Hunsbury 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.

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.

A pre-admission assessment was undertaken before people moved to the service to ensure they could meet people’s needs and that people’s differing needs were compatible.

We found that care plans and risk mitigation plans were regularly reviewed and people told us they were involved in and knew what was in their care plans. However, we found that the most up to date guidance for staff was either omitted or not always easily accessible.

For example, although there was a care plan for a person with epilepsy, there was no risk mitigation plan and we found there was not sufficient information for staff in relation to a person with a diagnosis of constipation.

The care plans and risk mitigation plans for one person who had move to the service through the provider’s rehabilitation pathway had not been reviewed since they had transitioned to the service. This meant some of the guidance for staff did not reflect the support staff were required to deliver.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider used nationally recognised evidence-based good practice tools to assess people’s needs. For example, Body Mass Index (BMI) was used to assess people’s nutritional risk by a dietician.

We reviewed the findings of the dietician for two people and the BMI had assessed that the people were an unhealthy weight, however, this had not resulted in adequate guidance for staff being reflected in people’s care plans and risk mitigation plans.

Although the dietician recommended they continued to review people’s nutritional needs monthly, the outcome of subsequent dietician reviews was not found in the care plan at the time of the assessment.

The provider work 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 MDT made up of managers, support workers, nurses, physiotherapists, occupational therapists, psychologists and therapy assistants as part of the team at Hunsbury House. The GP was part of the MDT for the provider’s community services, however, they were independent of the support provider.

Staff told us the provider’s handover process was effective and there was a written handover that was shared on the electronic system for all staff working in community services, including the MDT. A staff member told us, “We have a 15 minute handover at the start of shift to make sure we pass over relevant information.”

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 supported people to live healthier lives. For example, we found there was evidence of meal planning for some people. A staff member told us, “[Person] requires support to plan their meal, so we help them do this each week and then plan a shopping list.” We observed people helping prepare their meal. A person told us, “I cook myself – they [staff] help me.” A person also told us, “I do batch cooking for myself – I like cooking.”

The provider employed a physical health nurse who worked with the GP to ensure people’s physical health needs were met. We observed the benefits of this during the assessment and this meant a concern could be dealt with quickly, as the nurse was able to liaise directly with the surgery and agree a treatment plan.

People were supported to access healthcare services and staff worked collaboratively with external professionals to support people to attend medical appointments. For example, opticians and dental appointments.

The provider supported staff to carry out a range of health promotion initiatives with people. For example, physical health safety week. This included a range of sessions to support staff to promote physical health promotion, including monitoring food, fluid, and bowel management.

People were achieving clinical expectations and those of people themselves. However, the provider did not always routinely monitor people’s care, treatment and support to continuously and consistently record it.

The provider identified people’s goals and desired outcomes in their care plans and these were evaluated by a member of the MDT responsible for the care plan.

It was evidenced from talking with people, relatives and staff that people were achieving their clinical and social outcomes that they wished to achieve. We also saw photo books that demonstrated people were achieving social outcomes. However, records did not always reflect the positive outcomes that people had achieved.

The provider had identified that recording outcomes was an area for development. We saw a new initiative called ‘Circle of Support’ had been introduced. This empowered people to lead their circle of support and identify their expectations in relation to their care and outcomes. Action plans were agreed in the ‘Circle of Support’ meeting and evaluated at regular follow up meetings.

The initiative had recently been implemented, however, we were assured this would have a positive impact on the records relating to monitoring and improving outcomes.

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

We found people had mental capacity assessments and best interest meetings for individual decisions. However, some mental capacity assessments and best interest decisions had not always been completed in line with the principles of the Mental Capacity Act (2005). For example, decisions were not always specific and there was not sufficient detail in relation to how people had been supported to understand the decision being made.

The provider had previously identified a development need in relation to the completion of mental capacity assessments and best interest meetings – the provider shared with us details of the workshop staff had attended. This assured us that as mental capacity assessments and best interest meetings were reviewed, the quality of these would improve.