Keys Hill Park

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 57 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We identified some joint working and support for staff both internally and externally. Regular staff were strong in their resolve and tried to give people good experiences. However there were some limiters, including always having the right staff team in terms of experience, skills, and being able to drive. Alternative modes of transport were always considered to support people's choice and independence.

People and their relatives were not always involved in decisions about their care, treatment and support. Where they were included, it was not always in a meaningful way. People’s relatives gave mixed reviews of their experiences over time. Whilst some said the service had improved, others highlighted concerns in regard to staffing and changes across the service. Communication was considered poor or inconsistent with relatives telling us there were no relatives’ meetings, there was mixed communication with management, and they had not always been told about hospital appointments or changes in need. For example, one family member told us, “My only concern is staff retention. They [provider] can't hold on to them and don't recruit the right people.There is a lack of communication skills with some staff especially when I ring. My belief is that senior management are responsible for the service and my communication with them is not good.” Another said, “They (my relative) does not go out much but that is their choice. They would not go out with agency staff and there is not always a driver. They keep me informed most of the time. We don't have regular meetings, but we used to.”

Collaborative working with people worked well, when their preferred staff were available and for those who had key teams. However, unplanned changes in staff and unfamiliar staff unsettled people and impacted on how they received person-centred care.

There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Although the service had a good understanding of the diverse health and care needs of some people, this was not consistent for all people living in the service. A few concerns were raised with us about people's dietary needs but we observed staff supporting people to make suitable food choices based on their needs and wishes.We also identified concerns about epilepsy management and consistent recording. However the provider took immediate actions to address our concerns and improve records and oversight of recording.

People did not always receive safe care, as described in the safe section of this report. However, care plans for people who had been living in the service for some time, were well written, and regular staff knew people well. Nonetheless, we saw that where agency staff only had access to paper care plans, these were not up to date and we identified gaps in agency staff’s knowledge, as well as poor handovers and inductions at times. This placed people at risk of unsafe care. Following this assessment, the provider took action to improve agency staff access to people’s care plans to address risks.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Care records were stored on the provider’s electronic care record system, and the provider told us people could access these and add photographs and notes if they wanted to, but we were not provided with any evidence of this. This meant we were not assured people were always given information in a way they could understand and access, in line with the accessible information standard.

Families advised us they did not have access to electronic records. The provider told us the electronic recording system was introduced in a phased way to ensure staff's familiarity, compliance and accessibility which included giving access to relatives in time with people's needs and relevant permissions.

People told us that staff could not always understand their needs but, we observed people being supported by regular staff who were effectively communicating with them. Some communication aids were used to promote choice, and we saw evidence that the service worked with specialist teams such as speech and language and the autism team as appropriate.

Staff picture boards and agency profiles were available to help ensure people knew who were supporting them, but these were subject to change, which could be confusing to people especially when last minute changes were made.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

People did not always feel listened to and involved. We received mixed feedback from people about how involved they felt, depending on which staff were available. Some people told us about negative situations they had experienced, but it was not clear how these were recorded. This was important to ensure actions were taken. For example, a family member told us their relative was called a derogatory name and this had upset them. Another person using the service referred to staff telling them to go to bed and clicking their fingers at them. Whilst another said staff could be rude, ignoring them whilst they were out and being on their mobile phones. This was fed-back to the nominated individual for them to address.

People were invited to take part in surveys and the outcomes of these were fed into the service development plan to help inform improvements across the service. People’s relatives were asked to contribute to surveys, but some felt a greater sense of involvement than others. For example, several relatives told us there were no meetings, and they had limited feedback. We were told that family forums were held. However, we did not see evidence of these.

The provider had a 4-tier system to assess and measure quality, and this involved senior staff and daily walkarounds to review different aspects of care and support, including observations and direct feedback of care. Although regular house meetings were held and helped some people engage and discuss what they would like to do and what changes they would like to see, these were not always accessible to people. This was due to a lack of staff availability and understanding about people’s individual communication needs.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

People had access to services and support. Aids were used where appropriate and some adaptations had been made to properties. We have already raised concerns about risk and unmet need elsewhere in the report and the provider explained they had a dynamic risk assessment process in place so unmet needs could be identified and addressed.

People lived largely without restrictions but where restrictions had been imposed, the implications of these had not been considered fully for others in shared houses.

We shared the same concerns that some relatives raised with us about the lack of security arrangements, which we felt exposed people to unnecessary risks. One relative of a person who needed support when going out, told us, “I’m not sure if they are in a safe place. There is nothing to stop them going out. They [staff] don't notice if they have gone missing. they are not safe on their own as they have no road sense. I worry that they could just walk outside on their own. I think they need some code locks and a gate as they are always open.” This meant we were not assured risks to individual people had been assessed and mitigated to ensure equity in access.

Staff and leaders listened to information about people who are most likely to experience inequality in experience or outcomes and responded to changing needs.

People were supported in line with their needs, and the staff told us about a number of successful transitions where people had been able to manage with less staff support as they grew in confidence and became more independent. This included people who had previously lived in more restrictive environments and now enjoyed increased freedom due to a reduction in their distress and associated risks. By providing inclusive support, some people were having an improved quality of life, and their needs were regularly reviewed to evidence how they were being met.

We did find however the service had faced a number of challenges in regard to staffing and stability of support for people. This made it more difficult to provide support in line with people’s needs and wishes.

Activities were planned in line with people’s individual needs and wishes. It is important people are supported to live as ordinary a life as possible, for example, being able to go to the cinema, shops and music venues. We found staff availability and changes to staff, impacted on people’s ability to have these experiences and choices.

The provider reviewed people’s placements to ensure they remained appropriate to their needs. Where possible, people’s individual staffing levels were reduced, meaning they were less restrictive.

The provider gave us examples of when high staffing ratios had been necessary to support people who were showing distress, but also how staffing levels had been dramatically reduced over time as people became more settled.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We recognised that people were consulted about their needs and goals were set with them. However, we were not fully assured that people were all supported to achieve their goals and wishes for the future, due to the constant change and concerns regarding staffing. Whilst the site offered different accommodation and support, according to people’s abilities, choice was sometimes restricted due to the availability of staff with the right skills and knowledge to meet people’s needs.

The age profile of people meant some younger people did not have advance care directives or end of life care plans. However, the recent ill health of a person led to concerns about the lack of training for staff in end-of-life care. It is essential to ensure staff have the right skills to carry out people’s wishes appropriately. We discussed this with the provider and were assured the persons end of life care was appropriate to their needs and that the training needs of staff had been recognised.

The service recognised different models of support and explored options for people about moving on from living in a residential care setting. We met with a young person who had moved from a shared house within Keys Hill Park, to their own home and whilst they still had contact with people they used to live with, they were enjoying their increased independence.