Essex Care Consortium - Marks Tey

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 remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. People had been involved in their own assessments and reviews. Before people moved into the service, a full assessment was carried out to ensure the service was able to meet their individual needs. The assessment included the full range of the person’s diverse needs, including their wellbeing, communication needs, mental and physical health. The initial assessments were used to formulate people’s care plans. Care plans showed people’s views and opinions had been captured, respected, listened to and implemented as part of their day-to-day support. People’s care plans were reviewed on a regular basis and revised accordingly to accurately reflect changes in their needs and the level of support required to maximise their health and wellbeing. This meant people received proper, consistent and safe care and support. Staff demonstrated a clear understanding of people’s needs and how to support good quality of life. One member of staff told us, “We stay updated about changes in people’s needs through meetings and a group chat.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. People’s nutrition and hydration needs were being met in line with current guidance to maintain their health and well-being. Where people had been assessed by the speech and language therapist (SaLT) as needing a modified diet, guidance was widely available to staff and competency assessments were completed to check that staff were providing this safely and in line with the International Dysphagia Diet Standardisation Initiative (IDDSI). This is a national framework providing standardised terminology, definitions, and testing methods for texture-modified foods and thickened liquids used for people with dysphagia (swallowing difficulties).

Relatives told us, their family members nutritional and hydration needs were being met. Comments included, “Staff keep an eye on (Persons) weight and will adjust their food accordingly. They have never complained about the food,” and “They have Fish Friday suppers.” We observed people had enough food and drink to prevent malnutrition or dehydration. Kitchens and snack areas were well stocked. We observed a person making their own snack and hot drink with support from staff. Fresh fruit was available, and menus were displayed throughout the home in formats such as pictorial and written word so that people could be involved in choosing their own meals.

Routine health checks can effectively identify previously unrecognised health needs in people with learning disabilities. Records showed people were being supported to attend annual health checks. One member of staff told us, “All people have an annual health check, if anything is identified, we always ring the GP.” An external professional told us, “Staff manage the clients well and their health needs, taking them to annual health checks and making sure they have their yearly vaccines.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Managers and staff communicated with relatives, external professionals and services to ensure a coordinated approach and continuity of care for people moving into the service. The registered manager showed a strong awareness of the risks to a vulnerable person across their care journey to their recent admission. They had advocated for this person and pro-actively sought support from other professionals, commissioners and safeguarding to keep the person safe.

Staff told us information was shared between staff and services to ensure continuity of people’s care. One member of staff commented, “We have good links with district nurses, so we can access support and intensive support where needed.” Relevant professionals were positive about how the service worked with them to ensure people received good care and support that met their needs. Comments included, “I have seen the staff working well with other professionals such as GP, physiotherapist and occupational therapist,” and “Staff have the client’s needs first always. I advise around physical and mental health. The staff work well with me completing assessments and recording evidence for example completing ABC charts. They feedback well to me and the consultant at clinic reviews. They contact me or the team when they need further support and advice.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. The registered manager told us people were empowered and supported to manage their own health. For example, “(Person) is independent, doesn’t take medicines, if they are unwell, they will make their own appointment at the GP surgery. They also collect their own prescriptions.”

The service focussed on identifying risks to people’s health and wellbeing early and on how to support people to prevent deterioration. Relatives commented, “They (staff) will take (Person) to all their appointments,” and “(Person) goes to the hygienist for their teeth they have their eyes checked annually as they previously had cataracts.” The service worked well with external professionals and services to ensure people stayed well. A health professional told us “We have worked closely with the staff and clients offering advice and support as required to ensure the clients living there have a good quality of life. The whole service works well with myself as a professional and my colleagues and are led well by the home managers”.

People were encouraged and supported to make healthier choices. Minutes from staff meetings showed that conversations were taking place about healthier food options, and we observed fresh fruit, and vegetables were readily available. Care plans showed that a range of physical leisure activities had been encouraged such as swimming and going to the gym to help people get fitter. Relatives commented, “(Person) enjoys going to the joined-up day centre for three days per week and goes to the gym on Monday and does swimming there as well, and “Staff helped my (Person) to do weight training.”

The registered manager routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Care plans included person-centred information about people’s needs, including details of any enhanced monitoring, risks or related health conditions such as epilepsy. The service worked well with the epilepsy nurse to monitor and review peoples’ epilepsy. Seizure management plans were in place clearly setting out actions for staff to take to monitor for seizure activity. One relative commented, “Staff are aware and watch (Person) for absent seizures, if they just drop or have longer seizures then they (staff) all know what to do. (Person) is under a specialist hospital and they adjust their medication if necessary.”

Staff supported people to access routine health screening and check-ups, as well as reviews of prescribed medicines and any long-term conditions. People's records reflected appropriate health professionals, including psychiatrists, enhanced support team and community learning disability nurse were actively involved in reviewing their medicines including long‑term antipsychotics to monitor effects on their health and wellbeing and reduce them when appropriate.

Staff showed a good understanding of how to monitor people’s health. A staff member told us “[Person] needs constant monitoring, we take [Person’s] temperature x3 a day to monitor for signs of infection and complete fluid charts to monitor their catheter fluid input and output and their bowel movements, because of the potential of urinary tract infection (UTI). If their urine looks dark, odorous or off colour we know to refer to single point of access (SPA) straight away.” This is a local authority central hub responsible for processing referrals, managing enquiries, and coordinating services.

People had health action plans (HAPs) in place designed in an easy-to-understand document. The HAP identified their health needs, their preferred method of communication and goals, such as diet and exercise aimed at monitoring and improving health outcomes and address any inequalities by making care more holistic and focused on what was important to the individual.We received positive feedback from relatives about how the service monitored their family member’s weight. A relative told us, “My (Person’s) weight and their food portions must be monitored. Staff watch their weight with portion sizes and dietary needs and offer different food options.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Mental capacity assessments had been completed for decisions about care and treatment, with relatives and advocates involved where appropriate. However, the provider was not consistently applying the Mental Capacity Act (MCA) 2005 in relation to financial decisions. Capacity assessments were not carried out for people unable to consent to purchase items, such as furniture or equipment, and the provider did not follow its finance policy requiring third-party authorisation for spending over £50. No best interest meetings with relevant professionals or family members were held to consider financial decisions for people lacking capacity. This is currently under investigation by external agencies.

However, our observations showed on a day-to-day basis people were offered choice, independence and control. Staff knew about people's capacity to make decisions, including those assessed as lacking capacity for certain decisions and could explain how they would gain consent for people with alternative communication methods. A staff member said “We give people choice. If people lack capacity, we still need to give them choice, but we keep choices simple and give 2 options.” Staff confirmed they asked people’s consent before carrying out any care. A staff member commented, “[Person] will nod for yes and stamp their feet for no”. Meeting minutes also showed conversations where staff had highlighted the importance of people’s preferences and choices being considered around their diet. We observed staff asking permission to enter people’s bedrooms and before administering their medicines.