Archived: Iceni 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.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to people’s consent.

This service scored 38 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. We reviewed 8 peoples care records and we found inconsistencies throughout them. We found care plans had incorrect information recorded in them. 1 person’s care plan said they would evacuate on foot in the event of an emergency and then in the other parts said they are unable to mobilise. Another person’s care plan recorded that their vision was ok and then recorded elsewhere that they had poor vision. We found care plans had duplicated information throughout which made them unclear for staff to follow. We found people were not consistently involved in assessing and reviewing their own care plans on a regular basis. 1 relative said “I cannot remember when they last did a review, probably years ago”

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. We found 1 person whose care plan recorded they were on a level 5 international dysphagia diet standardisation initiative (IDDSI) diet that meant their food had to be minced and moist to prevent the risk of choking. The guidance states to avoid dry foods such as bread. In this person’s care plan, it was recorded that they liked to be offered an assortment of sandwiches. We reviewed another person’s care plan and found they were not being supported appropriately to manage their diabetes. They were not actively being offered food after having their insulin which was recommended with the type of insulin they were prescribed, and this was contributing to their hypoglycaemia.

The provider did not always work well across teams and services to support people. We found care plans were not clear for staff to follow and they did not actively record and implement guidance that was recommended by healthcare professionals. At the beginning of our assessment, we spoke to several healthcare professionals who had concerns over the service operating efficiently, 1 healthcare professional we spoke with said “instructions are not always followed; hence people get worse.” However, feedback at the end of our assessment evidenced this situation had started to improve. We received mixed feedback from staff on the communication between the teams, 1 staff member told us “No one tells me anything really unless I ask. I ask the people what they need.” While another told us “I raised with [interim manager] that a person was not eating well and could use more support. He included it in the handover notes and now the person is supported more to eat at mealtimes.” We observed a daily meeting completed with the heads of departments and observed shared communications with what was happening within the service.

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. We found care plans had contradictions in them around peoples care and support needs which prevented staff effectively understanding the support required. We found the service had menus displayed in the dining area with the choices of meals, however, noted they were not accurate for that meal choice or day. This did not always support people to maximise their level of choice.

However, staff told us how they support people; 1 staff member told us “I talk to our residents whilst I am with them to understand how I can help. I want to improve their quality of life and give them something to smile about.” 1 person told us “they've let me use a carer to wheel me into town to the dentist and they've sorted my glasses out for me also.”People were prescribed dietary supplements to improve their nutrition.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. We found people that required regular re-positioning to prevent their skin breaking down were not routinely supported to be repositioned as guided by healthcare professionals. We reviewed 1 person’s care records and found 12 out of 14 entries evidenced they were not repositioned in the agreed timeframe. However, the management team had been working with healthcare professionals to improve this. We found a person that was diabetic, when their blood glucose levels were low it was not always evidenced that their levels were re-checked after consuming food to ensure they were at a safe level for that individual.

The provider did not always ensure peoples consent was gained correctly, and mental capacity assessments were not always conducted when appropriate. We found 1 person’s care records noted there had been a significant decline in their memory cognitive impairment and there had been no mental capacity assessments carried out. In peoples care records where people lacked capacity in certain aspects of their care, when it came to them giving consent, there was no mental capacity assessments conducted; however, their consent was signed on their behalf by staff members. There was no evidence that a best interest decision was discussed. We received mixed feedback from staff, 1 staff member told us “I ask if I can enter a person’s room, but I do not always see other staff asking if they can help someone, they just do it.” However, we were also told “I always gain consent, its important”