Chaucer 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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to person centred care and managing people’s health risks.

This service scored 38 (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 did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

The provider had not ensured people’s needs were fully assessed and were reviewed regularly or when peoples need changed. For example, one person’s care plan detailed they required their food to be IDDSI level 6. However, their care plan also detailed they needed their food to be level 7. IDDSI stands for the International Dysphagia Diet Standardisation Initiative. It is a global, standardized framework that uses a 0–7 level system to classify food textures and drink thicknesses for people with swallowing difficulties.

People’s care plans detailed they were routinely reviewed, however we found the routine reviews did not pick up on changes to the persons health and wellbeing or identify where there were gaps in people’s support plans. For example, people’s care plans were not updated following significant incidents. This meant staff did not have the most relevant and up to date guidance to support people safely.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

People’s hydration needs were not consistently met. Staff recorded people’s fluid intake. However, we found this was inconsistent and records showed some people only had 200mls of fluid in one day. Staff had not recorded what action was taken to address this or justify the low level of fluids. During the inspection we observed one person had the same drink in front of them from 10:12 until 14:43 with the same amount of fluid in. When we raised this with the registered manager, they told us staff had given the person a drink with their breakfast and lunch, however we noted that the persons thickener remained empty during this time. The registered manager could not be assured that the person either had a drink, or that their prescribed thickener was used.

Another person who was able to drink independently did not have access to fluids consistently. During the inspection we observed the person to not have any fluids on their table or within reach throughout the morning.

Staff could not demonstrate that best practice guidance was followed and good practice was consistent across everyone’s care. For example, staff were not following NICE guidance for Dementia, in relation to managing people’s distress. Staff were also not following NICE guidance for medicines management or pressure ulcers prevention and management.

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.

Information was not always shared between services to ensure people received the care and support they needed. For example, one person was assessed by the manager as needing 1-1 support, and the local authority required evidence of why the additional support was required. Staff had not been recording information with detail or accuracy to evidence why 1-1 support was needed.

However, people received a range of support from different health care professionals including tissue viability nurses, mental health team and physiotherapists. We spoke with an external physiotherapy assistant who shared they supported people with exercise programmes to help their mobility.

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.

People who had diabetes were not always encouraged to choose healthier food choices where the need was identified. One person’s care plan detailed their diabetes was diet controlled and required staff to support and encourage a healthier diet. Daily notes detailed the person had snacks and puddings regularly and records did not demonstrate how staff were encouraging the person have healthier food choices.

However, people were able to access services such as GP and dieticians. Where people’s weight had decreased, they were referred to the dietician and measures such as prescribed milkshakes and fortified food with higher calorie alternatives, were implemented.

The provider 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.

The provider had not ensured that daily monitoring was effective to highlight any deterioration in people’s health. For example, one person’s fluid intake was recorded by staff daily. Records showed that over 3 consecutive days, the person had only 750 mls of fluid in total, on 2 of the days only 200 mls. The records did not detail if the person was unwell or what action staff had taken to support them to have more fluids. The person’s care did not detail a set amount of fluid needed, however on other days its recorded they had 1473 mls of fluid. The person’s care plan detailed staff should encourage fluid intake to support bowel health due to their risk of constipation, however records demonstrated staff were not following this guidance.

The provider had not ensured that continence monitoring was effective for people that were at risk. Staff documented when people had opened their bowels on handover documents, however this was not consistent and did not identify when people were constipated. This meant staff could not take action in a timely way, such as referring to other health professionals.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. The provider did not always ensure capacity assessments and people’s best interest was considered in line with the Mental Capacity Act 2005. For example, one person needed their medicines crushed due to swallowing difficulties. Crushing a tablet before administration may make its use ‘off-licence’, this means it is not being used in line with manufacturers licence, and appropriate processes need to be followed. The provider had not ensured a capacity assessment was in place as the person did not have capacity to consent to the medicine being crushed.

The provider had not ensured capacity assessments were in place for all people who had their medicines administered covertly. There were 2 people who had their medicines administered covertly but only 1 person had a capacity assessment in place to ensure this was the least restrictive option.

Other capacity assessments were in place for restrictions such as bed rails and sensor mats.