Richardson Duston Limited

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• 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

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.

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

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

This service scored 79 (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 ensured people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider had an multi-disciplinary team (MDT) in place which consisted of consultants from varying professions and specialities. This meant that people’s needs were assessed holistically. Within this team there was a Speech and Language Therapist who would assess communication needs and develop plans and systems to enable staff and people to communicate with each other. These communication systems needed to be embedded to ensure all people could access information about their care plans. Where required, people were supported to access external health professionals in addition to those within their MDT. For example, mental health professionals.

People were involved in their reviews and care planning; relatives also told us that they were involved too. The service uses clinical assessment tools where needed to ensure they identify a changing need promptly.

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. They worked to develop evidence-based good practice and standards.

Some people required their needs to be anticipated by staff; however, the provider took steps to still involve people in the planning and formulation of their care. Staff used daily notes to gauge a person’s feelings about a care task or activity, and shared the information in care plans, staff meetings and other communication methods.

Where required, the provider used clinical assessment tools such as Malnutrition Universal Screening Tool (MUST) to assess people’s risk of poor nutrition and Waterlow scores to assess people’s risk of acquiring pressure ulcers. The provider completed robust and thorough Mental Capacity Assessments (MCAs) in line with legislation and best practice. People and their relatives were involved in best interest decisions.

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.

Where people had moved between services or used multiple services, communication had been effective. Documentation such as care plans and assessments were clear and coherent, and in a format that could be shared between services. Some people’s documentation that was designed for emergency or short notice transition between services was lengthy and could be more succinct to enable other services to access the most important and vital information relating to people.

Where external partners had been involved, this information was shared with staff through handovers, memos and staff meetings.

There was a culture of coordination and collaboration, and the service worked well between their own organisation and with external partners. One staff member told us “There is a strong culture of teamwork.”

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.

People’s care plans contained relevant information which enabled staff to understand people’s healthcare needs. This included preferences on how people liked to be supported and where possible, developed independence. For example, people had been involved in medication administration processes. Clinical assessment tools were used to help identify changing needs and the provider’s multi-disciplinary team (MDT) provided expertise and support for staff and people using the service.

Staff promoted healthier living by providing nutritional meals, whilst considering people’s preferences and choices. Staff supported people to use their individual timetables for activities to promote social interaction. However, feedback was mixed from people and relatives around people’s social needs being met and there was room for improvement in this aspect. One relative told us, “I don’t think our relative’s social needs are being met” and “at the moment they don’t socialise with their peers”. Another told us “[Staff] are always engaging with them, going places and doing stuff with them”.

People living with physical disabilities were supported to take part in therapeutic activities such as hydrotherapy.

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.

The provider used monitoring tools, such as Antecedent, Behaviour and Consequence charts (ABC charts) to monitor people’s distress and reactions to situations, to identify themes. This information was then used to develop creative solutions to improve outcomes and quality of life for people.

The staff were trained to use Crisis Prevention Institute (CPI) holds, where a person’s behaviours or actions could pose a risk to themselves or to someone else. Records showed staff used the least restrictive techniques such as speaking to people first and the use of CPI was kept to a minimum. The provider had been accredited by the Restraint Reduction Network as recognition of this.

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

The provider utilised the Psychologists on their multi-disciplinary team (MDT) to complete best practice mental capacity assessments, they included all relevant people, such as relatives and advocates, in best interest decision making processes. They adhered to best practice set out by legislation such as the Mental Capacity Act 2005.

Where people were able to consent to all or some aspects of their care and support, they were empowered to do so.

There was some room for improvement around informing people of their rights, as we found little evidence that information was adapted to everyone’s communication needs.