Your Support

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• 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 provider met people’s needs.

This is the first assessment for this service. This key question has been rated good.

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

This service scored 86 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

One person had not been happy about the way in which they were receiving a particular aspect of a medical treatment they were undertaking. The person’s unhappiness impacted upon other aspects of their life and health. The staff team and managers listened and planned strategies to enable the person to no longer need this treatment. The plans were successful and enabled the person to be free from the stress of treatment they disliked.

Managers ensured people were supported by the staff best suited to their needs. For example, one person sometimes spoke a language they learned in childhood. Efforts were made to ensure staff who could also speak this language supported them. This helped staff to better communicate and understand the person’s wishes. It also helped the person to feel better understood by their staff team. Another staff member who had a particularly soothing voice was matched with a person for whom this was especially valuable and important. This staff member was then able to support and encourage the person to feel calmer and be braver. The person was able to engage with important health care appointments they had not been able to attend previously.

The management team told us about the importance of fully understanding a person’s personal history. They ensured staff were trained and able to provide trauma-informed care. This meant people were supported by staff who knew why certain situations could trigger distress or concern for them. Staff were able to support people to either avoid such triggers or learn to respond differently to them. Staff worked in collaboration with people to help them feel more empowered to cope.

People did not have set mealtimes unless they wanted them. They could choose to eat wherever they wanted to in their home. There was a communal space near where most people lived. Shared events and celebrations were held here. These included birthdays, religious celebrations and cultural celebrations. We saw photographs of people enjoying sharing the space together.

People did always not fully understand or could not communicate their needs. The management and staff teams used all the information and tools available to them to help people cope better with difficulties. They ensured people were central to decisions about their care and how they spent their time. People were encouraged where possible to think about future goals and strive for happy, healthy lives. Each person receiving care was being supported to develop or progress in ways which were meaningful and realistic for them.

The registered manager and staff demonstrated an excellent understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. Staff and managers had an in depth understanding of people’s strengths, goals and support needs. They worked in collaboration with external professionals to provide cohesive and empowering support.

Professionals told us about the complexities of the care needs of some of the people the service supported. They described how well people’s needs and risks were managed. All the professionals we spoke with praised the communication and responsiveness of the managers and the staff teams. A professional told us the management and staff team would work alongside them to plan appropriate changes to people’s care and treatment. They said “[The team] have learned about how we want to support people and we share the risk. [The team] autonomously implement the changes agreed.”

For some people their time with Your Support services represented their longest period of living in the community as an adult. This was a testament to the support and care of the management, staff teams and the wider community of health professionals working collaboratively.

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The management and staff teams thought carefully about the best way to share information and communicate effectively with people. Their considerations also extended to people’s loved ones and other professionals involved with their care and treatment. The management and staff team’s dedication to adapting information to each person’s individual needs had a significant positive impact on people’s wellbeing, confidence and involvement in decisions about their care.

We saw numerous ways in which information was tailored to people’s specific needs. These included easy-read documentation, pictures, symbols, simple words and phrases and story boards to convey plans and events. We saw a lot of use of photographs of individuals used to promote a positive image of themselves in communication. Photographs showed people were clearly at the heart of the planning and delivery of their care. ‘My Journey photograph books showed people the story of their time living with the service. People could reflect on their achievements and their progress using these.

When information was sought from people, it was through the use of methods tailored to the individual. Communication boards were used for people to plan out some of their activities for the week ahead. For some people, simple phrases and gestures were used to both provide and seek information. We saw staff were exceptionally effective in communicating with a person who had previously been labelled as unable to verbally communicate. Staff had developed a very personalised system of touch and also used simple words and phrases to communication with the person well. The person had begun to use simple phrases and could use these in combination with gestures to ask staff questions. This gave the person much more autonomy and helped them prepare for their planned activities.

Staff supporting a person who could not communicate their needs verbally had a deep understanding of how the person expressed themselves. The person was supported and comforted by proximity and touch. Staff understood the meaning of different sounds. They demonstrated the person’s ability to understand simple phrases well. They were patient and gave the person time consider and respond. The person clearly knew they were understood and trusted their staff team.

Guidance for staff detailed and exemplified the ways in which people needed information shared with them. People’s communication needs were assessed and reviewed in line with the Accessible Information Standard. Important documents such as tenancy agreements and complaints policies were provided in easy-read formats. This ensured people were supported to understand with the use of tailored communication. Plans and guidance to help people achieve goals and prepare for upcoming events were personalised to them. Photographs, story boards, and easy-read documents specifically designed for the individual were used. People were able to engage more meaningfully in appointments, meetings and experiences as a result of this preparation. Clear and transparent provision of information also supported people to make more informed decisions leading to better outcomes for them.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

Each time a person went out into the community, their feedback about how they had experienced the event was recorded. This feedback could include what people had said. It also recorded their mood and how engaged they had been in the experience. It recorded aspects people seemed to particularly like or dislike. This enabled the management and staff teams to review over time how successful community experiences were for people. It also helped to plan for what was most enjoyed and avoid less enjoyable aspects where possible.

Daily notes contained very detailed information about people’s experiences. This related to a wide variety of aspects of their day. It included what had worked well for them and what had been less successful. In this way staff could better see and understand any emerging patterns which could benefit future planning.

Best interests decisions demonstrated that wherever possible people were involved in decisions, including more complex decisions and areas in which they required significant staff support. This included decisions around budgeting and personal expenditure. People’s wishes were considered and planned for to make sure they had the experiences they wanted to have. Staff supporting someone who was unable to communicate verbally, understood gestures and sounds the person used to express themselves. They knew which the person liked to have mirrored back to them to reflect understanding and reassurance. Care records also reflected this to ensure consistency of approach from the staff team.

Staff were very skilled at breaking down goals into manageable steps. This helped people to feel more in control and gave them more practical achievable targets. Staff regularly checked in with people about how they were feeling. Goals were regularly reviewed and checked to make sure they were realistic and in line with how people were feeling from week to week. If a person was experiencing a setback, staff would modify their approach accordingly. A manager explained in detail how they were supporting a person who was showing increased signs of distress. Changes had been made to the person’s support to help them feel more comfort with less focus on development and change. The person needed a period of feeling safe and this had become the priority.

The provider ensured people could access the care, support and treatment they needed when they needed it. Whenever people needed additional care or treatment, any relevant reasonable adjustments they required were advocated for by the team. Staff consistently supported people to make sure they had fair and meaningful opportunities to participate in community life, with consideration of their related anxieties, abilities or support needs.

The provider tackled inequalities in achieving equity of access to care and support by allocating time and effort to removing possible barriers. The management team spoke very positively about local services such as the dentist and GP surgery. They told us they worked together well to make adjustments which made attending appointments easier for people. Possible adjustments included a first appointment of the day to avoid the anxiety waiting can create. A quiet place to wait was needed for someone for whom the noise of people in a waiting area could be over stimulating. Some people required longer appointment times to give them time to process choices or cope with receiving treatment, and the staff advocated on behalf of people to ensure they received these.

People were consulted about potential barriers to treatment and care plans were made to support them. Each time a person attended an appointment, the experience was reviewed with them. In this way they and their supporting team could learn about what helped them to attend appointments, and what was unhelpful. Reasonable adjustments people needed were recorded in their hospital passports and emergency grab sheet. These were then taken with the person to appointments and healthcare settings. They were used to help external professionals understand how people wished to be supported and what their key needs were. For example, they provided clear guidance about effective communication. This ensured the best possible chance of effective communication when people attended health appointments. The management team told us when a person was attending hospital, they would always inform the learning disabilities team at the hospital. They would make sure the team were aware of the adjustments a person would need to help them make the best of their experience. Relatives told us they were very happy with the support their loved ones received to be able to engage with health professionals and services.

The work people and the staff team did together meant people were able to access services they had not been able to before. People’s concerns and fears were carefully considered and planned for. They were supported to engage with services which many people may take for granted.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Difficulties and barriers people had previously experienced were considered and planned for carefully. In this way they ensured people’s right to health care was supported. For example, people who had not been able to attend a dental appointment before were supported to do so. People were able to address pain management and eating issues associated with previous dental problems. This meant people could enjoy simple but important pleasures. They could enjoy their meals and drinks and be pain free. They could ensure longer term that their dental health was maintained and prevent deterioration which could lead to worsening symptoms.

Staff and leaders took time to learn about people’s past issues and traumas. This enabled them to identify that some people may benefit from psychological therapy. They were supported to engage with this and saw positive outcomes. One person was particularly proud of the work they had achieved with their therapist. This achievement was celebrated with them. They were able to approach challenges more calmly and feel a greater sense of control and safety. Following a careful assessment, people were provided with touch therapy. Because they responded so well, staff were also trained to deliver this to maximise the benefits for people. The impact for one person in particular was described as ‘transformational’ by the staff team.

People were given person-centred support because staff and leaders consulted them and listened carefully. People’s previous experiences of discrimination and inequality were understood because they were given a safe place to express them. Staff and leaders took this understanding and proactively sought ways to improve people’s experiences and outcomes. People’s experiences and feedback were at the heart of ongoing planning to ensure their right to good care was upheld.

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future. At the time of our assessment, the service was supporting younger adults. The service was not supporting anyone at the end of their lives.

People were given extensive support to help them make informed decisions about their future care. They were provided with information which was prepared to maximise their understanding in this regard. Staff and leaders spent time talking through important issues to help them understand their choices more clearly. Guidance for staff detailed decisions with which people might need support and staff had a good understanding of this. Staff supported people to make their own decisions whenever possible, about their future goals and plans.

People’s care records detailed what was important to them and they were supported by staff who knew their needs wishes and preferences well. People were supported to gain greater independence and rely less on staff and on care interventions. We saw many examples of people being supported to achieve their goals, gain more independence and make plans for the future.