Longhouse

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.

There was a clear assessment process completed prior to people visiting the service for respite. This was completed prior to each stay at the service to ensure any changes in peoples assessed needs, were documented in their care plans and communicated to staff. This included a holistic assessment of their needs, preferences and aspirations which ensured staff fully understood people’s individual support requirements. One relative said, “we sat with the manager and one other staff member and went through a full assessment of needs. Then someone visited the college setting to meet him and we were sent a copy of the care plan.”

A respite parent/carer guide was made available, providing essential information about the service, including key contact details.

Staff had received bespoke training around people’s specific health and social needs, such as long-term health conditions, life limiting conditions and behaviours of distress. Care plans and risk assessments were comprehensive, detailing individual need and the methods used for staff to meet those needs.

Regular reviews of care plans were carried out to ensure they remained accurate and reflective of people’s current needs. One staff member told us “The care plan involves the person, their family and any relevant professionals where we gather the information to better care for the person in a holistic perspective. These updated as soon as there are any changes informed, during the pre-visit or handovers.”

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

We saw evidence that, where people required specialised support, such as PEG (Percutaneous Endoscopic Gastrostomy) feeding, staff had received additional training delivered by a registered nurse (RGN) via an external provider. Records demonstrated that competency assessments had been completed, to confirm staff had the skills required to meet people’s needs. However, the provider had not followed the correct process for delegating healthcare activities. This meant that we could not be assured that staff were receiving continuous oversight of the delegated healthcare activity. Whilst we saw no evidence of impact, we raised this with the registered manager who liaised with delegating authority and took immediate action to address this.

Care plans included person-centred information about people’s nutrition and hydration needs, allergies and intolerances, including details of any enhanced monitoring, risks or related health conditions. Staff supported people in a person-centred way and ensured they had access to food they liked. One staff member told us, “We have people with food allergies such as nuts, meat and gluten and provide alternatives.”

People with swallowing or eating concerns had their choking risk assessed, and in some cases, this resulted in alterations to the texture of their food and drink. Where needed these people were referred for assessment by a speech and language therapist. Alterations to the texture of food and drink were done in line with the International Dysphagia Diet Standardisation Initiative (IDDSI). Staff were trained to understand how people’s food and drink needed to be prepared and provided this in line with this guidance. One staff member told us, “We have people who have dysphagia and follow their eating and drinking guidelines which may include modifying food or drink”

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.

Communication between staff, professionals and relatives was effective and supported continuity of care. A professional spoke about a person who required specialist support. They told us the provider had identified the person’s needs and made a collaborative decision to trial adjusting the service opening times to better meet the person’s needs. There was a prompt and proactive response to this requirement, with a clear focus on maintaining safety and effective risk management throughout.

Information was shared with the wider staff team, via staff meetings, supervisions and handover information. Staff told us communication was good between their staff team and to and from management. One staff member said, “We have great leadership, respect and want the best outcome and support for the individuals, safe space for the people and staff.”

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.

Information was available in people’s care plans relating to specific health needs, and any support required in relation to this. Care plans also included information about promoting a healthy lifestyle, where people needed support to manage their food choices. People were encouraged to live a healthy lifestyle but also supported to live the life they wished. Staff understood people’s needs and preferences. One staff member said, “When planning meals or if you are shopping with a person. You may offer suggestions such as healthier options to a chocolate bar or say what about buying just one and a piece of fruit.”

The provider 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.

Information about people’s health conditions was clearly recorded. This enabled staff to be aware of any deteriorations from a person’s usual presentation. For example, we saw one person’s care plan clearly recorded their epilepsy, with clear protocols for staff to follow. This was accompanied by a risk assessment to effectively guide staff in monitoring and supporting the person. Another person required support in maintaining good skin integrity. Reminders were documented within the care plan for staff to monitor this, remain vigilant and report any concerns or changes.

Staff were trained and supported to recognise changes in people’s presentation. One staff member told us, “We are able to monitor urine output. If the individual needs more fluid or food. Food and fluid charts can be put in place to prevent dehydration and malnutrition.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Consent to care and support was routinely obtained when delivering care to people and clearly recorded in their care notes. Where people lacked capacity to make specific decisions, staff followed the principles of the Mental Capacity Act 2005 (MCA). This ensured that care was delivered lawfully and in line with people’s wishes. Staff had received training on consent and mental capacity so they could apply this knowledge in practice. One staff said, “We receive training for MCA, so the capacity is assumed to support people to make decisions. When the capacity is not deemed, we follow the best interest process and have the information documented and recorded in care plans.”