Herondale

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

People’s needs were assessed when they started living at the service. The provider had made some improvement to the monitoring and managing of information about people’s needs since our last assessment, but further work was needed. Some care records did not always capture people’s current needs, risks and preferences as their previous needs and history were intertwined with new information about them. These would not always provide staff with people’s most up to date assessed needs and be able to meet them effectively. This included people’s risks of smoking and mobility. The registered manager told us the keyworker system they had introduced should help to ensure care plans were person centred and up to date.

The registered manager used information provided by the referrer to inform the plan of care. People were involved in these assessments and their views about their health, care, wellbeing and communication needs were discussed. A person said, “When I came here, I talked with [registered manager] all about what I wanted to do and not what I want people to do for me.”People’s changing needs were reviewed with staff and they had an input into these reviews. We saw people had completed a person-centred support plan about their likes and dislikes and support with daily tasks and activities. One person we saw had typed up their own review.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Some people had lived at Herondale a long time and were settled. Some people were getting older and for example experiencing difficulties with their mobility. There was no plan about how the service kept up to date and developed positively in this area to ensure the care provided was right and reflected best practice.

Some nationally recognised tools to assess and monitor people’s mental health needs were being used to ensure their mental health was being monitored. We saw one tool used to assess people’s mental health risk and safety management

Staff supported and encouraged people to eat a healthy and balanced diet. People were involved in going shopping with staff, preparing drinks and snacks. Main meals were cooked by staff. Menu choices were discussed and agreed with people, and they could eat as a group or individually. People were happy with the food offered and understood any restrictions on their access to particular foods and the kitchen area. A person told us, “Staff help me to get snacks in the kitchen when I want.” Another person said, “The food is edible, and they have a menu, and they ask us what we want for dinner.”

The staff team did not always work effectively with health and social care professionals to ensure people received joined up care to meet their needs. Whilst we saw some good practice in relation to advice and information obtained from professionals such as the speech and language team for people at risk of choking, we did not see any information or correspondence with the occupational therapy team for people with needs relating to their mobility and use of equipment. The referral process was inconsistent and therefore joint work to obtain the best outcomes for people were not always in place.

Social care professionals told us of the advice and support they had offered to Herondale staff to improve their practices in relation to safeguarding, risk assessment and person-centred care. Whilst this advice and support was welcomed, there was limited improvement and lack of ongoing dialogue to effect change and improve outcomes for people.

Information was available if for example people had to go to hospital. Some people we saw had hospital passports (a document to inform hospital staff about the persons needs and circumstance). This supported coordinated care. Notes from medical professionals were recorded where people’s needs had changed, such as GP and district nurse instructions for staff to follow.

People told us they had support with their health care needs. A person said, “[Name of staff member] went to see the doctor with me, we got a taxi together. I told them how I was and all going okay.” Another person said, “I am still going out and keeping busy. Staff look out for me.”The provider supported people to manage their health and wellbeing in discussion with them. People were supported to attend medical and other appointments and staff reported back any actions needed. Staff responded to changes in people’s acute care needs by contacting medical services such as the GP and district nurse, psychiatrist or social worker when needed.

People were supported to understand and make choices about their diet, lifestyle and physical activity. Where these were declined, it was recorded in their daily notes. However, we did not see where staff offered any alternative ways to reduce negative impacts on people’s health and independence. For example, when a person was not able to go out for a walk due to lack of staff availability.

The provider did not always routinely monitor people’s care and support to continuously improve it. They did not always ensure that outcomes were positive and consistent. Examples included, people’s needs relating to their smoking habits, clothing and access to the community. These aspects of their care were not monitored effectively to help them reduce risks, keep themselves safe and provide alternatives in order to improve their outcomes.The provider was not always proactive in utilising appropriate resources to increase people’s level of mobility, access to social opportunities and building independence. People’s access to comfortable and safe bathing facilities had not been improved to meet their personal care needs. People’s records of their daily lives were still task focussed and did not always record how people thought and felt about the outcome to their day.However, we did see some positive practice, for example, people taking increased responsibility for cleaning the shared areas of the service and a person supported to try out new skills such as typing on a laptop and practicing a musical instrument.

Most people were independent to come and go at the service and spend time as they wanted. People were comfortable with staff who responded in a timely way to requests for snacks, meals, support with personal care and money to go out.

The provider did not always respect and consider people’s rights when assessing their needs, capacity and ability to make every day or significant decisions. There were not effective systems in place to ensure that people’s capacity was assessed and recorded as mental capacity assessments were not always undertaken. Mental capacity assessments considered people’s ability to manage medicines, finances, smoking risks, and whether they could leave the building unaccompanied. However, some information seen around consent and capacity was unclear and did not give staff a full understanding of people’s needs or rights. While assessments addressed some decision-making areas such as medicine-taking and smoking, other restrictions, like going out alone, were not always considered, even for people identified as unsafe to do so. The registered manager acknowledged this and took action during our visit.

Where people could consent to their plan of care, their signature had been obtained. Some people had representatives such as the Court of Protection or a Lasting Power of Attorney (LPA) who looked after their best interests. Deprivation of Liberty Safeguards (DoLS) were in place. DoLS set out the legal authority for people to be deprived of their liberty, in their best interests. Others we saw were awaiting approval by the local authority.