Asquith Hall

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 inspection this key question was rated good. At this assessment, the rating has now changed to inadequate. People’s needs were not accurately assessed, monitored and reviewed. Care and treatment planning was not collaborative, and delivery was of a poor standard. People were not always supported to eat and drink enough, and monitoring of food/fluid intake and people’s weight was inadequate. Partnership working was ineffective and information sharing inadequate, therefore people were not supported to manage their health and wellbeing to live healthier lives. People’s care and treatment was not being suitably monitored and outcomes were often poor. Consent to care and treatment was not always considered.

This service scored 25 (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 needs were not adequately assessed. Reviews of people’s care did not always take place, where they had taken place, they were often inaccurate and were not done in collaboration with the person. Assessment and monitoring tools used to identify people’s needs contained out of date or inaccurate information and were therefore not reflective of people’s needs. For example, people often did not have an up-to-date weight recorded therefore this had an impact on the accuracy of assessment tools in place in relation to pressure damage and/or malnutrition.

Leaders and staff did not ensure people’s needs were accurately assessed or monitored and that information used to inform people’s support was accurate and up to date. One staff member told us, “We want to monitor people, but we can’t."

The provider did not maximise the effectiveness of people’s care and treatment by accurately assessing and reviewing their health, care, wellbeing and communication needs with them. Systems and processes did not ensure effective assessment and review of people’s needs.

People did not receive a good standard of care and support. People were not engaged and encouraged to participate in the planning of their care to include matters that were important to them. People who needed additional support and encouragement to eat and drink did not receive this. For example, 1 person had a full bowl of porridge left next to their bed, it was congealed and appeared to have been there for some time. The person appeared confused. When we asked, “Are you eating your breakfast,” they responded, “Eat, what’s that.” No assistance had been offered to the person. In addition, people did not always have access to drinks and people were observed in their rooms without drinks. Food and fluid records were inaccurate and sufficient monitoring was not taking place.

Lack of effective communication and information sharing between leaders and staff meant that clinical reviews and discussions were often ineffective in identifying risks and planning appropriate intervention. Where concerns regarding people’s health and wellbeing were shared there was a lack of discussion and follow up. For example, during an information sharing meeting between leaders and staff, a staff member stated that a person had fallen. A second staff member responded, “[They have] had a few recently.” The response from the manager was, “[They have had loads. Is that it”. Calling an end to the meeting. There was no discussion about what could be done to support the person.

Systems and processes had failed to ensure people’s care and treatment was planned and delivered collaboratively based on evidence and that good practice standards were adhered to. The provider failed to ensure people were supported to eat and drink enough and failed to ensure effective monitoring was in place regarding this.

People were not well supported by an effective team.

Leaders and staff did not work effectively together as a team to support people. High use of agency staff meant new staff were constantly present at the service, on a shift by shift basis. This, combined with poor leadership and ineffective oversight, meant additional pressure for employed staff, and substandard information sharing, task allocation and care for people.

Partners expressed significant concerns regarding staff and leaders at the service, the assessment of people’s needs and the sharing of accurate information. Lack of basic assessment information being accurate and available meant partners did not have information they needed to inform their assessments of people.

Systems and processes were inadequate in ensuring effective working across teams, both internally and externally. They were ineffective in ensuring assessments were up to date, accurate and available for sharing with health professionals and key stakeholders.

People were not supported to manage their health and wellbeing to maximise their independence. People did not have choice and control over their care. They were not supported to live healthier lives or participate in activities to support their wellbeing.

There was no evidence to suggest leaders and staff spent time with people discussing their health and wellbeing needs. There was no evidence to suggest discussions were had with people regarding changes that could be made to enhance their care experience.

Systems and processes were inadequate in ensuring people were supported to live healthier lives. They were ineffective in ensuring people had access to healthcare appointments when they needed them.

People’s care and treatment was not effectively monitored to continuously improve their outcomes. People’s experience was often negative and standards of care fell below clinical expectations.

Leaders had limited knowledge of people’s needs and their oversight and monitoring of the care people were receiving fell short of good practice standards. Staff often did not have the necessary support, skills and resources to provide positive and consistent care.

Systems and processes were ineffective in ensuring routine monitoring of people’s care and treatment. The provider failed to ensure outcomes for people were positive and consistent and that standards of care were good.

People’s consent to care and treatment was not always sought.

Staff and leaders did not fully understood or consistently follow the principles of the Mental Capacity Act (2005) (MCA). They did not know people well and did not know whether some people had capacity regarding specific decisions or not. For example, leaders said 1 person had capacity to refuse care interventions and therefore the person was left unsupported. However, the person’s records stated they lacked capacity to make the specific decision of care interventions in order to maintain their health and safety, prevent abuse from others, and to ensure they received appropriate nursing care. It was also noted the person lacked the capacity to understand, recall and retain the information in relation to declining both supported and independent care, and the effect this had on their physical health and the environment.

Systems and process were not effective in ensuring the principles of the MCA were implemented for all people. The provider failed to ensure staff provided support in line with the principles of the MCA.