Aden House Care Home

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

At our last inspection we rated this key question requires improvement. At this assessment the rating remains unchanged. People were not always involved in planning their care. They didn’t have access to their care plans and had not always been involved in assessments or reviews. Whilst people were supported to access health appointments as needed, other aspects of supporting people to live healthier lives required improvement. For example, supporting people to access fresh air and outdoor spaces. Guidance and legislation regarding the Mental Capacity Act had not always been followed and 1 person did not have the required documentation in place to support a best interests decision. Fluid targets for people were not individualised but people did have readily available access to drinks. The service worked effectively in partnership with other health professionals to support people. Professionals working with the service noted a proactive approach by staff. Staff worked well as a team to support people.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always involved in assessing and reviewing their health, care, wellbeing and communication needs. They did not have access to their care plans. People we spoke to were not aware of having a care plan nor of being involved or being asked about the care they needed. One person told us, “I have not been asked what support I needed for the care plan.” However, 1 relative told us they had been involved in reviews of their relative’s care.

The manager told us people’s care plans were reviewed monthly. This was reflected in records. The reviews were mostly completed by staff with no evidence of involvement from people. However, there was evidence of some relative involvement.

There was a process for assessing people’s needs prior to admission to the service. Improvements had been made since the last inspection and risk assessments and care plans were up to date and accurately reflected people’s needs. They were reviewed regularly by staff. However, improvements were required to ensure people were involved in the process. The provider was aware of this and had included it on a service improvement plan.

People’s care and treatment was not planned collaboratively with them. Not all people had their preferences included in their care plans. People had fluids available to them. However, we observed people had to wait for a hot drink despite having been awake for over two hours. People told us, “I get my coffee at 08:30. They wake me up at 06:00 for my tablets but I don’t think I could have a coffee at that time” and “I sometimes wait a little while for my morning cuppa.” People told us there was enough to eat and drink. In addition, relatives told us, “The food looks lovely, I have stayed with [Name] at lunch. There is always tea/coffee on the go” and “[Name] has put on weight."

When speaking to us the manager showed poor understanding of the meaning of evidence-based practice and how they would keep up to date with this. They did however share ideas regarding new initiatives that may be incorporated into the service in the future. For example, having a resident ambassador.

Processes to support the collaborative planning and delivery of evidence-based care and treatment required development. Improvement was required to ensure that people were fully involved in their care and that best practice initiatives were implemented for all people across the service. Fluids were readily available. However, generic fluid targets remained in place and were not reflective of people’s individual needs. In addition, it was not clear what discussions were being had or what action was taking place when people were not reaching those targets.

People and relatives were supported to liaise with health care professionals when needed. One relative told us, “[Name] has district nurse input and [staff] are following the advice. [Name] can be got up for 2 hours and they always make sure his 2 hours start when [relative] comes to visit."

Staff worked effectively as a team and with other health care professionals and services to support people. They worked collaboratively to understand and meet people's needs.

Health professionals working with the service told us that staff were proactive with making referrals for people who needed intervention. One professional told us, “Their proactiveness is refreshing.” They also told us the staff listened to their advice, worked well together as a team and shared information appropriately. Comments included, “They’re trying to improve people’s [health]” and “Staff work together really well and definitely listen to me."

Systems and processes were in place to support partnership working with other health care professionals. We observed people being reviewed by health professionals during this assessment.

People told us they were supported to access health appointments when they needed to. Feedback included, “I see the nurse and the chiropodist,” “I see the doctor when I need one. I also see the chiropodist,” “I get a doctor when I need one” and “I go out to see the doctor and the optician.” However, people did not always have access to fresh air and outside space to promote their health and wellbeing. One person told us, “I can’t remember being outside since coming here. I used to be an avid walker and hill climber."

Staff assisted people to attend appointments and made referrals as required. The manager informed us the dentist attended the service or people could go out for appointments arranged by families. They also spoke about encouraging people to eat more healthily.

Systems and processes were in place to support people to access appointments when needed. In addition, weekly multi-disciplinary meetings were held at the service with the GP. There was evidence of referrals being made to speech and language therapy and falls teams when needed. However, processes had failed to identify and address concerns regarding some people not accessing outdoor space and fresh air.

People were not always involved in their care planning or goal setting. There was some evidence of relatives being involved in care reviews and decisions for some people. One relative reported a positive outcome. They told us, “[Name]’s health was deteriorating before he came here and [now] has improved."

Staff knew how to monitor people’s health and when to involve other health professionals. One staff member told us, “We have direct contacts so we can get support for residents quickly.” The manager told us the involvement of the chiropodist at the service had improved people’s outcomes, noting that when their feet had been cared for, they were able to walk better.

Care records were up to date and reflective of people’s needs. However, there was no evidence of collaborative goal setting. It was not always clear how goals were set for people and how their outcomes against these goals were being measured. In addition, it was not clear who had oversight regarding some aspects of health monitoring for people. For example, if someone had not had their bowels open for several days.

We received mixed feedback from people and relatives regarding consent to care and treatment. Comments included, “The staff are very nice, they bath me, they explain what they are going to do and always check that it is okay with me. They respect my choices for example they get me up if I want to get up but sometimes it’s they who want to get me up, they seem to know when I want to get up,” “They always knock on the door before coming in [their] room and ask if [they are] okay with what they are doing,” “Some staff knock and wait before coming in your room but some don’t and more often than not they don’t” and “They don’t confer, don’t ask my permission."

Staff received training relating to the Mental Capacity Act. Staff had an understanding of legislation and were able to explain how to manage consent. However, we observed that staff did not always ask for consent. For example, we observed 1 person being transferred from their wheelchair. Staff did not explain what they were doing or check that the person was okay with that. Staff also put the TV on for the person but did not ask if they wanted to watch TV.

Policies were in place to support staff in the application of the Mental capacity Act. However, mental capacity was not always consistently assessed and not all decision-making was in line with guidance and legislation. For example, 1 person’s cigarettes were being kept and they had limited access to them. This action was being done in their best interests due to health reasons however the required documentation was not in place to support this. This had not been identified by the provider prior to the assessment. The provider took action to address this when it was raised by the inspection team.