High Lea House

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• 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 consent to care.

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.

People did not always have their needs assessed and care plans were not regularly updated. We found care plans lacked detail about how to care for people with known risks such as choking, mobility issues and health conditions such as diabetes.

Care records did not contain detail about people’s preferences, history and religious and cultural needs.

The new manager told us she had recognised the short falls in the care plans and had just commenced a plan to update them and include the voice of people in them.

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.

Most people told us they were happy with the meals they received however one person said they didn’t get enough meat with them.

Where people required modified or special diets, they could not be assured they would receive them. We found one person’s care plan showed they had diabetes but there was no information about what they should or should not eat to control this condition. Another person had been identified as requiring a modified diet to avoid the risk of choking., Kitchen staff were unaware of this and we observed the person given food of normal consistency.

Where people required food or fluid intake monitored and recorded there was no information for staff to guide them when they needed to intervene. For example, staff were recording a person’s fluid intake but despite recording low amounts no action was recorded.

The provider did not always work well across the staff team and services to support people.

People told us they were not involved in their care planning. As a result, they were not given the opportunity to share their personal information or provide information crucial to tailoring support to their own needs.

Information held about people was not kept up to date as reviews had not taken place for over 12 months.

This approach could hinder the delivery of person-centred care and prevent personalised and meaningful information being shared to other services involved in supporting people.

Staff did not always have access to correct information regarding people’s needs. due to care plans not always being updated and a lack of information sharing

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 we spoke to had access to a GP. Staff told us people had access to health professionals such as podiatrists, dentists and opticians.

People had access to external healthcare professionals, however we found appropriate referrals were not always made. For example, referrals to a falls specialist were not consistently made when people experienced repeated falls. This placed people at further risk.

People could not be assured the home would follow guidance from health professionals when they gave input to people’s care.

At the time of this assessment an activity coordinator was not employed. However, a staff member volunteered twice a week, meaning there were days when there were no activities taking place. Staff would support when possible, however due to people’s needs and the staffing levels, this was not always possible.

The provider did not always 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 both clinical expectations and the expectations of people themselves.

Feedback from people and their relatives was positive in relation to the support they received. However, people were not aware of their care and support plans therefore were not involved in devising any outcomes. We could not be assured people were supported to achieve positive, personalised outcomes.

Care plans lacked personalised information. Information within care plans was based around people’s needs, but the identified outcomes were not always reviewed or adapted as required.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

People could not be assured that where they had capacity to make decisions they would be consulted as set out in the Mental Capacity Act (MCA) and where they required their liberties restricted the provider would follow the process in the Deprivation of Liberties Safeguards (DoLS).

We found that 2 people had authorisations granting the home permission to deprive them of a liberty and in both cases, there were conditions for the provider to meet to make the deprivations legal. In both cases we found that the provider had failed to meet the conditions. In one of the cases, we were told that the person no longer needed the deprivation, but the home had failed to immediately inform the authorising body that the authorisation was no longer required. This is a required action.

We found that one person had recently had a significant decision made about them by a third party without an assessment as to whether they had capacity to make the decision themselves. The decision was also made without following the principles of the MCA in identifying that the decision was in the persons best interests and the least restrictive option.