Bells Piece - Care Home Learning Disabilities

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 changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to person centred care.

This service scored 54 (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 check and discuss people’s health, care, wellbeing and communication needs with them.

Assessment processes were in place to ensure people’s needs were assessed prior to them moving into the service. However, people’s needs were not regularly reviewed with them to ensure they were updated, and people were able to move forward. Review dates within people’s care records were inconsistent with some people’s care records not having been reviewed for over a year. Where changes to people’s needs were identified this was not always changed throughout people’s care plans which meant information was not always consistent.

Despite these concerns, we found staff knew people well and on a day-to-day level were able to provide people with personalised support in line with their needs.

Staff were not always aware of best practice guidance and how this impacted the way support was provided.

Staff we spoke with were not aware of Right Support, Right Care, Right Culture guidance (RSRCRC). Whilst staff demonstrated many of the principles and wanted people to have a happy and fulfilled life, they did not always ensure people were able to have as ordinary a life as possible. For example, people were not routinely involved in cooking their meals, and we saw that people generally had the same menu as each other. We did not see people routinely involved in domestic tasks, and there was very little information within people’s care plans in relation to the support they required to complete day to day household chores.

In other instances, we found the guidance was followed to enable people to have opportunities to try new things, form relationships and be involved with local groups. Other statutory guidance, such as monitoring people to assess people’s risk of malnutrition and falls were also used to support people’s effective care and support.

The provider worked well across teams and services to support people.

Systems were in place to support staff communication and any changes to people’s needs or routines. Regular handover meetings took place to enable staff to share information and understand any specific tasks which needed to be completed. In addition, written records were available for staff to refer to should this be required.

We observed that staff communicated well with each other and planned what was happening with people, so everyone was aware. Staff told us they felt the team had a strong bond and their skills complemented each other. One staff member told us, “We work really well together. We’re a team, the staff and the residents as well, really. We’re all here for them and want the best for them. They’re the reason we all pull together.”

The provider did not always support people to manage their health and wellbeing to maximise their independence, choice and control.

We received mixed feedback from people and relatives regarding how they were supported to maintain their health and well-being. One relative told us their family member had not been supported to maintain a healthy weight, and the amount of exercise they were supported with had reduced significantly. They believed this was contributing to their family member struggling more with day-to-day tasks. One person told us they would like to do more physical activity with staff support. Other people told us they felt well supported with their health and exercise, and one relative said, “They support [person] well. They are always out doing something but take it at [person’s] pace so [they] get the full benefit from it.”

Whilst the service had introduced some positive steps to promote a healthy lifestyle, this was not always built into the day to day running of the service. For example, a healthy eating group had been started to discuss healthy choices and cook a meal once a week. However, this was a standalone group and not something which was built into people’s goals and discussed with them individually, so people could be supported to design their personalised food menus.

In other areas, we found people were supported well to maintain good health from having regular health checks and medicine reviews. Where health concerns were noted, people received prompt support to access health services, and staff demonstrated a good knowledge of people’s individual healthcare needs.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

We received mixed responses from relatives regarding how outcomes and goals were set with people. One relative commented, “Communication is poor, we get no feedback to queries/questions about [family member’s] hopes and dreams, [their] timetable, [their] personal outcomes.” Another relative told us, “[Working towards goals] varies from staff to staff. Some staff are brilliant. I don’t really know if the manager understands autism enough to support staff with this though.”

Whilst systems were in place to monitor outcomes with people, these were not always followed by staff to ensure people’s views, aspirations and achievements were recorded. The manager told us monthly update reports were completed with people and their keyworkers. However, we found for many people, these were not completed consistently, with some people having not had a meeting for almost 6 months. Care records did not clearly highlight what people wished to achieve or how staff would support them in these areas. For example, one person had indicated they would like to be more involved in cooking their meals. Whilst staff told us they had started to involve the person, this was on an ad hoc basis, which made it difficult for the person to see what they had achieved.

In other instances, we saw people were supported to do things they enjoyed, and which motivated them. These included involvement in the local church, voluntary employment and educational opportunities. We saw people were supported to make day to day decisions regarding how they spent their time, and staff motivated people to join groups and go out.

The provider did not always tell people about their rights around consent as the principles of the Mental Capacity Act 2005 were not followed.

Staff offered people choices and gained consent prior to supporting them with their day-to-day support, such as where they spent their time, and what they chose to eat and drink. We observed people making decisions regarding how they spent their time together at Christmas and specific things they wished to do. However, whilst staff understood people’s rights to make independent decisions, they did not always evidence discussions regarding how decisions were made and what support the person may require going forward. The manager told us this was an area they were working on, although they felt staff had a good understanding of ensuring people had the right to make their own choices.

People’s capacity to make decisions had been assessed in some areas, although more robust systems were required to ensure any restrictions in place were/remained in people’s best interests. The provider told us they were aware of the need to review systems in relation to this, and this formed part of their action plan. We found that whilst capacity assessments had been completed in areas such as the decision to live at Bells Piece, medicines and finances, no best interests’ decisions had been completed where it was determined people lacked capacity. In addition, contradictory information about one person’s capacity to decide was found within their care records. The manager ensured this was rectified during our visit, and there was no evidence of any unnecessary restriction having been placed on the person.