Archived: Ermington 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider assessed people’s needs before they moved into the service to ensure their individual requirements could be met. Care records detailed people’s assessed needs and how staff should support people to meet these needs and preferences. Although we identified a small number of records contained some conflicting information, this did not impact people. People’s needs were assessed and regularly reviewed to ensure they showed current and accurate information.

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.

We saw evidence the diverse range of people’s needs had been assessed, including their communication needs, and this was generally documented in a person-centred way. Nationally recognised tools were used to assess matters such as skin integrity. Records showed the service had liaised with professionals such as occupational therapists in order to promote good outcomes for people. Clear health visit records were maintained.

Records showed concerns about weight loss were escalated to relevant professionals. Nutritional care plans were in place and detailed any dietary requirements. This information was recorded for catering staff to follow.

The provider did not always work well across teams and services to support people.

Staff had access to people’s care and support plans to understand people’s needs and deliver their care. However, we received feedback from health professionals who worked with the service that was less than positive. One told us, “We have had several delayed [referrals], and I am concerned about this.” Another comment was, “Communication with care staff is often hit and miss, they do seem receptive to advice or guidance but unsure if they understand the direction given.Whilst some professionals told us outcomes for people had recently improved, some put this down to the reduced number of people living at the service. This was due to a suspension of placements by the local authority, and the service were no longer commissioned to provide care to people who were ‘discharged to assess’ from hospital.The provider told us the latter arose from system-level decisions involving commissioning and primary care arrangements.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Records evidenced staff monitored people’s health and escalated concerns appropriately. However, we saw examples of where records indicated people’s care had not been delivered as assessed in relation to their skin integrity, which placed them at risk. Healthcare professionals we spoke with gave examples of where the service had failed to identify and escalate concerns when people’s health had declined. This resulted in safeguarding alerts being raised.In addition to this, some people’s care records did not evidence they had been supported to go outdoors despite this being known as their preference and that it would positively impact their well-being.

People who may have been at greater risk of malnutrition had regular weights recorded. Where required appropriate escalation and referrals had been made.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or met both clinical expectations and the expectations of people themselves.

Whilst there were monitoring processes in place, these needed improvements to ensure people's care and treatment were monitored effectively. Records were in place to monitor areas such as repositioning and malnutrition, however, records relating to repositioning did not always evidence people had been supported in line with their care plan or assessed needs. The provider was unaware staff were using an additional record to monitor who had eaten breakfast and who had received personal care. The provider told us this was not aligned to current processes and staff should not have been completing this record. Whilst we did not identify this had impact on people, it did not evidence effective monitoring, recording and provider oversight was in place.

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 identified improvements were required in relation to consistent record keeping.

Consent to care was not always recorded clearly within people’s care records. Mental capacity assessments and best interest decisions had been completed for most people where required, however there was no recorded best interest decision for people who had or lacked capacity to consent to the surveillance the provider operated within the service. Some communal areas of the service were under 24 hour surveillance which was recording both visual and audio, meaning people could not be afforded privacy in some areas of the service.There was a risk that people, their relatives or other people visiting the service were not aware they were being recorded due to the absence of appropriate signage.

Throughout our onsite assessment people were offered choices and staff were consistent in communicating choice and consent when offering care and support.