Chase House Limited

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• 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 inadequate. 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.

At our last assessment, the provider was in breach of the legal regulation relating to consent. Improvements were found at this assessment and the provider was no longer in breach of this regulation. However, further work was required to ensure decisions and associated risks were always clearly documented in line with the Mental Capacity Act 2005.
 

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At our previous inspection, we identified significant concerns in relation to how people’s needs were assessed and reflected in care planning, which impacted the consistency and safety of care delivery. During this inspection, improvements had been made; however, these were not yet consistently embedded.

The provider did not always ensure people’s care and treatment were effective, as people’s health, care, wellbeing and communication needs were not always assessed consistently.

Information in care plans was not always accurate or consistent and, in some cases, contained contradictions in areas such as repositioning, dietary needs, mobility and levels of supervision. For example, repositioning frequencies differed within the same care plan, and diet information included conflicting details regarding swallowing needs.

This meant care plans were not always reliable tools for staff to follow, which impacted their ability to deliver safe and consistent care.
 

At our previous inspection, we identified concerns in relation to care not being delivered in line with people’s assessed needs and risks not being consistently managed in practice. During this inspection, some improvements had been made; however, these were not yet consistently embedded.

The provider did not always deliver care as planned. For example, people assessed as being at high risk of pressure damage had repositioning schedules in place; however, records did not consistently evidence that this had been carried out. In addition, care plans for health conditions, such as diabetes, identified risks but did not consistently provide clear guidance for staff on recognising deterioration or responding appropriately.

This meant that while risks were identified, actions to manage those risks were not always clearly defined or followed, and there was limited assurance that care was consistently delivered in line with identified needs.

However, clinical tools to assess risks, including malnutrition and skin integrity, were in place and used to identify concerns.
 

Staff worked with external healthcare professionals to support people’s care, and there was evidence of referrals being made and acted upon. Care plans and records showed input from healthcare professionals, and staff described working with nurses and other professionals to manage changes in people’s needs. A person said, “If I felt unwell, the staff would notice straight away.”

At our previous inspection, we identified concerns in relation to how people’s health and associated risks were monitored and managed, which impacted outcomes. During this inspection, improvements had been made.

Systems were in place to monitor people’s health, including nutrition, hydration and clinical risks. Records showed people were offered well-balanced meals.
 

At our previous inspection, we identified significant concerns in relation to governance and oversight, including ineffective systems to monitor and improve outcomes. During this inspection, improvements had been made, with monitoring tools introduced; however, these were not yet consistently effective.

Systems to monitor outcomes, including audits and reviews, had not consistently identified or ensured action on issues. For example, gaps in repositioning records, inconsistent supervision and failures to escalate safeguarding concerns were not always recognised or addressed through these processes. This meant the provider could not be assured that outcomes for people were consistently monitored or improved, or that risks were effectively managed.
 

At our previous inspection, we found people were not always supported in line with the Mental Capacity Act 2005 (MCA). During this inspection, improvements had been made, with staff demonstrating a better understanding of consent and capacity, and capacity assessments completed for most decisions. However, this was not always supported by clear or robust processes, particularly in more complex or risk-based decisions.

For example, we identified a person who was refusing a modified diet despite identified choking risks. Records reflected that the person did not wish to follow this diet, and the service manager confirmed they had capacity and were choosing to refuse it. However, a formal capacity assessment had not been completed to support this decision, and this remained outstanding across multiple visits. This reduced assurance that the decision had been assessed in line with the MCA and that associated risks had been appropriately considered.

In another example, a person’s care plan stated they had capacity and their preference not to use a hoist should be respected; however, it also permitted staff to use a hoist if transfers became unsafe. The care plan did not clearly define when capacity should be reassessed or when a best interests decision would be appropriate. This created ambiguity and increased the risk of inconsistent application of the MCA in practice.