14 Thornhill

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 good. At this assessment the rating has changed to 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 regulation in relation to consent.

This service scored 46 (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 and registered manager did not always ensure people's needs were effectively assessed and clearly documented to support consistent care delivery. Assessments, care plans, communication information and behaviour support documentation were in place; however, records were not always clear, accessible or detailed enough to consistently support staff practice.

Staff demonstrated a good understanding of people's needs and preferences and relatives told us because staff were familiar with people they supported, they noticed changes in people’s health and wellbeing in a timely way, but this knowledge was not always reflected clearly within documentation. Assessments, Positive Behaviour Support documentation, STEP plans and risk assessments required improvement to ensure information was aligned, practical and easy for staff to follow. This created a risk that support may not always be delivered consistently, particularly for staff less familiar with the people using the service

Staff did not always plan and deliver people's care and treatment with them, including what was important and mattered to them.

People were consulted about aspects of their lives through key worker meetings, activity planning, residents' consultations and person-centred reviews. Easy Read plans, Individual Support Plans and STEP plans were available and contained information about people's preferences, routines, communication needs and support requirements. Staff knew people well and supported them in line with many of their expressed wishes and preferences. However, this knowledge and involvement was not always consistently reflected across the wider care planning documentation, and records did not always clearly demonstrate how people's preferences informed care planning, treatment approaches and longer-term outcomes. Although staff generally provided care in line with current good practice and people's individual needs, documentation was not always sufficiently clear, consistent or aligned with best practice to support this consistently.

The provider did not always work well across teams and services to support people.

Staff worked with a range of external professionals, including GPs, dentists, epilepsy specialists, social workers and specialist services, to support people's health and continuity of care. Records demonstrated regular attendance at healthcare appointments, professional reviews and multidisciplinary discussions, and staff shared information appropriately to support people's health and wellbeing. Professionals described staff as knowledgeable, responsive and proactive. However, partnership working was not always consistently evidenced across all records, and documentation did not always clearly demonstrate how decisions were recorded, communicated and followed through.

Within the service, regular staff meetings supported communication about incidents, activities and care. Relatives described communication as open and responsive. This helped people receive coordinated support and reduced the risk of important information being missed."

There was limited evidence within records of structured longer-term planning to demonstrate how health, independence and skill development goals were monitored, measured and progressed over time. Communication support was not always clearly recorded, which could affect people's ability to make fully informed choices.

People were supported to maintain their health and wellbeing through access to healthcare services, health action plans, medication reviews and regular health appointments. Staff worked with healthcare professionals and supported people to follow medical advice and treatment plans. People participated in a range of physical and community activities, including walking, swimming, bowling, trampolining and other recreational opportunities aligned to their interests. Some people were also supported to develop practical daily living skills, including shopping, meal preparation and domestic tasks. However, there was limited evidence within records of structured longer-term planning to demonstrate how health, independence and skill development goals were monitored, measured and progressed over time.

People were supported to attend healthcare appointments and take part in activities they enjoyed, and relatives told us staff encouraged people to be as independent as possible.

The registered manager did not always have effective systems in place to monitor, review and improve outcomes for people. A range of checks, audits and meetings took place, including organisational quality assurance and peer-review processes. Staff meetings provided opportunities to discuss care, incidents and service improvement. However, records did not always clearly demonstrate the findings from monitoring activity, the actions identified, how these were followed up, or the impact on people’s outcomes.

There was limited evidence to demonstrate that feedback from people, relatives and professionals was routinely captured, analysed and used to support measurable improvement. Care records did not consistently contain clear longer-term goals, measurable outcomes or recorded progress. Although staff supported people to participate in activities and develop independence, this was not always linked to defined objectives or monitored over time. Consequently, the available records did not consistently demonstrate how quality assurance activity resulted in meaningful and sustained improvements for individual people.

Staff did not ensure people’s consent to care and treatment was always obtained in line with legal requirements.

Although DoLS authorisations and associated assessments were in place for some people, there were no decision-specific mental capacity assessments or best interest decisions in place when people lacked capacity for a range of care and treatment decisions. Whilst some relatives held legal authority through Court Appointed Deputy arrangements, relatives were sometimes involved in decisions without a clearly evidenced best interest process being followed. This had a significant impact on people because it meant their rights were not always protected and decisions may not always have been made lawfully or in their best interests

The registered manager and staff sought consent in day-to-day interactions but did not demonstrate they understood the Mental Capacity Act and associated code of practice. Staff did not use advocacy services or appreciate when these might be needed. This meant people may have missed opportunities to further support their inclusion, independence, rights and have a say in any restrictions being imposed.