Ashfield House - Raunds

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 did not always make sure people’s assessments and care plans accurately reflected their individual needs.

People’s needs were assessed before they moved into the service, including their health, care, wellbeing and communication needs. Relatives were involved where appropriate. Care plans and risk assessments were in place and regularly reviewed. However, some records lacked individual detail or contained inconsistent information. For example, one person’s continence care plan identified the support and equipment they required but did not clearly state how often staff should support them with toileting or continence care. There was also limited guidance about protecting their skin and keeping them safe during longer periods on the toilet. Some information about their continence needs was inaccurate. The provider corrected this when we raised it.

We found another person’s records contained inconsistent information about their hearing and sight, and one risk assessment incorrectly referred to another person. This meant information about their needs was not always accurate and consistent.We also found contradictory information in one person’s nutrition care plan. Different sections gave conflicting information about whether they could eat and drink independently or required full support, and there was inconsistent information about the texture of food they required. This could make it difficult for staff to understand and consistently meet the person’s nutritional needs.We raised these concerns with the provider, who acknowledged them and agreed to review the relevant care records.

Overall, people’s needs were assessed, and care plans and risk assessments were in place. However, records did not always accurately and consistently reflect people’s individual needs or give staff sufficiently clear guidance about the support they required.

The provider did not always make sure care and treatment plans gave staff clear guidance to meet people’s health needs consistently.

People received support with their healthcare needs. Monitoring records were in place, and staff worked with GPs, district nurses and other healthcare professionals when needed. However, some clinical care plans did not provide sufficiently clear guidance for staff. For example, one person had a pressure sore and was at very high risk of pressure damage. Their care plan included regular repositioning, and records showed this was taking place. However, the wound care plan did not clearly state how often dressings should be changed, what signs of deterioration staff should look for, or when and how urgently concerns should be escalated. It also did not clearly describe the support and equipment needed when repositioning the person.

We found similar concerns with catheter care. People with long-term catheters had care plans and monitoring in place, and there was evidence of involvement from healthcare professionals. However, some care plans did not clearly tell staff what action to take if a catheter became blocked, leaked, stopped draining or came out, or when and how urgently concerns should be escalated.We raised these concerns with the provider, who acknowledged them and took action to review and update the relevant care plans.

Overall, people received support with their healthcare needs and staff worked with healthcare professionals. However, some clinical care plans did not provide sufficiently clear guidance to make sure care was delivered consistently and changes or concerns were responded to appropriately.

The provider worked well across teams and services to support people and make sure their care was coordinated.

Staff worked with a range of health and social care professionals, including GPs, district nurses and other community healthcare professionals. Referrals were made when people needed additional assessment or support, including to the falls team and dietitian. The multidisciplinary team was also involved when there were concerns about whether people’s changing needs could continue to be safely met.

Staff understood how to respond to changes in people’s health and told us they reported concerns to senior staff so advice and support could be sought from appropriate healthcare professionals.

Feedback from a community nurse was positive. They told us staff were expecting their visit and understood why they were attending. They also described the person they visited as well cared for and said staff had provided the information and support needed for their visit.Staff also described good teamwork and told us they supported each other to meet people’s needs.

Overall, staff worked effectively together and with external health and social care professionals to support people’s needs and provide coordinated care.

The provider did not always support people to maintain their health and wellbeing through consistent mealtime support and opportunities for meaningful activity and stimulation.

People were supported to access healthcare services when needed. Staff recognised changes in people’s health and sought advice from GPs and other healthcare professionals. Relatives were generally positive about access to healthcare. There were examples of positive outcomes. One relative told us, “Here they make sure [relative] eats and drinks and [relative] are so much better.”People’s nutritional needs were assessed and monitored, with referrals to the dietitian when needed. Dietary information was available to kitchen staff, and people’s identified dietary needs were being met.

We observed staff supporting people at mealtimes was generally kind and patient. The meals were well presented and served warm. However, support was not always consistent, and we observed limited encouragement for some people who had not eaten. This could impact people’s health and wellbeing. Feedback about food was mixed, with some people and relatives raising concerns about quality, choice and whether individual preferences were consistently followed.

People did not always have enough opportunities for meaningful activity and stimulation. We saw some positive examples, including people playing Scrabble and spending time in the garden. However, during other periods, people spent long periods in communal areas with limited activity or staff engagement. One person described the music being played as “not their sort of music” and said they found it “boring.”Relatives also told us activities had reduced and some people did not receive enough mental and physical stimulation or one-to-one engagement. Staff recognised that the amount and variety of activities could be improved and told us care tasks could sometimes take priority over meaningful time with people.

Overall, people were supported to access healthcare, and their nutritional needs were assessed and monitored. However, mealtime support was not always consistent, and people did not always have enough opportunities for meaningful activity and stimulation to support their health and wellbeing.

The provider monitored people’s care and outcomes. However, information from monitoring was not always used effectively to make improvements or check whether actions taken had improved outcomes for people.

Systems were in place to monitor people’s health, wellbeing and care. Care plans and risk assessments were reviewed, and the provider monitored areas including falls, infections, safeguarding concerns and pressure damage.There were positive examples were action improved outcomes. Following repeated falls, one person received specialist assessment and additional equipment, which their relative said had prevented further falls.

However, this was not consistent. The provider’s own monitoring identified an increase in falls, including a pattern of unwitnessed falls and contributing factors. Actions were taken, including monitoring, referrals to healthcare professionals and the use of sensor equipment. However, there was limited evidence of clear improvement plans or evaluation to demonstrate whether these actions had been effective in reducing further falls.

Overall, the provider had systems to monitor people’s care and outcomes, and there were examples of positive improvements. However, monitoring did not always result in clear improvement actions or demonstrate that changes made had been effective.

The provider did not always clearly demonstrate that people’s rights and choices were fully considered when decisions were made about their care and treatment.

Staff had received Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training and understood the importance of gaining consent. MCA assessments and best-interest decisions were in place for some decisions where people lacked capacity, and DoLS applications had been made where restrictions were required to keep people safe.

However, some MCA assessments did not clearly show how people had been supported to understand the decision, what information had been explained to them or how their responses had been considered. Some best interest records were mainly checklist based and contained limited information about how decisions had been reached, without considering people’s wishes and preferences, involvement of others and using least restrictive options.We also found gaps in decision specific assessments. For example, records did not always clearly demonstrate the lawful decision making process for sharing information, the use of photographs, or some equipment and restrictions used to support people safely.

Overall, the provider had systems for assessing capacity and making best interest decisions. However, records did not always clearly demonstrate that assessments were specific to the decision being made, how people had been involved, or how decisions made on their behalf had been reached.