by their relevant representative if they lacked capacity instead.

There was some confusing and contradictory information about people’s end-of-life preferences regarding resuscitation. A person’s ‘end of life’ care plan stated, they would like to be resuscitated, but did not wish to go into hospital. However, their emergency admission pack stated, there was a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) in place and the hospital Treatment Escalation Plan (TEP) stated, to allow a natural death, do not attempt CPR. A TEP form is a document used in healthcare to outline a patient's wishes regarding their care, particularly in the event of a sudden deterioration in their health.It ensures that healthcare professionals know a patient's preferences for treatment, including whether or not they want to be resuscitated, andit is often completed in conjunction with the Mental Capacity Act (MCA) 2005, which provides a framework for making decisions on behalf of individuals who lack the capacity to make those decisions themselves. This confusing information could lead to inappropriate care and treatment being provided which is not in line with the person’s wishes.