Ashgale 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.

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 because they did not always make sure people’s care, wellbeing and communication needs were reviewed and updated with them.

People needs were not always reviewed and re-assessed to reflect their changing needs. For example, a person who had recently been discharged from hospital had not had their care plan updated to reflect their changing needs. This meant that staff did not have up to date information about people’s needs to ensure the person’s changing needs were met.

Notwithstanding the above, people’s needs were assessed when they moved into the service and the process involved a recent move where the person was involved in day and overnight visits to enable them to make a choice to move to the home.

The provider did not always ensure people received care and support based on the latest good practice and relevant guidance.

Each person had an activities care plan, however we saw that staff did not always provide the identified support according to the care plan. Although people’s care plans referred to positive behaviour support and active support and staff had been trained in these, our observations showed that staff were not always observant of people’s changing health and wellbeing.

For example, all the activities care plans we reviewed said “[Person] is a sociable person who enjoys the company of others”. Yet all four that we reviewed were not supported to spend time with other people or with activities of their choice. One person’s plan said, “Person always likes to participate in activities, goes to clubs, goes shopping and goes to the barber”. However, records showed they had not been supported with activities they enjoyed like listening to music since they had recent changes in their care needs which meant that they needed to spend more time in bed.

Notwithstanding the above, relatives told us people were supported safely and could access health professionals if needed.

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 told us the teamwork within the service was good. A staff member said, “Some of us have been here for years, so we know each other really well and get on together.”

People’s relatives reported that staff communicated well and coordinated support effectively. One relative told us, “The staff let us know outcome of appointments.” Another relative said, “When [person] was in hospital recently, staff went to see them daily which was very reassuring for me as I couldn’t make it to the hospital.”

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.

Staff supported some people to get regular exercise and enjoy time outdoors. However, we saw that people were not always supported to eat nutritious and healthy meals. Records and our observations showed that staff prepared food for people that did not include enough fruits and vegetables, and people were not supported to maintain a healthy, balanced diet.

Although the weekly menus provided choice for people and appeared balanced, we saw that what was on the menu was not always what was prepared for people to eat. Lunch on the first day of our visit was pizza, chicken bake and cauliflower. Dinner on the second day we visited was garlic bread with baked beans poured over it. The menu said the choices for lunch on the first day were chicken curry and vegetables/ fried chicken and on dinner for the second day, mashed potatoes/ quiche and beans/ beans on toast. All but one person ate the garlic bread and beans. This meant people were not always offered the balanced and nutritious meals that had been planned for them.

Staff supported people to attend medical and other appointments where required and the outcomes of these were recorded.

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.

Two people using the service required referrals to healthcare professionals from our observations on the day of our assessment with eating and drinking. The provider was not adequately monitoring outcomes for people and were not aware of the risks posed to people in relation to eating and drinking and the need to make these referrals.

Notwithstanding the above, records evidenced people had been supported to access external health professionals appropriately, where the need was identified. Relatives confirmed this. One relative said, “They let me know of [relative’s] appointments and the findings of those appointments.”

After we raised the concerns we had identified with the manager, we requested and received assurances that both these concerns were acted upon, and appropriate healthcare referrals were made after our visit by the manager.

The service did not always demonstrate that people’s consent was sought and that their rights were respected when delivering care and treatment.

A person had recently been subject to additional restrictions on their liberty after an assessment was carried out by the provider to ensure that all people who lived in the home felt safe. We found no evidence to show that the manager had carried out an updated mental capacity assessment for this decision, considered all of the options including those that were less restrictive, or that the decision to impose the restrictions had been made and recorded in the person’s best interests.

The service had systems in place for assessing people’s mental capacity to consent to their care, and care plans recorded when decisions had been made in people’s best interests. Where people lacked the mental capacity to make complex decisions. Staff told us they liaised with their representatives to discuss the best interests for each person with different decisions. Staff completed training to understand their responsibilities in seeking consent from people and enabling them to make decisions and were able to explain these to us.