Elsenham House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. At our last assessment we rated this key question as good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met. The service was in breach of legal regulation in relation to person centred care.

This service scored 46 (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 had not always ensured people were at the centre of their care and treatment choices but did work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

A new manager was in post and working hard to support people appropriately and to improve their experiences of care including activities and ensuring they got the right levels of support. We found care plans had been reviewed, and people were consulted about their care needs. We found however daily notes were basic and did not enable staff to pick up on changes in people’s needs. We found gaps in records in relation to bowel care and safety checks across the day and night. We were not always able to see what actions had been taken following an incident such as choking. Whilst staff had responded appropriately to incidents of choking, we could not see if this had been followed up with a health care professional. Incident oversight was poor, so we did not see what learning took place. Clear objectives were not in place to measure people’s progress or to help ensure people were achieving the outcomes they wanted and living well. People did not have access to their care plans and relatives gave mixed reviews about communication.

The provider did not fully understand the diverse health and care needs of people and their local communities, so care was not joined-up, flexible and supported choice and continuity. Whilst staff had training to support a wide range of needs it was not clear how staff were supported to develop an individualised approach with each person to ensure they were placed at the centre of their care. 1-1 hours had been agreed for some and not others and some people had very little opportunity or encouragement to remain physically and socially active.

Staff were not supported to develop their skills and interests and take a lead role in an area they enjoyed. Having champions can enhance the service. The manager said she was going to develop champions. The staff member developing activities had not done specific training in activity provision and was not part of any organisation that could offer support and guidance re activities and well- being. This is important if the service are to follow the recovery model for mental health and provide therapeutic interventions. Equally a number of people had short term memory loss and other cognitive difficulties which could be supported by appropriate activities.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider had invested in an electronic monitoring system. Staff logged in and out, so this helped monitor their hours. CCTV was used to monitor communal areas and promote staff and people’s safety. Peoples care records were electronic but disappointingly were not routinely shared with people or families at their request.

People's daily notes did not really inform the care plan or show what changes had occurred or if the care plan needed updating. Notes were very generic and did not inform us if people were living well.

The provider mostly listened to feedback and ideas and had a complaints procedure in place to record formal and informal concerns which were responded to. Staff involved people in decisions about their care, but this is an area requiring improvement.

We had mixed feedback about communication. Whilst information was provided to people, care plans were not routinely made accessible. Staff told us they involved people but very few actions were identified from annual surveys or residents’ meetings, so it was unclear how their feedback was acted upon.

The complaints procedure did not capture feedback from people and did not record any complaints or concerns that people had. Audits did include reviewing people’s care plans and speaking to people but again this provided very little evidence of what was actually reviewed and how it was linked to the regulatory processes of assessment.

The provider mostly made sure that people could access the care, support and treatment they needed when they needed it, but records were poor around this.

People did have access to services and there was some joint working between the provider and other health and social care agencies. We asked for a chiropody list, and this did not provide us with a robust record of when people had received treatment. People were supported to manage their oral health but gaps in records and records of people declining care was a concern.

Some staff told us that people had avoided a mental health crisis because of the actions of staff and other agencies. However, this was not always the case with at least one person being recalled to prison after an assault.

Refusal of care had not been clearly escalated but during our assessment we found improved practices around this.

Staff and leaders mostly listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support, and treatment in response to this.

Policies and procedures were in place to help staff deliver safe and effective care in line with legislation and best practice. We found however policies were only updated after an incident. Assessments included areas of support, and we noted where people had a specific need or condition there was guidance for staff to follow to help them understand their needs around this.

We were concerned that the provider was not adhering to right support, right care, right culture. People who had a primary diagnosis of a learning disability did not live in a small, (family) environment and their opportunities (ordinary life principles) were not promoted.

People were not fully supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Care plans did include people’s wishes should their needs change or if they required palliative care or emergency lifesaving treatment. Both (DNAPR) Do Not Attempt Resuscitate forms and (RESPECT) forms: Recommended Summary Plan for Emergency Care and Treatment were in files where people were prepared to discuss this. However, there was no evidence that this was revisited regularly with people to help them think about the future. We were unable to see how people were supported to think about their futures because annual statutory reviews in all, but 3 cases were not up to date or known by the manager. This would have provided an opportunity to discuss with them their current and future needs.