Asher 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.

This is the first assessment for this service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The registered manager was in the process of assessing a person transitioning from children to adults’ services. This involved working closely with the person, their relatives, local authority professionals and staff to determine whether the service could meet their needs and whether they would be compatible with others living at the service.

Before people moved into the service, comprehensive assessments were completed to ensure their individual needs could be met safely and effectively. Care plans demonstrated people's physical health, mental health, sensory, social and communication needs had been assessed and taken into account. People’s views and opinions had been captured, respected, listened to and implemented as part of their day-to-day support. Care plans were reviewed on a regular basis and revised accordingly to accurately reflect changes in people’s needs and the level of support required to maximise their health and wellbeing. Staff demonstrated a good understanding of people's individual needs and how to support them to achieve positive outcomes and maintain a good quality of life.
 

People received care; support and treatment aligned to current legislation, national standards and evidence-based good practice guidance relevant to their needs. Care plans reflected recognised best practice, including National Institute for Health and Care Excellence (NICE) guidance on covert medication and the International Dysphagia Diet Standardisation Initiative (IDDSI) framework providing guidance for staff about texture-modified foods and thickened liquids used for people with dysphagia (swallowing difficulties).

Staff understood people's individual dietary needs, preferences and risks. They described how 1 person became unsettled when hungry and demonstrated good knowledge of a person at risk of choking, including foods to avoid, safe positioning and supervision during meals. Staff had received choking awareness training and were able to explain the action they would take in an emergency. Additionally, staff had completed a range of training, including statutory training for people with a learning disability and autistic people to ensure they delivered care in line with good practice standards. Staff also had access to a developing library of books and articles to build on existing knowledge.

The registered manager and staff worked effectively with a range of external professionals, including GPs, district nurses, occupational therapists, dietitians and speech and language therapists (SALT), to ensure people's care and support were tailored to their individual needs. Weekly multi-disciplinary meetings brought staff and external professionals together to review people’s progress, discuss risks, share updates and plan next steps. This ensured specialist advice was embedded into daily practice and both staff and professionals had a shared understanding of people’s needs.

Staff and external professionals worked collaboratively to support people to achieve positive outcomes. For example, sensory processing needs meant a person found wearing clothing distressing. The positive behaviour support (PBS) lead had been working closely with the organisation's regional psychologist and PBS practitioner to develop a personalised approach. Using fabric samples over time within the person's apartment, they had been able to identify textures the person preferred. The PBS lead told us, "It's not just the type of fabric, it's about texture and finding what they can tolerate best." This joined-up approach had reduced the persons distress and anxiety around clothing, improved communication and enhanced their quality of life.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lifestyles to help maintain wellbeing and, where possible, reduce future care needs. People’s care records reflected they were supported to make informed health choices, with risks to their health and wellbeing being identified and managed promptly to prevent deterioration. Each person had a health passport, a personalised document that supported them to manage their health, identify their needs and set well-being goals. It included important information about how they communicated, their medicines, care and support needs, and any dietary requirements.

People had access to health care when they needed it, including access to the local GP, hospital appointments and medicine reviews. Health appointments were coordinated through weekly meetings with GP input to review concerns and agree actions. Staff had worked closely with paramedics and community nurses to make reasonable adjustments for people who found engaging with healthcare difficult due to communication or capacity challenges. For example, staff worked with the community phlebotomy team to support a person who found blood tests distressing. Additional visits were arranged to help the person build relationships with the nurses and become familiar with the equipment, enabling the procedure to be completed.

The provider had effective systems in place to monitor people’s care and treatment to drive continuous improvement and ensure positive outcomes that met both clinical expectations and the expectations of people themselves. People’s needs, including details of any enhanced monitoring, risks or related health conditions were reviewed at daily meetings. Where concerns about people were identified, this enabled the registered manager to respond promptly to improve their care, support and where required treatment. For example, where a person was experiencing deterioration in their mental and physical health, the registered manager had contacted the integrated care board (ICB) and worked with relevant professionals to arrange an urgent review of their care and support.

Staff monitored people’s health, wellbeing and progress, using recognised tools such as the National Early Warning Score 2 (NEWS2) and Malnutrition Universal Screening Tool (MUST) to identify early signs of deterioration. People were supported to attend routine health screenings, health checks, medication reviews and reviews of long-term health conditions. Care plans were evaluated monthly to ensure they remained effective and responsive to people’s needs.
 

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Care plans showed people’s capacity to consent had been assessed. Where people lacked capacity for specific decisions, appropriate processes had been followed in line with the Mental Capacity Act (MCA) 2005. Assessments clearly detailed how people were supported to understand information, express their views and make decisions about their care, support and treatment. Relatives, advocates and professionals were involved in assessments and best-interest decisions where required.

Staff demonstrated a good understanding of MCA principles, including the presumption of capacity unless proven otherwise. They recognised the importance of supporting people to make their own decisions, acting in their best interests when capacity was lacking, and using the least restrictive options. Staff understood that capacity could fluctuate and that people had the right to make unwise decisions. One staff member said, “Even if someone does not have capacity, they can still be involved in the decision even if only a little.” Another explained, “If people are making a decision that is harmful, we inform them of the consequences, but this is their right if they have capacity.”