No 36

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 outstanding. At this assessment the rating has remained outstanding.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 96 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a consistent, holistic approach to assessing, planning and delivering care so that people experienced an exceptional quality of life. The provider worked closely with the person and their representatives to understand their needs before they moved to the service. There were exceptionally personalised transitions to the service where staff spent time with people before they moved to the service and supported them to familiarise themselves with the home and other people. The registered manager considered the compatibility of people before accepting a new person to the service. This ensured that people already living there and the new person would feel happy and safe. Staff continuously assessed people following their move, through observations and monitoring. Staff created person-centred care plans and assessments, adapting approaches and support to ensure people always had the right care for them.

Through these processes people had life changing experiences. For example, 1 person could not attend their place of education, medical appointments and expressed their anxiety physically way when faced with new situations. Staff spent time assessing the person and getting to know them. With a tailored support placing the person at the centre of all decisions, they started to take part in a wide range of activities, attended the dentist for essential dental work and engaged with other professionals at a range of health appointments.

There was a culture where staff were empowered to develop a deep understanding of people’s needs. This was driven by their curiosity to understand individuals and explore new approaches. For example, valuing people’s individual interests and hobbies. They supported people to travel around the United Kingdom and abroad to explore these and gain new experiences. For example, 1 person who enjoyed trains was supported to take journeys throughout the country where they could experience different trains and visit different cities.

The provider encouraged an innovative evidence-based approach. Managers and staff developed their skills and knowledge, researching best practice and completing a wide range of training. There was a culture of learning where staff regularly discussed best practice. A staff member told us, “Our training isn’t just about completing courses. We discuss everything we learn through supporting people. Everybody is different, so understanding individual needs is very important.” Two members of staff had undertaken a qualification in behaviour analysis. They shared their learning with staff to develop proactive approaches to understanding people. The registered manager told us this helped them to understand and meet underlying needs rather than responding to incidents.

Staff had an excellent understanding about best practice for supporting people with a learning disability and autistic people. The organisation had accreditation with the National Autistic Society. Staff told us learning was continuous.

The provider ensured people’s quality of life constantly exceeded expectations. Staff supported people to work towards personalised objectives and try new experiences, such as learning new skills and visiting new places.

There were effective systems to ensure staff worked together to provide good quality care. Staff took part in regular meetings, handovers and individual supervisions with their managers. They carried out additional ‘learning sets’ to discuss specific topics or areas of care. Staff had the opportunity to share their knowledge with others and learn from each other. Managers carried out spot check discussions with staff, asking them about specific people or areas of best practice.

Throughout the service there were posters of information for staff to remind them about areas of best practice. There were also Makaton (sign language) signs of the week for all staff to practice and familiarise themselves with.

There was positive, open and transparent communication with external professionals. Staff made timely referrals when people needed additional support. They followed the guidance of other professionals and used their expertise to improve staff knowledge. Professionals had consistently given positive feedback about staff and the provider. An external professional told us, “Staff are warm and hospitable.”

People were empowered to make healthier, informed choices and the service worked with them to monitor the impact. People took daily morning walks before undertaking a wide range of different activities, including cycling, hiking and swimming. Staff explained this had benefits for people’s mental wellbeing as well as physical health. These healthy routines helped to reduce longer-term health risks for people.

Staff worked closely with external healthcare professionals. There had been significant improvements in people’s health and wellbeing. For example, reducing the frequency of seizures due to proactive support and interventions. The registered manager explained, “Through consistent routines, medicines management, monitoring and trained staff [people’s] conditions have become more stable. Additionally, for some people, medicines have been reduced or discontinued.”

There was a deliberate focus on health improvement to ensure that care went beyond meeting clinical needs. People were empowered to make healthy informed choices about their diet. All meals were cooked from fresh ingredients by staff and people using the service. People were able to make choices about what they ate, and the staff guided them to understand about eating well. A relative commented, “They offer a wide variety of healthy home cooked food.” Staff placed an emphasis on positive interactions with food, involving everyone in communal cooking activities and celebrating food from around the world.

Through careful planning and empowering 1 person to understand about the importance of healthy eating, staff had supported them to achieve a safe weight and reduce unhealthy snacks and drinks. The person was now more active, healthier, had reduced cholesterol levels and had been discharged from their dietitian because of these improvements. Staff did not restrict this person’s (or others) access to the food they enjoyed; they helped to change people’s habits and relationship with food. This was an important part of promoting sustained healthy lifestyle choices.

Staff were exceptionally good at monitoring and improving outcomes for people. They knew people very well and understood how they were feeling. They were able to anticipate how people would respond in different situations and provided personalised support when they identified a person may become distressed.
Staff supported people to set personalised objectives and work towards these. Through this individualised approach people’s achievements had exceeded expectations. For example, improved health, reducing reliance on medicines, overcoming fears, being active members of the local community, reduced anxiety and fulfilling personal goals. For example, 1 person previously lived in a home where windows remained covered because of anxiety about seeing outside. With the support from staff at the service, they now went outside each day and had been on trips to places of interest, including busy environments, holidays and daily walks and exercise.

Each person worked towards their own personalised ‘SMART’ objective to help them to gain independence in an area they and staff had identified, for example household tasks. Staff broke these down into small achievable steps. They regularly monitored and adapted these. As a result, people had gained a range of skills, helping them feel a sense of achievement and giving them more control over their lives. The registered manager explained, “Our role is to support people safely and with patience to make their world bigger.”

Staff demonstrated exceptional skills and creativity to obtain consent. They found ways to overcome communication barriers. Staff understood how each person communicated and ensured they provider information in accessible ways. This included using words, signs, body language and visual aids. Staff always obtained consent for any interventions, care and activities. People told us they were asked for their views and able to make choices. Staff recognised that structure and predictability were important for people living at the service. However, they ensured people were always given choices within this and their decisions were respected. We observed very positive interactions. Each person was able to make decisions, and there were the staffing resources and skills available to ensure these were respected. Staff made sure people had informed choices and understood consequences. For example, when healthcare professionals had identified health risks for people, staff had found ways to explain these so people made healthy lifestyle choices based on their own knowledge and not because they were told to do so.

People did not have the mental capacity to make some complex decisions about their care. Staff tried to ensure people were involved in these decisions as much as possible. This had been successful helping people become desensitised to needles and some intrusive medical procedures. Staff also involved people’s relatives and representatives to ensure decisions were always made in people’s best interests. Relatives confirmed this telling us that people were involved in these discussions to ensure their views were central to any decision making.