Keys Hill Park

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.

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always identify risks and ensure guidance was in place for staff to safely support people.

Assessments of need were completed for people’s care and treatment and used information from other health and social care professionals, relatives and people. More detail in initial assessments would help staff in pre-empting risks and regular debriefs would help ensure staff were working consistently and the care plans and risk assessments were being reviewed as required.

People’s needs were assessed but not always delivered in line with people’s expectations. For example, people told us they were not happy to have constant changes of staff or to be supported by staff who did not know their needs. This we were told by staff and people could result in planned activities being cancelled. However despite challenges with in house transport and drivers, alternative transport was encouraged to support people's independence and choice.Some families we spoke with raised concerns about communication with staff, but this was linked to regular staff not always being available.

Regular staff did know people very well and were able to access electronic systems to record people’s needs. However, agency and new staff could not access electronic records and had limited knowledge about people’s immediate needs and risks. The standard of record keeping was impaired by having both an electronic system and a paper-based system. This meant that there was not a clear and contemporaneous overview of people’s daily needs and risks.

The provider did not always effectively plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Although the provider followed legislation and current evidence-based good practice and standards, the inconsistency in access to electronic or paper care records meant staff did not always have accurate and up to date information about people’s needs. The provider recognised the importance of supporting people to be involved in the development of their care and support plans, but this was not fully in place. The provider had identified work was needed to develop access to the electronic recording systems and support people, their relatives and all staff to be able to access as appropriate.

The provider had resources to support staff in meeting people’s needs which included online information and more specialist support around epilepsy and supporting people who were distressed. However, the high number of new staff and agency staff that required training was putting pressure on the amount of other skilled and experienced staff to safely meet people’s needs and to deliver evidence-based care.

The provider did not always work well across teams and services to support people. Information was not always up to date, so it could be shared when people moved between different services.

When people moved into the service, there were delays in putting in place robust assessments, including risk assessments to help staff meet people’s needs. We were not assured information about people’s needs was clear and robust to ensure if they moved between different services such as hospital or other care services, their needs could continue to be safely met.

Whilst there was evidence of joint working and consultation with other professionals, there were concerns raised about the continuity of care and support and staff members understanding of how to support people in line with their needs and preferences, whilst recognising risks associated with people’s choice.

The service supported people to manage their health and well-being, so people could maximise their independence, choice and control. The service sometimes supported people to live healthier lives, or where possible, reduce their future needs for care and support.

Staff told us people were regularly supported to ensure their health was promoted and they had access to services they needed. We saw examples of menu planning with people to ensure they had diets in line with their needs and wishes. A couple of relatives raised concerns about people’s unhealthy lifestyles and unplanned weight loss. Concerns were also shared with us about weight gain and unhealthy eating choices, although these were in line with people’s wishes.

However, the service shared with us evidence of how they supported people to understand the importance of nutritious food, eat well balanced meals, exercise and set achievable goals, which staff supported them to work towards. We observed people preparing their own meals and working on their own individual menus.

Regular staff received health-related training to enable them to carry out certain tasks, which would otherwise need to be carried out by an external health care professional. For example, we saw examples of where people who wished to do so, were supported either to cease smoking or, as a healthier option, use an electric smoking device. This demonstrated good partnership working.

We saw examples of people going out for walks, swimming and doing things they enjoyed. However, access to things they wanted to do and the frequency of this was affected by the availability of regular staff and car drivers.

The service did not routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We identified that the provider’s monitoring arrangements were not sufficiently robust and required improvement. The provider told us the introduction of their electronic recording system was intended to enhance the service’s ability to consistently collect and analyse data, enabling prompt action to be taken. However, we found, the use of both electronic and paper-based systems across different buildings at the location led to inconsistencies and a lack of standardisation in record keeping and auditing processes.

This inconsistency meant people were at risk of harm. For example, records for a person who had frequent seizures, were recorded either on electronic or paper records depending on if staff had access to the electronic record system. As a result, there was not a complete or accurate picture of the person’s seizure activity or the effectiveness of their treatment. This meant there was a risk staff would not recognise important trends or changes in health, or delay seeking medical advice, which was a risk to people’s safety and wellbeing.

Following our assessment, the acting manager took steps to address these failings by ensuring records were updated and cross-referenced, allowing staff to access all relevant information quickly and support people more safely and effectively.

Although we identified concerns, there was evidence of effective collaboration among individuals, their families, and professionals in addressing barriers to community access and in contributing to improved wel-lbeing and overall experience.

Staff told people about their rights around consent and respected these when delivering care and treatment. However, people were not always appropriately supported to access and process information about choice.
People were supported to make decisions about their care and support wherever possible. However, we observed that where best interest decisions had been made, they did not always take into account the risks and impact on other people in shared houses. For example, where environmental adaptations had been made, or safety gates installed. Consent had not always been sought where CCTV or audio monitoring systems were being used and people were not always aware when they were in use, which did not follow the Mental Capacity Act 2005 and impacted on their human rights.

People had consented for other decisions relating to their care and treatment, where able to. Where people had been assessed to lack capacity to make a decision, mental capacity assessments had been completed. Staff had received training to enable them to support people with decision making. We saw examples of how staff supported people with their day to day needs and how staff understood people’s communication needs by using picture boards or other aids where appropriate.

People’s mental capacity assessments did consider if there was an appointee or a named person who had power of attorney or any advance directives which might be in place. Deprivation of liberty safeguards (DOLs applications) were made where appropriate and the service was able to provide an overview of this showing when applications had been made, approved or were due to expire. Care plans gave details of actions of how to support the persons care needs and assistance in activities of daily living including physical and emotional well-being and promoting safety.