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 assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This service scored 50 (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 their health and care needs, but improvements were needed when it came to reviewing those needs. Assessments for people arriving at the home under the ‘discharge to assess’ scheme were carried out by the trusted assessor in hospital. However, the registered managers assured us they rigorously reviewed the assessments to be confident they could meet people’s needs when they moved to Allambie House. This included consideration of the person’s support needs, staffing levels and staff knowledge. One registered manager told us, “We have declined quite a few and we will give a reason why we don't feel we can safely meet their needs.” Pre-admission assessments of permanent residents covered their physical and mental health needs and included some information about their preferences for how they spent their day. Staff told us extra monitoring and checks were carried out for all new admissions and discharges into the home to ensure managers and staff had an accurate assessment of people’s needs. People had their care needs reviewed through a ‘Resident of the Day’ scheme. However, staff did not always recognise where people’s needs had changed over time, or when people may require support from other health and social care professionals as their well-being needs changed. This increased the likelihood people’s needs would not be promptly met. People were generally unable to recall being involved in reviews of their care. A typical comment was, “They never discuss my care. All they say is ‘are you alright’.”

The service needed to be more consistent in ensuring people’s care and treatment was delivered in line with current national guidance and best practice. Staff were aware some people required a specific texture of food to reduce the risk of them choking. However, staff had not received appropriate training to follow best practice standards such as International Dysphagia Diet Standardisation Initiative. This is important in order to ensure all professionals who may provide care to people have a consistent approach and understanding of how to reduce people’s risks. In addition, some people required their fluids to be thickened. We found people’s fluid thickener had not been consistently labelled to confirm it continued to be safe and appropriate to use. People were positive about the food provided. People were provided with a choice of meal options, and we saw drinks were always available. Comments included: “I get plenty of drinks” and “The food is very good. The chef comes round in the morning and asks me what I want.”

Systems to ensure referrals were made to other healthcare professionals in a timely way needed to be improved. For example, 1 person had demonstrated a change in their responses and behaviours which had potential to increase risks to their health and wellbeing. The registered managers had not made a referral for advice to other healthcare professionals involved in the person’s care. This meant there was a risk the person’s health could deteriorate further without prompt health care support. Another person was consistently leaning to one side or forward in their chair. No consideration had been given as to whether a referral should be made to an occupational therapist for advice as to the suitability of the person’s chair. A registered manager told us people living at the home had not always benefited from a good service from a key health organisation they worked with. The registered manager had started to address this, but their concerns over the impact of this remained. Records demonstrated other referrals to dieticians and the continence team had been made when a need was identified and staff told us about the support they gave people to enable them to benefit from routine health appointments. This included help to access support from dentists and podiatrists. One staff member said, “I have also seen the physio [physiotherapist] come out.” Processes to share information within the staff team needed to be more robust. For example, domestic staff had not been informed of potential risks around one person’s infection status. The written handover for one person described them as ‘fine’ but the second page of the handover indicated paramedics had been called to the person during the evening. There was no further information about the person’s presentation throughout the evening and night. However, verbal handovers contained more holistic information about people’s presentation and care needs.

Overall, the provider supported people to manage their health and wellbeing, but processes to support people with a learning disability needed to be improved. This was because some people with learning disability and autism did not have health action plans in place. These are important because people with a learning disability often have poorer physical and mental health, and higher rates of avoidable death. Health action plans also encourage an annual review of people’s health needs, so any health concerns can be identified promptly. The registered manager began to address this during our assessment. People at Allambie House were offered opportunities to enjoy gentle exercise, so their mobility and independence was promoted. Staff knew what health conditions people experienced and gave us examples showing how they took this into account when caring for them. This included offering people food options which helped them to maintain their health and adapting how they communicated with people, so people could continue to make their own day to day decisions about their health where possible. Some people had received recent medication reviews.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. Where people had risks identified with their health, care plans detailed outcomes and goals and any monitoring required to identify complications. For example, in relation to catheter care and diabetes. However, where people were prescribed medicines to support their emotional wellbeing or to relieve pain, staff were not routinely completing monitoring charts when the medicine was given. Detailed records would enable healthcare professionals to make a clear judgement on the effectiveness of this medication, and to consider if other, more enabling approaches would be more appropriate. This would also reduce the risk of people becoming dependant on some medicines. Some people had their food and fluid input monitored to ensure they ate and drank well to maintain their health. A senior member of staff told us, “[Registered manager] checks every day, and we also monitor the food and fluid intake on the gadget [electronic care plan] because it will highlight if someone’s fluid intake is low. It will come up with a red flag. We remind all the staff that we need to keep offering drinks.” However, these checks were not formally recorded, and we saw occasions when records did not evidence people had been offered regular drinks.

The provider respected people’s rights when delivering care and treatment but documentation in relation to capacity assessments needed to be improved. People did not raise any concerns about a lack of choice or feeling compelled to do anything they did not want to do. One person told us, “I can stay in bed if I like. I always go to bed when I feel like it, they don’t restrict me.” Another person commented, “I get up at 8.00am every day, it is what I want.” In their everyday practice, staff understood the importance of seeking people’s consent to care interventions and respecting their right to decline support. Staff told us if people declined care, they would respect this and provide an opportunity for them to reconsider their choice at a later stage. One staff member told us, “The staff will notify the senior that so and so at this point has refused personal care. We will say leave the person and try again later, but don’t force the person. We will work in the best interests of that person. If we are not getting anywhere, we will reach out to the GP for advice.” However, staff knowledge and confidence in completing formal capacity assessments needed to be further developed. Where capacity assessments had been completed, they were not always in relation to a specific decision. Capacity assessments contained limited information about how people had been supported to understand the decision to be made. The registered managers assured us if they had any concerns about a person’s capacity, they would seek guidance from external healthcare professionals.