Archived: Rock 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 requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes. The service was in breach of legal regulation in relation to person centred care.

This service scored 29 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. People’s care and support plans did not always contain information that was relevant to that person. For example, one person’s care plan detailed they had a community treatment order (CTO). A CTO is a legal mechanism under the Mental Health Act that allows supervised treatment in the community. However, upon investigation it was identified that this person did not have a CTO.

The provider had not ensured that people’s needs were fully assessed and were reviewed regularly or when peoples need changed. For example, care plans failed to detail how people’s needs were assessed around nutrition and if people were at risk of malnutrition using recognised tools. Recognised health care tools such as MUST had not been used to assess people’s malnutrition risks. TheMalnutrition Universal Screening Tool(MUST) is a validated, five-step screening tool developed byBAPENto identify adults who are malnourished, at risk of malnutrition, or are obese. BAPEN (British Association for parenteral and enteral nutrition) is an association dedicated to raising awareness, improving education and enhancing the nutritional care of patients at risk of malnutrition. One person’s daily notes detailed they often did not have any main meals and would choose less nutritious snacks. Whilst the provider told us people had the capacity to make their own choices around nutrition, the provider had not mitigated risks around malnutrition, such as using the MUST tool.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People did not receive can and support that was evidenced based and in line with best practice guidance.

People who lived with dementia, did not receive support from staff that was in line with NICE guidance for people living with dementia. NICE dementia guidance details care and support providers should provide all staff with training in person centred and outcome-focused care for people living with dementia. We found the majority of staff had not undertaken dementia awareness training.

People’s nutritional needs were not being met in line with best practice guidance. Best practise guidance from the Department of Health ‘Essence of Care 2010’ details that people are provided with food and drink that meets their individual needs and preferences. The provider had not ensured people were being consistently provided with nutritional meals. The provider had an approach where people were given a weekly budget and held responsible for the meal planning, shopping, preparation and cooking of food. This was a blanket approach that relied upon staff being encouraging and proactive to support people with their nutrition. Daily notes evidenced that staff were not consistently supporting people to eat healthy meals or providing healthy and nutritious alternatives. There was no evidence that staff were supporting people with their own meal plans or that staff were encouraging people to choose healthier options. When people ran out of their weekly budget or their health had deteriorated and they were not motivated to prepare and cook their dinners and there was no alternative provided by staff. One person shared with the manager that ‘They have no dinner support and haven’t had anything hot in a week’. There was not a system in place to ensure staff could provide healthy and nutritious meals that were available to all the people living at the service. This had a major impact on people’s health, and their well being. Mealtimes were not structured – leaders told us that everyone living at the service were all supported individually to make all of their meals by individual staff every day. There were not sufficient staff to enable this to happen. This meant that people often went without eating sufficient food, and food that was not nutritious.

The provider had determined that each person had £50 per week for food. From that they had to put aside £10 for a take away each week. That meant that each person had just over £6 to spend on 3 meals per day. The provider did not provide basic provisions such as bread, cereals, condiments or drinks for people. This was only available if people had not spent their full £50 weekly allowance and the left over money was used to buy these basics. The provider could not explain how they had judged that this was sufficient to ensure people had enough to eat and drink. People were at risk of harm because they provider had failed to adequately provide a sufficient food, sufficient resources or sufficient money to ensure people’s nutritional needs were met.

The provider did not always work well across teams and services to support people. Staff did not always work positively together to ensure people received positive outcomes. For example, information was not always shared within teams effectively to ensure they all understood the risks around choking for a person at the service. The service had a handover system between shifts, however this was not effective at ensuring that new information was shared with and understood by all staff.

For people that lived with dementia, there was no evidence of the external support this person received. Staff had not completed training to ensure they understood how to support people with dementia. However, the provider did make referrals to other healthcare partners such as mental health services when people were experiencing a mental health crisis.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support. Staff did not document and evidence where they had encouraged people to pick healthier lifestyle choices and habits. For example, staff did not document if and when they gave advice to people around nutrition and what healthy food alternatives they could have.

Some people were able to manage their health conditions independently, such as diabetes. However they did not do this consistently and were at risk of their health deteriorating. The provider told us people had capacity to manage this themselves, however it was not always clear when staff needed to intervene. For example, one person’s care plan detailed staff are to verbally prompt them to make food choices that are lower in sugar, however daily notes evidenced that staff were not following this guidance.

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 provider had not ensured people were supported to receive their annual physical health monitoring by their GP due to their anti-psychotic medicines. Staff told us they were unaware if these reviews had taken place and there was no evidence to confirm these had taken place, or that people were encouraged do this. When people are prescribed anti-psychotic medicines, regular physical health checks should be conducted to monitor for side effects such as weight gain or falls. People were at risk of the side effects as a result of their anti-psychotic medicines not being well managed.

The provider had not ensured that issues relating to smoking cessation and antipsychotic medicine had been considered in people’s care and support plans. Care plans did not highlight the risks around people stopping smoking and the adverse effect this can have on effectiveness of their antipsychotic medicines. Although no one had expressed they wished to stop smoking, this had not been considered or planned for should people wish to be supported to stop smoking.

The provider had not ensured that people’s capacity and consent was consistently recorded in their care and support plans. For example, one person’s care plan contained contradictory information in relation to the support they needed when leaving the home. The person’s missing person profile detailed that the person had capacity to leave the service independently, however in another part of their care plan it detailed they had fluctuating capacity and they needed staff support at all times when leaving the home due to an incident of the becoming confused with their surroundings.

People’s consent was gained by staff before providing support. However, when people declined support, it was not always evidenced what action staff took to ensure that support was offered again to that person. This meant there was a high risk of people being at risk of neglect through staff effectively monitoring their wellbeing.