Ash 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 of this key question, it was rated as 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.

People’s needs were identified, assessed and mitigated. Assessments were broad ranging and included people’s medical and psychological needs, preferences and functional skills. They covered areas such as communication, healthy eating, mobility and skin integrity. When people’s needs changed, they were reassessed. Where possible, records demonstrated people took part in reviews of their care to ensure their opinions and feedback was captured. One staff member explained, “Everyone is involved in the assessments. For people, you look at their gestures if they are non-verbal. You get together with seniors and managers. I get asked [my views] twice a month.”

The provider did not always plan and deliver people’s care and treatment in accordance with evidence-based guidance from others involved in people’s care.

Some health and social care professionals told us they were not always confident advice shared with managers was communicated to the care team.

Staff made sure people had enough to eat and drink to remain well. Improvements had been made in encouraging people who needed to manage their weight or have a modified diet due to a health condition to make healthy food options.

People had health actions plans which evidenced they had been supported to monitor and document their health.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Health and social care professionals told us whilst staff were appreciative of their guidance, they did not always work well together. For example, managers did not always promptly share key information to assist in deciding the best course of action for people. One health and social care professional told us, “Engagement has been poor.” Healthcare professionals also commented on the changes in managers and how this could impact on the effectiveness of sharing information about people’s health needs.

Staff told us how they shared information about people and any concerns about their health or emotional wellbeing through written and verbal handovers between shifts. One staff member told us, “There’s a handover of anything that’s happened. There’s a handover book staff update each hour. The handover book is at the front of [the person’s] support plan. You sign to say handover has been given or received.” When we asked another staff member if there was effective communication across teams, they responded, “We have the communication books, handover and meetings.”

Relatives raised no current concerns about the support their family members received to attend medical appointments or if emergency medical treatment was required. However, 1 relative did feel there had previously been a more collaborative approach to managing medical situations which had not been maintained.

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.

People were supported to live a healthy life. People had access to external health and social care professionals when they needed them. People had annual health reviews with their GP to help them stay well and identify any emerging problems so they could be responded to quickly. Where people needed routine health checks, these were referenced in their care plans.

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

Feedback from relatives indicated they did not feel the service was proactive in introducing new ideas to enhance people’s quality of life, such as new activities, skills and work/volunteering opportunities. One relative told us about a skill that was important to their family member and had potential to create new opportunities. Despite numerous conversations the relative told us, “Nobody could explain why it didn’t happen.” Another relative said discussions with managers about new opportunities were, “Not followed through.”

Some aspects of people’s health and day to day engagement were monitored to ensure positive outcomes. For example, in relation to what people had to eat and drink, personal care and continence care. However, where people were going through significant changes, relatives told us they received limited feedback about how their progress was being monitored.

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

On a day-to-day basis people made their own choices about what they did and their preferred routines. Where people were not able to verbally communicate their choices, there were tailored communication plans for staff to follow to ensure people made their own decisions.

People’s care plans contained detailed capacity assessments and included information about the most effective ways of communicating with people to give them the best chance of making their own decisions. Where people lacked capacity, there was evidence of a multi-disciplinary approach involving people, relatives, staff and social workers to ensure any decisions made were in the person’s best interests.

Staff understood the importance of giving people opportunities to make choices and respecting their right to decline support. Staff told us they would offer support later to ensure people were kept safe and well. Comments included: “You can engage but [Name] changes their mind quickly and can refuse. You wait 20 minutes and try again” and “I try and explain to them that it is best for their physical health to have personal care and if that does not work, I try another staff member. If that doesn’t work, I would have to ask the manager for advice if I had tried multiple things and it was still being refused.”