Chesham 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 remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. People’s needs were assessed and reviewed so care and support could be delivered in a way that met their physical, mental health, communication, nutrition, personal care and risk management needs. Support plans reviewed were detailed and person-centred. They included information about people’s health conditions, mental health needs, preferences, daily routines, risks and how staff should support people safely while promoting independence and choice.

Daily care records demonstrated staff used this information in practice. For example, records for 1 person showed staff supported them with medicines, meals, oxygen use, personal care prompts, exercise, shopping, social contact and activities in line with their support plan. Staff were also able to describe people’s individual needs and how they adapted support when people’s presentation or health needs changed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. People received care and treatment that was planned and delivered in line with their assessed needs. Records reviewed demonstrated consideration of recognised approaches including Positive Behaviour Support, health monitoring and RESTORE2 (system used to monitor people’s physical health). Support plans included guidance for staff on recognising deterioration, responding to mental health needs, supporting people with long-term health conditions and seeking professional advice when required.

Daily care records confirmed planned interventions were delivered in practice. Records showed staff supported people with medicines, as required medicines, insulin, oxygen use, meals, hydration, personal care, exercise and community activities. Staff documented when people declined support and showed that choices were respected while continuing to monitor people’s wellbeing. Staff also understood when to seek further advice. One staff member said they would contact the manager, team leader, pharmacy or GP for advice when needed.

Staff and managers worked together to support people’s needs and wellbeing. Staff described positive working relationships within the service and said they were able to seek advice and support from senior staff and the registered manager. Staff also described regular communication through handovers, team meetings and discussions with managers when concerns were identified.

There was evidence that staff escalated concerns appropriately and involved external professionals when needed. For example, 1 staff member described noticing weight loss, checking records and speaking with colleagues before escalating this to the manager, who then discussed the person’s medication with the GP. Staff also described contacting the pharmacy, GP, mental health team, safeguarding team or 111 where advice was required. External professionals contacted as part of the assessment provided largely positive feedback.

People were supported to maintain and improve their health and wellbeing. Support plans contained detailed information about people’s physical and mental health conditions and included guidance for staff about monitoring health needs, recognising changes and obtaining professional support where required.

Daily records demonstrated support with healthcare needs and health promotion. For example, staff recorded support with insulin, oxygen use, PRN pain relief, meals, exercise, hydration, personal care and healthcare appointments. Staff also supported people with independence and healthy choices, including shopping, preparing meals and maintaining routines. Staff gave examples of supporting people to understand health risks. One staff member described using information from the NHS app and developing a food plan with a person to help them reduce sugar intake while still supporting them to make choices.

People were supported to access community and family activities which contributed to their wellbeing. Leaders described plans to develop an on-site gym to further support people to improve their physical health and wellbeing. This would provide an accessible environment for people who may feel uncomfortable attending community gyms or who require additional support and encouragement to engage in exercise. Whilst not yet implemented, the proposal demonstrated a commitment to promoting healthier lifestyles and identifying ways to reduce barriers to participation.

The provider had systems to monitor people’s care, support and outcomes. Support plans included personalised goals and outcomes relating to health, independence, relationships, community access and wellbeing. Records reviewed showed these areas were considered in people’s day-to-day support.

Daily care records provided evidence that staff monitored people’s wellbeing and responded to changes. Staff recorded people’s mood, activities, personal care, meals, medicines, social contact, physical health needs and whether there were concerns. Staff also described escalating concerns where they identified changes in people’s health or presentation, including weight loss, possible infection, changes in behaviour, dehydration or mental health deterioration.

The provider used audits, reviews and quality assurance processes to monitor care quality and identify areas for improvement. This included internal quality reviews, medicines systems, staff training records, supervision processes and environmental checks.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. People were supported to make choices about their care and daily lives. Support plans and daily records showed staff offered choices, respected people’s decisions and supported people to make day-to-day decisions about meals, personal care, activities, community access and routines. Staff were able to describe how they would support people where they made decisions that may place them at risk, including explaining possible consequences and supporting people to make informed choices.

Where people lacked capacity for specific decisions, records demonstrated the provider had considered the Mental Capacity Act and best interest decision-making had been formally followed.