Abbott House - Oundle

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 mostly made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed with them or a family member on their behalf prior to them joining the service including their health, care, wellbeing and communication needs. This meant the provider could ensure they could meet people’s needs prior to them moving in.

Care plans and risk assessments were updated regularly. We received mixed feedback on how people were involved in the continued assessment of care with some relatives saying they were regularly involved in planning and reviewing care, and other people and relatives not being involved past the initial assessment stage. However, we observed that there was evidence in people’s care records where family were contacted regarding changes to care needs or conversations and suggestions on how care and wellbeing could be enhanced.

Improvement was required to how daily care notes were reviewed to ensure care delivery was delivered as planned. We found gaps in staff recording care such as meaningful activity and oral health. This made it more difficult to assess if planned care was effective.

The provider did not always deliver people’s care and treatment as planned and in line with good practice guidance.

Nationally recognised tools were used to calculate the level of risks to people such as malnutrition, falls and pressure sores, with care planned accordingly. Policies and procedures included best practice guidelines to support staff. However, we found best practice was not always delivered. For example, where a risk of pressure sores had been identified staff were not always repositioning a person as planned and ensuring pressure relieving equipment was checked regularly to ensure it was in working order.

The provider ensured that people were assessed for risks associated with eating and drinking and the kitchen had an organised and well managed system that ensured people received food and fluids that met their needs. For people that were supported with eating and drinking we observed staff followed best practice guidance to reduce risks and support dignity.

The provider mostly worked well across teams and services to support people. Records evidenced that people were referred to other services where required such as, falls teams and speech and language therapists and their professional advice was recorded in care plans for staff guidance.

The provider stored a piece of equipment for the district nurses to access as and when needed. A District nurse told us they were very grateful the home did this as it meant they could collect the equipment for use for people in the community outside of normal surgery opening times.

There had been some poor communication with the GP that the provider was working to address at the time of the assessment. For example, staff not always recording sufficient detail to assist the GP on their visits, such as when peoples pain had started or the level of pain they had experienced on a scale of 1-10. Staff feedback echoed the concerns with 1 staff member telling us that shift handovers were not always effective in sharing information.

A visiting health professional told us that staff were too busy to be able to accompany professionals when they visited the home. They told us professionals who didn’t visit the home regularly and knew people may not have all the information they needed to treat and support people well.

The provider did not always support people to manage their health and wellbeing. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were supported to access healthcare appointments and referrals were made to healthcare professionals as and when required. A relative told us, “An infection in relatives’ legs recently was quickly picked up by staff”. There were regular, routine visits from the GP and nurse practitioner to monitor and support people.

Support plans were in place for staff guidance to support people to live healthier lives, however, we were not assured these were always followed for oral care. We found that people were not always supported well with oral hygiene. People’s daily support records did not evidence they were receiving assistance with brushing their teeth or helped with dentures as planned. If people were refusing oral care this was not recorded so that patterns of refusal could be reviewed and care adjusted accordingly. One person who’s daily support records did not evidence oral care had been delivered as planned was experiencing tooth ache at the time of the assessment and had been referred for a dental appointment. Records evidenced that the tooth ache was affecting the persons appetite which was a concern as they were at risk of malnutrition. The same person had also previously had a chest infection and was nursed in bed making them and increased risk of chest infection as a result of poor oral hygiene. A relative told us of their concerns regarding oral hygiene in the home. “I’ve noticed relatives breath smelling lately but they wear a plate so I’m going to check if it gets cleaned”. Records evidenced that dentures were not always cleaned as planned.

The provider did not always 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.

We found care was not always delivered as planned and routine reviews had not identified that daily care notes did not evidence care was being delivered as planned. We spoke with 2 staff members who explained why care was being delivered differently, however this change had not been risk assessed and the care plan updated accordingly.

Recording of delivered or refused care needed improvement to improve monitoring identify issues and improve outcomes for people. For example, one staff member talked us through a personal care routine for a person that was time consuming and required specific steps to gain consent and cooperation. This was not recorded well in daily care notes therefore could not be reviewed to establish progress and improve planning including the level of dependency on staff.

An improved system was implemented by the provider during the inspection this would need to be continued and embedded into practice.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We observed and people and relatives told us that staff sought consent to care at the point of delivery. Staff had received training and had a good understanding of mental capacity, we saw care delivered in the least restrictive way possible. A staff member talked to us about people’s right to refuse care and support and the importance of not making people feel forced. Staff understood that some people’s capacity could fluctuate throughout the day and we saw some evidence in records of where staff had accepted a refusal but tried a different time of day and people had consented.

Individualised mental capacity assessments were in place and we were confident that people were supported within the Mental Capacity Act principles. There was evidence of family involvement in decisions but this and how best interest decisions had been made needed to be recorded more clearly on records.