Neptune 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 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 the legal regulation in relation to consent to care and treatment.

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.

People had their needs assessed before moving to the service. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person. The assessment included making sure that support was planned for people’s diversity needs, such as their gender, culture and their abilities. However, people had not always been reassessed in a timely manner when their needs had changed. This led to out-of-date and inconsistent information. Some people were able to recall being involved in their assessments and care planning process. The registered managers told us, “We always involve the service users and their next of kins."

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People had choices of food which met their assessed needs. Most people were weighed regularly to enable the service to monitor people’s weight and take timely action if people lost or gained too much. However, a person’s weight chart recorded an increase of 8lbs in January 2026. There was no record of action taken such as reweighing to check if this was a scale error. Another person had only been weighed once in the whole of 2025. There had been no attempt to monitor the person’s weight in alternative ways such as using a mid-upper arm circumference (MUAC) check. This tool is used to assess nutritional status and muscle/fat mass to determine malnutrition levels.

We observed food was given in accordance with The International Dysphagia Diet Standardisation Initiative (IDDSI) framework. The guidance was also available in the kitchen for staff responsible for preparing, cooking and serving meals. Staff had a good understanding of people’s assessed needs in relation to type and texture of food as well as any allergies and food intolerances. Staff told us they helped people to make their meal choices if they needed it.

Food records showed people had options for breakfast which included a cooked breakfast. People had access to snacks and drinks to meet their wants and wishes. People told us they enjoyed the food at the service. A person told us they helped with the cooking. One of the registered managers told us that people get involved with baking and making teatime meals mostly. Comments included, “My favourite homecooked food is roast chicken. My favourite pudding is apple crumble and biscotti cheesecake, [cook] is a good cook” and “All the food here is lovely, there is nothing [cook] cooks that I don’t like.” Relatives told us, “The food is excellent, very fresh with lots of choice, my son has a no dairy diet, staff and the cook are aware of this and keep a very watchful eye on the food and drink he consumes”, “I am very happy with the food, he has no allergies or intolerances, the cook is excellent, we all had a lovely Christmas meal in the home which parents/family members were invited to” and “The food is excellent at Neptune House, the chef/cook is brilliant, there are no allergies, our son’s favourites are puddings, which the chef always provides, everything is fresh and cooked on the premises.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. The provider had a clear process in place to escalate health concerns within a timely manner.

People’s care plans included hospital passports however care plans and hospital passports were not always up to date with people’s current care and support needs. The management team told us they planned to review and update these.

Staff worked with health professionals to ensure people got the care and support they needed. A staff member said, “We have nurses come in, we have someone with a catheter, it works okay, the communication is brilliant, I would go to one of my seniors if I felt someone needed to be referred for any issues relating to their health.” A health professional told us, “We have a nominated clinician who visits the home regularly and is known to staff. Home visits are requested when appropriate and at other times patients are brought to the surgery by staff when appropriate.”

The registered manager and staff told us, there were good links with other health professionals such as district nurses, respiratory nurses, SaLT (Speech and Language Therapy), occupational therapists, the mental health team and social workers. Relatives told us staff accessed medical help when required. Comments included, “We have nothing but praise for Neptune House, they are genuinely committed to looking after all the residents, in particular we are aware of some residents being supported 24/7 when hospital visits have been necessary even for a long period of time”, “Our son had some very serious mental health issues a few years ago, we thought that Neptune House would not be able to accommodate him, but they responded amazingly well to the situation, and we are very, very happy with the service and the support the staff and management provide to our son and ourselves” and “My son was very, very ill last year, and I must say the care the home provided with his hospital stay was second to none, the care in an emergency situation was excellent, and the service is to be applauded for this.”

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.

People were supported to attend medical appointments if they were needed. People were also supported to attend regular dental check-ups and eye tests when they were needed. Staff respected people’s decisions around medical appointments. For example, during the assessment a person refused to go to a screening appointment. Staff accepted this and made arrangements to reschedule. We observed staff explaining to a person that a health specialist had called the service and they wanted to visit the person the following day to carry out some checks. The person became upset and the staff member reassured them and explained what the appointment was about and offered support during the appointment which the person accepted. Staff had a good understanding of meeting people’s changing needs. Staff provided clear information about reporting concerns such as catheter care to the surgery so that a nurse could attend. A staff member told us how they would deal with seizures, “If it is a first seizure for anyone or the first seizure for a long time, we would call 999.” A person said, “I go to the doctors for a blood test.” A relative said, “Staff do sometimes arrange medical appointments, he has not seen a GP for 3 years and not seen a dentist since 2019, I need to take this up with the home.” Another relative told us, “Staff arrange and attend all medical appointments for him and keep us informed of any issues/changes to medication. He last saw a dentist very recently.”

We observed staff supporting people to maximise their independence, providing lots of praise and providing reassurances. We observed that plenty of fluids were offered to people to keep them hydrated and in good health.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff worked together as a team to support people and to ensure people received their care and support in the way they chose. People were referred on to health care professionals when this was required, referrals had been completed in a timely manner. A healthcare professional told us, “The team recognise their patients’ needs for referrals and contact the practice or raise this with a visiting clinician when needed.”

Staff completed handover meetings between shifts to pass on important information including any changes to health. Staff had communication books and communication messaging groups to enable effective communication and consistency.

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

We checked whether the service was working within the principles of the Mental Capacity Act (MCA), whether appropriate legal authorisations were in place when needed to deprive a person of their liberty. The service did not always work within the principles of the MCA. Some people told us they made their own choices and decisions. Some people had full capacity to make specific decisions and some people lacked capacity regarding specific decisions. There was no record of capacity assessments to show that the person lacked capacity to make specific decisions and who had been involved in best interest decision making. There were no mental capacity assessments and best interests’ discussions recorded in relation to the use of video and audio monitoring devices in place in the service for any of the people living there. Although each person did have a capacity assessment in place relating to decisions to live at the service and management of medicines; these did not always evidence who else had been involved in the assessment such as any relative holding lasting power of attorney (LPA) or health professional. Therefore, the principles of the MCA were not always followed.

We observed people making everyday choices and decisions about their lives during our visit such as what they wanted to eat, drink, what activities they wanted to do. Relatives told us staff respected their loved one’s choices. Comments included, “Our son has a lot of choices regarding bed time and what time to get up”, “Staff do explain to him about his choices” and “My son is a very much routine type of person, he can make choices to a degree, and staff in my view do not always stick to his routine they seem to have “a play it by ear attitude” to his needs and requirements.”

Staff had a good understanding of consent. A staff member said, “In the morning when they are picking their breakfast, they pick what they want, if they want to get up and do something, they have a big list of activities they can pick from, some people because they really like routine they stick to the same things but we do encourage to do different things.”