Allambie 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 inspection we rated this key question Requires improvement. At this inspection the rating has changed to Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 a care plan had been developed using this information. A member of the management team explained how the information in people’s care plans had been improved. They told us they had reviewed each person’s care plan to ensure they were accurate and contained people’s individual routines and preferences. They told us, “Care plans were not person centred (previously). They were basically 2 or 3 lines, and I spent a long time going through each and every one. They are now narrative based and tell a story about the person and how they want to be supported."

Care records showed people had been involved in decisions relating to their care. Care plans demonstrated a more person-centred approach to care delivery. For example, they took into account people’s preferences for who provided their care, and how care delivery impacted on their personal routines.

Relatives told us the service involved them in decisions about people’s care, where appropriate.

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.

Care plans showed clinical tools were used to manage risks associated with people’s care and improve people’s outcomes. Monitoring tools included one for assessing the risk of pressure ulcers in people. Staff also used a nutritional screening tool which generated scores to help them assess a person's risk of malnutrition and weight loss.

We saw records relating to nutritional management had improved since the last inspection to help ensure a safe and more consistent approach to care for people with swallowing difficulties.

Staff were aware some people required a specific texture of food to reduce the risk of them choking. One staff member described how they met the needs of people who had been identified as requiring their drinks thickened because they had swallowing difficulties. Staff told us they received regular training to ensure they worked in accordance with best practice.

The provider worked across teams and services to support people. They aimed to make sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

When people needed to attend hospital, we saw there was a hospital pack generated from the electronic care planning system that contained key information about the person. This was sent with them. The pack included information about people’s medication to ensure their healthcare needs continued to be met effectively.

Staff told us information was shared between the staff team to ensure people’s needs were met.For example, one staff member told us, “There was a service user with a chesty cough, and a carer told me, so I rang [health professional] and got them medication.”

The service continued to have some challenges in receiving a good service from a key health organisation they worked with. Managers told us they advocated on behalf of people to ensure they got the care they needed when they needed it, and referrals were responded to. Staff told us improvements had been made in the level of detail they recorded which helped when they shared information with other healthcare professionals involved in people’s care.

Overall, the provider supported people to manage their health and wellbeing, but processes to support people with a learning disability needed to be improved.

Some people with a learning disability did not have health action plans in place to ensure there was clear information about their health needs and appointment outcomes. Health action plans are important because people with a learning disability often have poorer physical and mental health, and higher rates of avoidable death. However, people were supported with healthcare appointments, and the provider told us the health action plans had been requested. Following our visit, we saw records confirming these had been requested again.

People had opportunities to join in some activities provided by the home or use the gardens to help maintain their wellbeing. However, there were limited opportunities for people to be supported to engage in activities of interest to them outside of the home.

Where people had specific health conditions such as diabetes and chronic obstructive pulmonary disease (COPD), care plans contained information about any signs of deterioration so staff could act quickly to get external healthcare support.

Care staff told us they felt able to report any changes in a person’s health to the senior staff member in charge and were confident these would be acted on.

The manager told us that since they had started at the home, they had encouraged and supported people who were previously cared for in bed to sit out to help improve their wellbeing. Some people were sitting on chairs in their room, and some had been supported with equipment to be taken to the lounge where they had contact with others. We saw people in the lounge participating in activities such as jigsaw puzzles.

The provider monitored people’s care and treatment to improve but there were some gaps in records. Despite this, they ensured that outcomes were positive they met both clinical expectations and the expectations of people themselves.

Staff monitored people’s health and wellbeing and completed records to demonstrate the care provided. Staff recorded care interventions, and managers monitored records to ensure care was provided appropriately and safely. However, there were gaps in some records which meant it was not always clear people had received care consistently. Monitoring records included people’s food and fluid intake, weight and when people needed to be repositioned to prevent skin damage. Increased daily scrutiny would ensure any gaps in providing planned care were quickly identified and addressed.

Managers explained how they worked with other healthcare professionals to improve outcomes for people. They gave an example of 1 person who had been cared for in bed. With support and guidance from an occupational therapist, the person was now comfortable to spend part of their day sitting in a chair.

The provider told people about their rights around consent and respected these when delivering care and treatment.

People did not raise any concerns about a lack of choice or feeling pressured to do anything they did not wish to do. Since the last inspection, all staff had completed Mental Capacity Act training to improve their understanding of this legislation.

Staff understood the importance of involving people in decisions about their care and respecting their right to decline support if they wished to. One staff member told us, “We give them time and go back in 20 or 30 minutes. We keep going back to encourage them. I can't force anyone; it is their wishes and their choices." However, staff told us they would escalate any refusals for support to their managers when it placed people at risk of harm. One manager gave examples of how they had worked with people to develop strategies which encouraged them to accept the support being offered.

Processes were in place to ensure people’s capacity and their ability to consent to their care and make decisions about the support they needed. Where it was felt people did not have capacity to provide consent in relation to a specific decision, capacity assessments had been completed in accordance with the requirements of the Mental Capacity Act 2005.