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

The service is in breach of a legal regulation related to person centred care. People’s support needs were not assessed when they started using the service in line with their aims and preferences. People’s care plans were not detailed to help staff understand how to support them to achieve their goals. Staff were not consistently supporting people to have positive outcomes.

This service scored 33 (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 effectively and consistently check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed when they started using the service. However, these assessments were not thorough. Care plans and risk assessments produced as a result were of poor quality and lacked detail. There had been numerous occasions where people had started using the service, however had to leave quickly to return back to hospital. The assessment process was not robust enough to realise that people were not well enough to use the service. People’s care plans were being reviewed however this was not done with people and their relatives. Reviews did not effectively pick up on care plans that lacked detail. This put people at increased risk of harm. One relative told us, ‘‘I know they assessed [family members support needs] when they started but it wasn’t right from the get-go. We were not involved and have still not really had the opportunity to have a look at the original assessment.’’

The service and regional manager showed us evidence of how they would be making sure improvements were made to the assessment process. People gave more positive feedback about starting to use the service. One person said, ‘‘I was given a very warm welcome.’’

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.

It was more difficult for staff to support people in line with best practice. It was unclear if staff training areas such as supporting people living with specific health conditions was effective as staff competency was not being checked. People used the service to rehabilitate, regain independence and return home. However, records about people’s rehabilitation lacked detail and were not being reviewed to make sure people’s needs were being met. People’s care plans and risk assessments identified specific support needs such as living with epilepsy or being autistic. However, no guidance was then given to staff about how to support people in line with best practice in relation to these support needs. One relative told us, ‘‘[Family member] can do a lot but the staff do not encourage this and as a result they are not moving forward.’’

Some people and relatives gave more positive feedback about staff supporting them in line with their needs. One person said, ‘‘[Staff] know I might get confused and allow for this when they speak with me.’’ A relative told us, ‘‘I think [staff] try their best to do right by [family member].’’

The provider did not always work well across teams and services to support people. Staff were not working well together and were not always communicating with each other to share information. Staff at the service in clinical roles, told us care staff did not always understand or follow their advice. They explained this could lead to inconsistent care for people. For example, staff did not always follow guidance about how to support people to eat and drink safely or to be as independent as they could be when walking around the service. There were limited opportunities for staff in clinical roles and care staff to speak together and share information. One relative said, ‘‘[Staff in clinical roles] were very visible but not so much now. They are always in the office so I am not sure how much staff would be able to learn from them now.’’

However, the staff team linked and worked with other service and health professionals such as GP’s and district nurses. These professionals were positive about their working relationship with the staff team. A person said, ‘‘[Health professional] is always doing the rounds and we can see them whenever we need to.’’

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

Some people were assessed as being at risk in relation to malnutrition and needed the amount they ate and drank to be monitored. Staff did not record and monitor this in detail. It was unclear what actions were taken when people were not eating and drinking the amount identified as safe in their care plans. We observed some occasions where people were not supported in line with their known dietary support needs. There had been several recent occurrences where people had become unwell and timely action was not always taken by the staff team. For example, a person was positioned unsafely in a piece of equipment for an extended period of time. A relative told us, ‘‘[Family member] is supposed to have someone with them at mealtimes but this never happens [when we are there]. They are supposed to be [supported in certain way] but we have found them to not have been several times.’’

However, we saw people being offered food and drink regularly throughout the day. We received mixed feedback about the food and drink at the service. One person said, ‘‘The food is always frozen, so we don’t get much choice.’’ Another person said, ‘‘Staff do a good job and keep us well fed.’’

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.

People’s care plans and risk assessments continued to contain conflicting information about how to support them to monitor and improve outcomes. People were using the service for rehabilitation, however their goals and outcomes were not discussed with them or monitored effectively. It was unclear what progress people were making with their rehabilitation and if people refused sessions appropriate support was not offered to help encourage them to do so. One relative said, ‘‘[Family member] is determined and was walking before starting to use the service. They are not now. I think staff do a lot of things for them as it saves time.’’ Another relative told us, ‘‘I am not sure what the plans are for [family member]. They are not really improving, and I don’t know whether staff are following [plans] with them.’’

The service and regional manager told us how they would improve in this area. This included implementing more robust checks of people’s records and sourcing training for staff about how to support people with their rehabilitation more effectively.

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

People who may lack capacity had capacity assessments completed, and decisions made in their best interests. However, these covered all or a lot of areas of their support and were not decision specific. This limited people’s opportunities to be involved in and discuss specific support needs which they needed to consent to.

However, capacity assessments that had been completed were of good detail. Staff asked people for consent as they supported them. One person said, ‘‘[Staff] are polite and always ask me if things are okay before they help me.’’