Ash View

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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. This is the first assessment for this 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.

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.

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. Care records were not always maintained consistently. The quality and level of detail within care plans and risk assessments varied between people, with some records containing comprehensive information and others providing limited guidance for staff. There were also gaps in care documentation, including records of completed visits and activities people had attended. As a result, it was not always clear whether people had received support in line with their assessed needs and preferences.

Care planning did not always demonstrate that people’s assessed communication needs were fully supported in practice. For example, one person’s care plan identified the need for pictorial communication aids and stated staff should use their preferred method of communication; however, the pictorial resources referenced in the care records were not available when requested. This meant we were not assured people were consistently supported in line with their assessed communication needs.

Information about how people preferred their care to be delivered was not always readily available or clearly documented. For example, some records referred to people requiring a specific routine and structure to their day; however, this information was not always detailed within care plans. We found information about one person’s preferred care routines was kept within a folder held in their bedrooms rather than being clearly documented within their care plan. Other people did not have similar information readily available within their records or homes.

We found examples where important guidance was either incomplete or not reflected in daily records. For example, one person's care plan stated catheter care should be regularly completed and recorded, but records did not consistently evidence this had occurred.

The provider had some systems in place to support the delivery of evidence-based care and treatment. The implementation of evidence-based care was not always consistent in practice. We found gaps in care records, communication aids referenced in care plans were not always available, catheter care was not consistently recorded and medicines management concerns indicated that guidance was not always followed. These issues meant we were not fully assured that care and treatment were consistently delivered in line with people's assessed needs, current guidance and best practice.

However, managers attended regular management meetings and worked alongside other services to share information, discuss practice and implement organisational guidance. Staff also worked with external professionals, including GPs, district nurses and specialist teams, to support people in line with professional recommendations.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. Systems to support effective communication and information sharing between staff were not always effective. Staff told us formal handovers did not consistently take place due to shift patterns, as night staff finished at the same time day staff commenced, resulting in limited opportunities for face-to-face handovers. Although handover documentation was in place, records showed these were not completed consistently, with gaps, omissions and missing entries identified. This reduced assurance that important information about people’s care, wellbeing and risks was being effectively communicated between staff teams to support continuity of care.

Emergency information was not consistently available for all people. Records did not always contain accessible information that could be taken with a person in the event of an emergency or hospital admission, such as details about medicines, allergies, health conditions and support needs. Managers were aware of this issue and told us they were developing systems to strengthen this area.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. Staff encouraged people to make informed decisions about their lifestyles and supported them to access opportunities that promoted physical, mental and social wellbeing. For example, people were supported to participate in activities such as yoga sessions, pursue individual interests and access community facilities and social opportunities

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Systems were not always effective in ensuring people received care and support as planned. Electronic call monitoring records identified a high number of unlogged and incompletely logged calls, which meant it was not always possible to verify whether planned visits had taken place or the duration of support provided. Leaders told us some issues related to system faults and staff login errors; however, there were no alternative records available to confirm whether care had been delivered. As a result, the provider could not consistently demonstrate that people were receiving their commissioned support in line with their assessed needs and preferences.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Most people using the service had capacity to make decisions about their care and were able to verbalise their preferences and choices. Staff told us people were encouraged to make their own decisions and understood that if a person did not want support or wished to make a different choice, they would communicate this and staff would respect their wishes.