Mount Ephraim House

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.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent to care.
 

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.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Although some people’s care assessments and records were completed well, providing detail to enable staff to provide care that met their individual assessed needs, this was not consistent. This meant there was a risk some people received care that was more appropriate to their needs than others. The provider told us they were aware of this; however, it continued to be a work in progress.

Some people had bed rails, but a bed rails assessment had not always been undertaken to determine if this was the safest option in their individual circumstances.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Not all people’s care had been planned with them and some relatives confirmed they had not been involved. This meant some people were at risk of not always receiving the most appropriate care, with risks increased by the numbers of agency staff covering shifts.

However, some people’s care had been planned with them or their loved ones and staff used good practice standards to do this, for example, to assess the risks of skin damage, or malnutrition. This meant their care plans covered the areas that were most important to them as well as to ensure their needs were met.

The provider did not always work well across teams and services to support people. They did not always make sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
The information and guidance recorded in some peoples care records was not always detailed and consistent. There was a risk that if those people moved between services, for example to hospital, or another care home, there needs may not be fully met as their care story was not complete.
Staff engaged with external healthcare professionals to make sure people received the appropriate healthcare advice and treatment when they needed it. People had been referred to professionals such as occupational therapy and opticians and had seen a GP when they needed to.
 

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

Staff had not received training to support important healthcare needs such as Parkinson’s disease and diabetes, even though people were living at the service with these care and support needs. Some people’s care plans and risk assessments did not always address the factors and risks in relation to these needs. A person with Parkinson’s disease had a mobility care plan, however, the risks associated with Parkinson’s disease and how this may affect their mobility was not included.

The reliance on agency staff and the lack of important detail in some people’s care plans increased the risks of people not receiving the most appropriate individual care to promote their ongoing health.

A relative told us, “Sometimes, we don't know that they are calling the doctor, and we only find out afterwards. (Person) has a cough which we have told them about on numerous occasions, but nothing has been done about it.”
 

The provider did not always routinely 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.

People’s care plans were not always designed with goals and outcomes in mind and had not been monitored to check they included accurate information and included outcomes for people.

Some people’s care plans were detailed and clearly demonstrated that the person had been involved in setting goals to achieve. For example, a person’s care plan recorded how their wish was to maintain and maximise their own involvement with their personal care routine, doing as much as they could themselves. This meant staff, including agency staff, were aware of this before providing support and could help them to continue to achieve their goal.
However, other people’s care plans did not include this level of detail and used standard generic text in relation to improving outcomes. There was a risk staff, particularly agency staff, would not have the individual detail in relation to people’s aspirations to be able to support success and a sense of well-being.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider did not consistently act in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and associated code of practice, and staff did not always follow the provider’s MCA policy.
Some people had signed their consent in relation to relevant areas of their care while living at the service, including consent to care and treatment, medicines administration and using their photograph on documents such as care plans. However, some people had no consent forms to evidence their agreement in these areas. A person had not signed a consent form to use their photograph, yet a photograph was in place on their electronic care record.
Some people who had been deemed as having the capacity to consent to particular decisions had not signed their consent form, a relative had, without explanation why, or if they had the legal authority to do so.
Some people had appointed a Lasting Power of Attorney (PoA) in relation to health and welfare decisions, to speak on their behalf if and when they lacked the capacity to make particular decisions. Staff were liaising with relatives who confirmed they had the relevant PoA, but without a copy of the legal document to evidence this. There was a risk people’s basic rights may not be upheld.
Mental capacity assessments had been undertaken where there were concerns people may not have the capacity to make particular decisions.
However, we observed and overheard staff asking people if they needed anything and seeking consent before acting.