Ashfield House - Raunds

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• 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 Good. At this assessment the rating has remained Good.This meant people’s needs were met through good organisation and delivery.

This service scored 68 (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 care plans clearly reflected people’s current individual needs and the outcomes they wanted to achieve.

People had individual care plans which included information about their needs, preferences and routines. Care plans were reviewed, and people and relatives were generally positive about the care provided. Staff also demonstrated good knowledge of people and their individual preferences.

However, some care plans contained needs and goals that were too general or did not fully reflect people’s current circumstances. For example, one person was assessed as being at very high risk of pressure damage and already had a pressure sore, but their care plan only described them as being at risk of developing pressure areas.

Another person had recurrent falls, but the goal in their falls care plan focused on maintaining independence without clearly reflecting the need to reduce their risk of further falls. The same person had a long-term catheter, but the goal focused mainly on personal hygiene rather than the outcomes needed to safely manage their catheter care.

Overall, people had care plans and staff generally knew them and their preferences well. However, care plans did not always clearly reflect people’s current individual needs or include meaningful goals that reflected the outcomes their care and support were intended to achieve.

The provider supported continuity of care through a core staff team who knew people and their needs well. The registered manager had worked at the service for a long time before being promoted to the manager role. This meant they had good knowledge of the service, the people living there and their individual needs.

People and relatives generally felt staff knew them well. Relatives described staff as understanding their family members’ needs and told us they were kept informed about changes in their care and health. This helped provide consistency in the way people were supported.

Staff worked closely with health and social care professionals to coordinate people’s care.Information about people’s needs was available through the electronic care system, and handovers were used to share important information and changes in people’s needs.

Overall, people received joined up and coordinated care. A core staff team who knew people well, experienced management and effective working with external professionals helped support continuity of care.

The provider provided people with appropriate information and considered their individual communication needs.

People’s communication needs were assessed and recorded in their care plans, including information about their hearing, sight and how staff should communicate with them. Staff knew people well and understood how to communicate with people who may have difficulty expressing their needs.

The provider understood the Accessible Information Standard. Information could be provided in different formats where needed, including large print and other languages, to meet people’s individual communication needs.

Overall, people’s communication needs were identified, and information could be adapted to help people understand and communicate effectively.

The provider did not always make sure people and those important to them were consistently involved or that their feedback was used to improve the service.

The provider had systems in place to gather people’s views. We saw evidence of surveys and feedback involving people living at the service, staff, visitors and visiting professionals. The provider also told us questionnaires were regularly sent to families. However, relatives’ feedback showed involvement was not always consistent. While some relatives had received questionnaires, several could not recall being asked for feedback. Some were also unaware of relatives’ meetings.

People and relatives generally felt able to approach staff and management with questions or concerns and said they were kept informed when something happened. However, some relatives told us concerns they had raised did not always result in change. There was limited evidence to demonstrate how informal concerns were consistently recorded and used to support improvement. One relative told us, “I do go and speak to people straight away if I have concerns, but nothing happens.” Another, who had raised concerns about food quality and choice, said the provider had acknowledged the issue but “it doesn’t change.”We raised this feedback with the provider, who acknowledged the concerns and told us they would review the practice.

Overall, the provider had systems to seek feedback from people, relatives and others involved with the service. However, involvement was not always consistent, and the provider could not always demonstrate that feedback and concerns had resulted in improvements.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People’s needs were assessed before they moved into the service to make sure the provider could meet their needs.People had access to healthcare services and were supported to attend appointments and receive treatment when required. Relatives were generally positive about access to healthcare and told us GPs and other professionals were contacted when needed.

People’s individual needs and circumstances were considered when supporting them to access care and treatment. However, access to meaningful and individualised activities and stimulation was not always consistent, which could impact people’s equitable access to opportunities that supported their wellbeing.

The provider considered people’s individual needs and circumstances and adapted their care and support to promote fair experiences and outcomes.

People’s health conditions, disabilities, communication needs and preferences were assessed and recorded within their care plans. The service supported people living with dementia and people with complex physical health needs. Staff generally understood how these needs affected people and adapted their approach according to people’s abilities and level of understanding.

People and relatives generally felt they were treated fairly and as individuals. Staff supported people to make choices wherever possible. However, people did not always have consistent access to meaningful and individualised activities and stimulation. At the time of our assessment, activity staff were on annual leave and there was greater reliance on care staff to provide activities. We also observed periods when staff were not present in communal areas, which reduced opportunities for engagement and interaction. We raised these concerns with the provider, who took action in response.

Overall, the provider considered people’s individual circumstances and generally adapted care and support to meet their needs and promote equitable experiences and outcomes. However, opportunities for meaningful and individualised engagement were not always consistent.

The provider supported people to plan for their future care, including their wishes and preferences for end-of-life care.

People had end-of-life care plans in place where appropriate. These included Do not resuscitate cardiopulmonary resuscitation (DNACPR) and ReSPECT arrangements, involvement of families and regular reviews. However, some information was generic and could be more personalised to clearly reflect people’s individual wishes, preferences and the support they wanted at the end of their life.At the time of our assessment, no one was receiving end-of-life care. Staff understood the importance of involving relevant healthcare professionals when people approached the end of their life.

Overall, appropriate arrangements were in place to support people to plan for the future, although some end-of-life care plans could be more individualised.