Rock 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

This is the first assessment for this newly registered service, since the provider changed legal entities. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulations in relation to consent to care and treatment and safe care and treatment. People’s physical health needs had not always been consistently assessed. People lived with unnecessary restrictions which had not been identified by the provider. However, we did find some evidence that people had been supported to access mental health services and staff had supported and advocated for people.

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.

People’s physical health needs were not consistently assessed. One person had some physical health concerns and had been referred for tests and investigations. On the day of our assessment the registered manager told us they were no longer having symptoms of the concern. However, on the day of our assessment it was clear this was not the case. The person’s current presentation was not clearly documented within their care plan, and therefore the frequency of their symptoms could not be shared with healthcare professionals. Staff we spoke with did know the person continued to have symptoms and told us this was discussed during handovers. Relatives told us staff knew people well, one said, “Staff have been there a long time, they seem to know what is going on with (name).”

Care plans were not sufficiently detailed to ensure that people’s past history and exposure to trauma been considered in all of their care planning. There was not a trauma informed approach to understanding people’s needs throughout assessment and review. Guidance on how to support people to gain new life skills, and move on from the service was not in place for people. Staff told us of one person, “We try and encourage them, I’m not sure we are doing anything for them, we should move them on, that was the aim, we have tried but done nothing for them.”

Whilst staff planned and delivered people’s care and support, involving people as much as they wanted, staff did not always follow legislation and best practice. For example, the principles of the Mental Capacity Act (2005) (MCA) were not always considered and documented. People’s care plans did not contain information relating to best practice around their support needs, for example for people living with dementia, or living with diabetes. We could not be assured people were receiving evidence based care and treatment.

People were not always supported to manage their health and wellbeing and maximise their independence choice and control. Staff told us they encouraged people to live healthy lives, but people did not want to be active or join a gym for example. There was no evidence of how staff tried to engage with people to try different things to be healthy and active.

Staff supported people to make appointments to see the dentist, however people frequently refused to attend their appointments. Efforts to re-book and engage and encourage the person to attend a further appointment were not clearly documented within people’s care plans. There was no evidence of staff trying to engage a community dentist to visit people who refused to attend their appointments within a practice.

People were supported to access emergency health care when needed. Staff told us they supported people to ensure their disability would not prevent them from accessing prompt care and treatment.

People were not always supported to manage their health and wellbeing and maximise their independence choice and control. Staff told us they encouraged people to live healthy lives, but people did not want to be active or join a gym for example. There was no evidence of how staff tried to engage with people to try different things to be healthy and active.

Staff supported people to make appointments to see the dentist, however people frequently refused to attend their appointments. Efforts to re-book and engage and encourage the person to attend a further appointment were not clearly documented within people’s care plans. There was no evidence of staff trying to engage a community dentist to visit people who refused to attend their appointments within a practice.

People were supported to access emergency health care when needed. Staff told us they supported people to ensure their disability would not prevent them from accessing prompt care and treatment.

There were not always effective approaches to monitor people’s care and treatment and their outcomes. Although staff told us they monitored people’s care and treatment to improve it, we found this was not consistently documented. For example, when someone had a health concern this was not being documented anywhere to ensure all staff were aware of the current situation or that accurate information could be shared with other professionals. A relative, however told us their loved one was being well supported, they told us, “This year there’s been a lot of contact and lot of concerns, staff are doing all they can, I know, it is complex.”

People’s goals aspirations and ambitions were not consistently documented and supported so people had positive outcomes. Staff gave mixed feedback about supporting people with their goals, aspirations and activities. Some staff told us they consistently encouraged people to discuss aspirations and ambitions, but this was not something people always wanted to discuss. However, the recording of this was not always consistent or effective. People were not always engaged in meaningful activities. Staff told us about a person they supported, “They’re bored, they don’t have structure.” When we asked staff what could improve at the service one staff told us, “Going out, we could do better, maybe have a van where we take them out all together, we could go to places, activities are lacking.”

The registered manager and provider did not always seek consent or document discussions around consent for restrictive practices. Staff including the registered manager and the provider did not understand restrictive practices. For example, all communal bathrooms at the service were locked, and to be able to access them people had to ask staff to unlock them. Although people had access to en-suites. staff and the registered manager did not recognise this was a restriction on people. The registered manager told us the restriction was in place due to a person who left the service 6 years prior. When we raised this restriction with the registered manager they organised for the locks to be removed.