Harper house - Wolverhampton

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 the service under this provider. 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 50 (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 all people’s care and treatment was effective because they did not always check and effectively assess people’s dietary needs with them.

Where people required modified diets, detailed care plans were not in place to guide staff in how to provide effective care to meet individual dietary needs. Staff confirmed this information was missing. For example, when we asked staff how they knew which foods were appropriate for people on modified diets 1 staff member said, “I am unsure as we have no paperwork to tell us what residents should be eating and not eating.”

However, people’s needs around other physical health conditions and mental health conditions were appropriately assessed and planned for. Care records contained evidence of assessments and plans for physical health conditions.

The provider did not always use evidence based guidance to plan and deliver people’s care and treatment with them.

Internationally recognised guidance that describes the texture of modified diets was not used effectively to ensure people consistently received food that met their individual needs.

However, we found nationally recognised guidance was used to formulate care plans around other health needs such as catheter care and respiratory support. Staff were knowledgeable about the information contained in these care plans.

The provider did not always work well across teams and services to support people. They did not always follow recommendations made by professionals from other services.

Staff gave us mixed feedback about how they worked as a team which suggested effective teamworking had not been successfully embedded. Comments from staff included, “There’s no teamwork” and, “Yes, we all work together and pull together.”

Advice and recommendations from other services was not always followed. For example, advice from speech and language therapists was not consistently followed to ensure people’s individual dietary needs were met and recommendations from the fire service were not implemented in a prompt manner to ensure fire risks had been effectively addressed.

However, staff shared information about people’s needs and progress with each other through daily notes and handovers.

The provider did not always support people to effectively manage their health and wellbeing. This was because people were not consistently supported to eat foods that promoted their health and wellbeing when modified diets were required.

However, staff did take action to promote healthy living by supporting people where possible to make healthy food choices and advising people to reduce smoking. Referrals to health care professionals were made when people’s needs changed.

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.

Relatives were not always assured that effective action was taken to improve people’s outcomes and meet expectations. For example, 1 relative told us they had requested a continence assessment for their family member, but they had not been informed this had been completed as requested. They said, “We have to keep buying extra pads for [relative] as they don’t have enough. I raised this with the manager and she said they are only allowed so many a day. We asked the manager to raise a continence referral but I’m not sure that was done.”

Effective systems were not in place to ensure people’s outcomes were monitored to ensure they consistently received care that met their individual needs. For example, the foods people consumed who were on modified diets were not effectively monitored which meant the provider had not identified people were receiving incorrect and unsafe foods.

Care records contained evidence of reviews. However, we were not assured these reviews were effective in monitoring people’s outcomes as these reviews had failed to identify that some people were unhappy living at the service.

We were not assured that people consistently consented to their care when they had the ability to do so. Some people told us they had restrictions placed upon them that they did not fully agree with. For example, 1 person told us the number of cigarettes they could access was restricted by the staff. Staff told us this person had the ability to make decisions about their care and we found no records to show the person had consented to this restriction. This meant we were not assured this person had consented to this restriction.

However, where people did not have the ability to consent to aspects of their care and support, the requirements of the Mental Capacity Act 2005 (MCA) were followed. In these circumstances, best interest decisions were documented to show care was being delivered in people’s best interests. Staff had received training in the MCA and showed an understanding of mental capacity.