Elsenham 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 as requires improvement. At this assessment the rating has remained the same. 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.

The provider did not always make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

People were not placed front and centre of their care and care plans were not accessible to them. Assessments were completed and developed over time, and care plans were up to date. However, the daily notes did not give a clear overview of how staff were monitoring and meeting people's needs or how they were identifying changing or unmet needs. Gaps in record keeping such as food, fluid and monitoring checks did not give us confidence that there was sufficient oversight of risk. Daily meetings had been introduced following a significant incident. These were yet to be firmly embedded. Resident of the day gave an opportunity to take an in depth look at the person being reviewed needs, but the process was not used to its full advantage and did not involve key members of staff, relatives, or advocates.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them or do so in line with legislation and current evidence-based good practice and standards. Information was mostly stored electronically and securely and provided evidence of review. However, the planning and delivery of care was not always completed in line with peoples wishes and needs and long-term planning was absent.

The provider has not always ensured staff teams worked well together or across teams and services to support people. Information had not always been shared across teams to ensure people’s needs could be met holistically as they moved between different services.

Staff competencies for their roles had not been clearly assessed or staff skills developed over time. The lack of senior delegation could be considered as an outcome of not having a deputy manager or other full time team leaders of equivalent. A lack of oversight of people's needs had resulted in a significant incident occurring and since then processes have been tightened up to help ensure risks were identified and shared across the staff team. We felt however systems were not firmly embedded and staffing levels impacted on the team’s ability to effectively meet peoples needs.

The provider did not fully support people to manage their health and wellbeing to maximise their independence, choice, and control. Staff were not supporting people fully to live healthier lives and where possible, reduce their future needs for care and support. Whilst we were able to see evidence of how people were supported to maximise their health concerns such as support around accessing health services and medication reviews.

We were concerned about people’s chronic mental health issues and the impact this had on people’s physical health needs. For example, of the 26 people living at the home 4 people were in the overweight range and 13 in the obese range. Specific health care conditions such as diabetes were prevalent. Activity schedules and daily notes did not demonstrate how people were supported to access a healthier lifestyle and take exercise. Meal portions were large, and we saw little evidence of promoting lighter, healthier meal options. A lot of people at the service smoked and risk assessments indicated people had not been supported to cease smoking.

The provider did routinely monitor people’s care and treatment to continuously improve it, but outcomes were not always positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Whilst we received some assurances about people’s health and reviews from the GP we were concerned that a wider assessment of people's needs would be difficult due to the lack of clear recording. In 1 example the lack of escalation of risk and staff being clear about their roles and responsibilities in relation to people refusing care and where a person lacked or had fluctuating mental capacity. We noted concerns around hoarding and self-neglect has since been flagged with appropriate authorities to help ensure people got the right level of support for their needs, but this had not happened in a timely manner.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Mental capacity assessments were in place, but we were concerned about staff’s understanding of mental capacity and rights and restrictions. Records highlighted a person refusing care and staff not escalating this as a significant risk. The person was deemed to have mental capacity consideration had not been given to any factors that may have impacted this such as ill health. Consequences of decisions had not been carefully weighed up, for example when a person refused personal care, medicines and, or support to manage their environment. We noted people refusing treatment but not any potential outcome of this.

Whilst deprivation of liberty safeguards was put in place we noted obvious restrictions. For example, key codes had been introduced to increase security but not everyone was subject to a DoLs authorisation and could not easily enter or exit the building in the main house. Locked cupboards and fridges were imposed on everyone due to 1 person’s behaviour around food. This had not been assessed or the impact considered. Shared toilets/ bathrooms had not been considered in line with people’s needs and gender and considerations around single sex care had not been fully considered.