Ash Cottage

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 was in breach of legal regulation in relation to person-centred care, safe care and treatment and the governance at this service.

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 service 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. The registered manager told us people, and their relatives were involved in the care planning process and involved in regular reviews of their care provision. However, one relative fedback that they had only been contacted during the assessment process about a review of a person’s care plan, despite them asking for this for some time. We saw no evidence people or relatives were involved in the care planning process.

Staff told us about the process for initial assessments for new admissions to the service and how this was shared with staff. However, some staff said they didn’t have time to read people’s care plans. Handovers were taking place at least twice daily and service user guides were available and included detailed easy read information to help people settle into the service.

The service did not plan and deliver people’s care and treatment with them, including what was important and mattered to them. Modified diets were not being managed well. We saw one person was given food they could not eat according to their SALT (Speech and Language Therapy) assessment. This meant the person was at significant risk of choking. Staff did not appear to be aware of this person’s specific dietary needs. Although most of the food looked pleasant, people seemed to be offered the same meals most days, and the menu plan was not always being followed. For people who required a blended diet as per their SALT assessment, they were given soup most days and we witnessed a meal that was blended together in a bowl which did not look appetising. There was a lack of options for people who were on a blended diet in terms of snacks and yoghurts were being offered most days. We also noted some staff members were not encouraging people to eat who may initially refuse and be at risk of malnutrition.

People and relatives were positive about the food on offer. One person said, “The food is great here and there’s a couple of choices at each meal.” One relative commented, “(Person) likes the food. It’s homemade when we’ve been at mealtimes. They always finish it.”

The service did not always work well across teams and services to support people. Concerns were raised by professionals about staff communication. One professional said, “Communication over the phone is almost impossible, little better face to face, but again I feel I cannot put too much trust in their (staff) capabilities.” Professionals also spoke of concerns with staff following instruction and guidance. They said, “The main issue for us as a team is that we don’t have confidence in the staff to follow instruction with regards important information regarding patients (people’s) medication.”

Relatives felt they would be kept informed of any changes in care provision. They said, “Communication is good and they (staff) let me know of any falls and trips [person] may have occasionally.” Staff told us they are a good team. They said, “Staff work well together as a team, we help each other all the time.” The registered manager told us they had strong relationships with various healthcare professionals and when monitoring is required, a clear plan was agreed with all relevant professionals to ensure staff know exactly what to record and escalate. We saw evidence of referrals being made, as needed and people being seen by services including chiropodist and opticians.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. We observed a physiotherapist who attends the service every other week. They told us they had been coming into the service for 6 months to carry out assessments of people. They said, “This isn’t just an activity, it is also about health and wellbeing. I gauge which type of physio will suit each individual best and work closely with the home (service) so they can continue the exercises when I am not here.” We observed people engaging with the physio which included activities to help people improve their posture and hand/eye co-ordination. However, we saw no evidence in people’s care records that they engaged in any other active activity such as chair exercises or walks when the physiotherapist was not present.

The service 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. Tools for monitoring people were in place, but they were not robust or effective. Behaviour charts did not hold enough detail to be able to analyse the events that occurred, what triggered the behaviour or the outcome for the person. For people who were under the care of the dietician, there was no evidence the diet plans were being followed or evidence people who were underweight were being offered regular, high calorie snacks.

People were not being supported to maintain their oral care needs. It was clear people were not being encouraged or assisted to maintain good oral hygiene. Oral care risk assessments did not guide staff on how to assist with oral hygiene and where people’s assessments stated they required a referral to the dentist, there was no evidence this had been actioned. Staff champions were allocated in certain areas including oral care and nutrition. However, the staff we spoke to in these roles could not explain what their responsibilities were or how this benefited people. There was also confusion amongst the staff around pressure relief, and we were not assured people were being appropriately monitored or risk assessed to help prevent skin breakdown.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff did lack some knowledge in this area, and not all staff knew what was meant by asking for consent, however, staff did advise people were always given a choice of meals and activity preferences. The registered manager said, “For people with capacity, we support them to make their own decisions, even if the choice involves some risk. We provide information in a way they (people) can understand and record their wishes clearly.” We saw a range of consent forms in place including consent to care and treatment and medicine administration which was either signed by the person or LPA (Lasting Power of Attorney). We also saw evidence of mental capacity assessments and best interest decisions being made where appropriate.