The 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

People’s needs were not robustly assessed before they moved into the service. People living at the service did not have their needs re-assessed, and care plans had not always been reviewed and updated, in some occasions since 2021. People’s capacity had not been assessed, and people lived with unnecessary restrictions. For example, there was CCTV in use at the service; people’s capacity to consent to this had not been documented. People who lacked capacity to consent to this had not had best interest meetings to agree that this was the least restrictive option and in the person’s best interest. People’s capacity to consent to the use of restraint had not been assessed. We found two breaches of the legal regulations in relation to safe care and treatment, and the need for consent.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us that staff did not always recognise when people's needs had changed, or when their loved one was unwell. Relatives told us their loved ones needs were not fully assessed.

While some of the staff we spoke to told us they knew people well, and could recognise when people's needs changed, we found this was not always the case. For example, when a person has unexplained weight loss, there was no record of actions taken to investigate this, or any referrals made to healthcare professionals. Staff told us that care plans were helpful but needed to be updated more frequently to reflect people's needs. We found some key care plans such as PBS plans had not been updated since 2021.

A comprehensive assessment of each persons physical and mental health had not been completed on their admission or soon after. Care plans did not set out people's current needs, or promote strategies to enhance independence, or evidence of planning and consideration of the longer-term aspirations of each person. People's health was not regularly assessed. For example, some people had no weight records; some people had been weighed occasionally. On person lost 9kg in 5 months, but there was no supporting information to inform if this was planned, or a possible sign of a health concern. There were not processes in place to complete on-going assessments of people's needs. For example, when a new person moved into the service, staff told us that incidents of distress increased. However, there was no oversight or analysis to support this theory. There was no request for support from any healthcare professionals to review if incidents could be reduced based on learning.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People had not been consulted and included in the decisions about the use of surveillance. People had not been provided with information regarding all aspects of the surveillance, including records management, to enable them to give informed consent. Relatives told us that for decisions that their loved ones did not have the capacity to make, staff did not involve them in making decisions in their loved ones best interest. A relative told us staff made the decision to remove their loved one's mobile phone. The person could not consent to having their phone taken away, and their loved one was not involved in the decision making process.

Staff told us they knew about people’s capacity to make decisions through verbal or non verbal means, however this was not well documented. Staff did not demonstrate best practice around assessing mental capacity, supporting decision-making and best interest decision-making.

Processes to ensure people were empowered to make decisions about their care and treatment were not effective. People's care plans contained no information about their capacity to make decisions. We requested evidence that people's capacity was assessed, and best interest meetings were held when people lacked capacity. However, staff were unable to provide any evidence that capacity assessments had been completed for any people living at the service. One person's care plan stated that staff could use physical intervention. There was no capacity assessment, or best interest meeting to support this decision being made. Another person's care plan detailed that their social worker needed to have agreed to physical intervention being used. This is not in line with best practice, which states that any physical interventions should be agreed by a multi disciplinary team. Incidents showed that this person was restrained, however there was no evidence that staff had spoken with the person's social worker regarding this. CCTV was used within the service. We asked staff to provide mental capacity assessments to evidence that people had been consulted about the use of CCTV, but they were unable to. The provider, and leaders within the service failed to regularly review this restriction to ensure it remained necessary, and the least restrictive option for people.