The Grove -4

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 inspection we rated this key question Requires Improvement. At this inspection the rating has remained Requires Improvement. This meant people’s outcomes were not consistently good.

People’s needs were assessed when they started using the service, however care plans, risk assessments and guidelines were not always updated or put in place when people’s needs changed. People were not always supported to identify how to live healthily and be supported with this. It was unclear how people were being supported to identify and achieve their preferred outcomes. However, the staff team worked well with each other and with other professionals. People were supported in line with the MCA and staff were trained in this.

This service scored 58 (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 reassess people’s support needs when they changed.

People had lived at the service for a long time and their needs had been assessed when they moved in. As time went on people’s needs changed in areas such as eating and drinking safely, health conditions and how they showed how they were feeling. Staff knew people well and supported them on a day-to-day basis and knew about these changes. However, these changes were not always recorded in people’s records and were not always used to update people’s care plans and risk assessments. There was limited evidence to show how changes, to how people wanted to be supported, were discussed between the staff team. This limited the opportunity for people’s needs to be reassessed and for support be put in place to help them with their changing support needs. The registered manager acknowledged this and started to make changes to people’s support plans and encourage the staff team to discuss how people needed to be supported differently on a more regular basis.

However, care plans did give a good overview of people’s assessed needs in other areas. The registered manager and management team spoke with us about how they were carefully working with other professionals and partners to make sure any future admissions to the service were successful. One relative told us, ‘‘[Service] is [family member’s] home for life. It is their family, and the staff know them like the back of their hand.’’

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always do this in line with legislation and current evidence-based good practice and standards.

Staff were trained how to support autistic people and people living with a learning disability. However, this training had not been discussed with them to see how they would apply what they had learned into their job roles at the service. Staff were not always supporting people in line with best practice in relation to using different methods of communication or identifying where people could be engaged with to decrease the risk of boredom and isolation. There was limited evidence staff competency in these areas were being checked. Staff were not noting when people needed more support in some areas of their daily routines and positive changes to help people at these times were not being discussed. Some people would have benefitted from some guidelines and a consistency in approach from staff at certain times of day to help them feel less anxious. These were not in place. The registered manager acknowledged this and started to make improvements. This included creating competencies for staff and putting guidelines in place for when people needed support at certain times of the day.

The registered manager was passionate about upskilling the staff team and wanted to support people to have the best experiences possible. They were working with the staff team to identify where practice could be improved and brought in line with current best practice. Staff told us they felt empowered to start thinking about new ways of supporting people in their best interests. One relative said, ‘‘I think [registered manager] is a breath of fresh air and will keep changing things for the better.’’

The provider worked well across teams and services to support people. Staff were positive and complimentary about their colleagues and how well they worked together. They told us they pulled together to support each other to help ensure people received the best care possible. Staff worked well with other professionals such as GP’s and nurses and followed their advice when it came to supporting people. Feedback from professionals about the service was positive. One relative said, ‘‘I am happy and secure in that the staff team get on with each other as well as [people living at the service.’’

The provider did not always support people to manage their health and wellbeing to maximise their independence, choice and control. They did not always support people to live healthier lives and where possible, reduce their future needs for care and support.

Sometimes guidelines were not in place to support people to be healthy. For example, some people needed support to stay healthy at mealtimes. There were no guidelines in place to help guide staff how to do this. As a result, people were at risk of not living healthily. Other people would benefit from having regular exercise to help them stay healthy. However, this was not always possible due to staffing levels and deployment at some times of day. There were no detailed guidelines about how to prompt and encourage people to exercise regularly and live healthier lives. Where there were changes to people’s health, these were not always updated in support plans and risk assessments in a timely manner. The registered manager acknowledged this and started to work on guidelines to help staff support people to live healthier lives.

People were supported to stay healthy in other ways, for example by having access to a wide variety of healthy food and drink. People were able to get snacks when they chose to, and people enjoyed the meals staff prepared for them. Staff also contacted health professionals such as dietitians to help support people to stay healthy if they needed this. A relative said, ‘‘We have never had a problem in relation to [family members] health. I think it can be quite difficult to encourage them to try new things, but staff always do a good job.’’

The provider did not always routinely monitor people’s care and treatment to continuously improve it. People’s outcomes were not always positive and consistent.

It was not clear how people were being consistently engaged with to find out what their interests were, or how they could be supported to identify and achieve their desired outcomes. Staff met with people to discuss how their support was going and whether there were any changes they wanted or if staff could support them with any outcomes. However, it was not clear how people had been supported to understand what was being discussed, nor was it clear how staff were monitoring any outcomes. People were sometimes limited in their opportunities to explore their interests and achieve good outcomes at certain times of the day, due to staff deployment.

The registered manager acknowledged this and was already working to improve in these areas. They had developed some ideas for in house past times for staff to support people with. They were also encouraging staff to take people into the local community more often. As a result, people had been supported to go out in the community more often. A relative said, ‘‘I have noticed a difference in [family member] recently. They are buzzing and seem really happy. I think it’s because staff are taking them out and about more.’’

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff were trained in the MCA and knew the importance of this legislation and making sure people were asked for consent whilst being supported. The registered team completed assessments and made decisions in people’s best interests if they lacked the full capacity to make decisions themselves. Staff asked for consent before they supported people throughout the day. A relative said, ‘‘[Family member] knows how they like things and the staff team are always very respectful.’’