Bells Piece - Care Home Learning Disabilities

On this page

• 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.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant people’s needs were met through good organisation and delivery.

This service scored 64 (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 were at the centre of their care and treatment choices on a day-to-day basis although records were not always reflective of this.

Whilst people’s support plans were person-centred in most areas, we found these principles were not consistently applied. For example, care records for supporting one person to make choices and decisions described them as ‘having a mental age of 8’, which did not demonstrate a person-centred and respectful approach. The manager told us they were in the process of working through people’s care plans with them to ensure they were up to date. We found that where plans had been reviewed, the information was more detailed and guidance was more accessible to staff.

We observed that staff were responsive to people and understood their needs and communication styles. People told us they felt assured staff supported them and felt they understood what was important to them. Staff supporting people on a one-to-one basis ensured they engaged with the person and involved them in conversations. The majority of people living at the service had lived together for several years and clearly valued the friendships they had formed.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Improvements had been made in the way the service engaged with other services to meet people’s needs. The manager told us this had been a focus of their time at the service and felt positive relationships had been developed with local health and social care teams. People’s care records contained information regarding services involved in their support network, and staff were aware of how to make referrals to external agencies when required.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We observed staff used different ways of communicating with people in line with their needs. They understood what might make people feel anxious and ensured they provided reassurance when suggesting things to them. Information was displayed around the home in pictorial formats to assist people’s understanding. When speaking with people, staff ensured they made eye contact and sat with people to demonstrate they were listening.

People’s care plans contained details of their preferred communication methods and guided staff on what different signs or expressions may mean to individuals. Where people had additional sensory needs, this was recorded and understood by staff.

The provider did not always make it easy for people and their relatives to share feedback and ideas, or raise complaints about their care, treatment and support.

Relatives told us they did not feel concerns were listened to and due to the lack of consistent management oversight, felt action was not always taken to resolve issues. One relative told us, “Because of issues that I’ve had to raise, staff probably see me as complaining. Sometimes, when I raise concerns is not well received. The previous manager told staff not to tell me things.”

Another relative told us, “I would complain but with the management as it has been I’m not confident what the response would be.”

Whilst a log of written complaints was maintained, not all the issues relatives told us they had raised had been logged. These included where more than one concern had been raised regarding the poor management systems, a lack of personalised support and the oversight of staff support. Where complaints were logged, we saw there was a process in place to investigate and minimise the risk of them recurring.

The management team told us they were aware of family concerns regarding the management of the service and how this was impacting the support people received. They shared a service improvement plan which considered the issues which had been raised during quality assurance audits by the provider and/or the local authority quality assurance team, such as reviewing people’s care and support and ensuring good oversight of risk management systems.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People were able to access all the areas of the home they needed to. Where people required equipment to support their needs, this was provided, and staff ensured it was in good working order. When people’s needs changed, adaptations had been made to ensure these could be met, such as fitting a new bathroom which was accessible to a person following them experiencing a fall.

The service had an on-call system where staff could seek support from a manager in the evening and at weekends in the event of an emergency. Staff told us they had rarely had to use this resource but had found it helpful and responsive when contact had been made.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff and the management were aware of barriers people may face in accessing support and doing things which they enjoyed. They ensured they advocated on people’s behalf to enable them to have an active social life in their local area. Staff were aware of the support they were able to access through the community learning disability team to help promote people’s rights, should access to healthcare be delayed.

The provider had an equality, diversity and inclusion policy in place to help ensure that people did not receive unfair treatment based on their protected characteristics. Staff received training in this area to enable them to identify issues and ensure people’s rights were protected.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People’s wishes at the end of their life had not been recorded, such as the support they wanted in relation to their spiritual and cultural needs, involvement of family and friends, or how people’s pain and comfort would be monitored. Additional work was needed to develop end of life plans, including having difficult conversations with people, their families or advocates. The manager told us they were in the process of researching what resources were available locally to support people and staff through this process.