Archived: Abbots House Registered Supported Living

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

People appeared to have a comfortable relationship with staff. However, some people were being restricted from using a communal area of the service at certain times of the night, due to the needs of another person. Whilst this was done in the best interests of a person living there, there was no evidence about the consideration of this on the other people living there. There was mixed feedback about how effectively information was shared between staff and whether communication was effective. However, staff were aware of the handover process and the diary recording pertinent information. People received enough food and drinks to remain well. However, a communal meal had been stopped due to the staff conduct during this time. This was being reintroduced as it was felt this was a loss for people.

People were involved in having their needs assessed and planned for. There was also additional internal support from a Positive Behaviour Support practitioner to help guide staff to support people when they are communicating their needs by expressing upset or agitation. Staff knew people’s triggers or how to spot the signs when they were becoming upset. Other health professionals were involved in the care of people and their feedback was positive about how well staff knew people. There were hospital passports and evacuation plans in place in an emergency and to assist other professionals. There were care plans in place about people’s health needs and people were supported and encouraged to be involved in their health care. However, the recording of the monitoring of some people’s needs, and the provider agreed to review this. People were not being overmedicated, in line with best practice guidance.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were involved in having their needs assessed and planned for. There was also additional internal support from a Positive Behaviour Support practitioner to help guide staff to support people when they are communicating their needs by expressing upset or agitation.

Staff were aware of people’s individual needs.

Other professionals who worked with the service did not have any feedback or concerns to share about the assessing of people’s needs. Professionals confirmed the staff worked well with them and knew people’s needs.

People had plans in place for specific needs with details about how they needed support.

People told us there was often a takeaway on a Saturday night which anyone could partake in, and people looked forward to. People had individual kitchens in their accommodation so they could be supported individually; people generally did their own shopping so they could choose the food and drinks they wanted. This shopping was planned based on the needs of the person, as not everyone would be able to do one large shop but worked better doing more frequent smaller shops.

We received feedback there used to be a regular homecooked meal in the communal area, but this stopped taking place which some felt was a loss. We were told this stopped due to the conduct of staff during this event. This meant people were not always supported in a way they may like due to issues in the service. We were told there had been discussions with people about reintroducing this and there was a plan to restart this.

Staff confirmed people had choices with their food and drinks and staff knew people’s needs in relation to their diets.

The service was mindful of ‘STOMP’, which is a programme called ‘Stopping over medication of people with a learning disability and autistic people’. This was reflected in medication records showing people were not over medicated on ‘when required’ medicines, for example.

There was mixed feedback about how effective the sharing of information and how effective communication was. Some relatives raised no concerns with us about this, whereas others felt it needed improving. A relative told us they felt there were issues with communication and gave us multiple examples of where things have not been shared effectively; “I am sick of telling them. [Improvement] happens a few times, then it is forgotten about.” Another relative said, “I know there are a lot of people there, but the communication could be improved.”

Staff were aware of the handover process and aware of the diary where people’s appointments were recorded. Staff were expected to review information about people between each time they were in work, so they remained up to date.

Other professionals confirmed staff knew people’s needs well. One professional said, “Staff at appointments with myself appear to be knowledgeable of the individuals they are supporting.” Another professional said, “[Staff] always bring their residents in for appointment when needed, and they do know their residents well.”

People had hospital passports in place to assist professionals, such as paramedics and hospital staff, should a person be admitted to hospital. There were also Personal Emergency Evacuation Plans (PEEPs) in place to assist staff and the emergency services in the event of an emergency.

There was a handover process in place between shift changes and a diary to record appointments for staff to review each time they were in work. However, relatives had fed back they did not always feel this was effective.

People were supported with their health needs. One person told us, “The staff know what they are doing [with my health condition]. I’ve got a care plan in place.” A relative told us, “They have called an ambulance if my relative is poorly. They [staff] really do look after my relative. If staff are not happy with something, they are straight onto the doctor. My relative is always telling me they have been to the doctors.” Relatives also told us they had the option to continue supporting people with their medical appointments, if that was their choice. People had access to healthcare services. People were involved in managing their own health, where possible. Some people were able to tell us about the medical specialists involved in their care, the appointments they had and what they needed to do to remain healthy.

Staff were aware of people’s needs and were able to discuss with people about their health appointments and what support staff could offer them.

Health professionals were complimentary of the service. One professional said, “They are approachable, and any queries are appropriate and timely. The staff always listen.” Another professional said, “Staff appear to listen to advice.”

People had care plans in place about their health needs, with information about symptoms and how staff should respond, if needed.

People did not give us any specific feedback about this. However, as the monitoring processes in place could be improved, this meant people may not always have the best experience, but no one had come to harm as a result of this.

The Positive Behaviour Support staff member analysed people’s behaviours to review how strategies worked and whether people were supported appropriately. This was tracked over time to monitor outcomes for people and work on changes, if needed. However, other monitoring processes in place needed improving, although no one had come to harm as a result of this.

Some people needed aspects of their needs monitoring, such as bowel movements, their sleep patterns or fluid intake monitoring. One person’s nighttime sleep record and bowel monitoring charts were not being clearly completed to clearly track when they had and had not been to the toilet, or when they were asleep or awake during the night. This meant, staff may not always have complete information to help them determine if advice from a health professional was needed or not. People with a learning disability are more likely to be constipated than others, so it is important this is effectively monitored when people need support in this area. Following our feedback, the provider agreed to review the forms in use to make them clearer.

People had a comfortable relationship with staff and were keen to interact with staff. However, some relatives felt people were being restricted and there was not always a clear formal agreement about this. For example, access to the communal lounge area was restricted at nighttime between certain hours and the lights were turned off. It was explained this was to avoid disturbing one person who would find it a distraction if the lights remained on. However, this reduced other people’s access to this area. It was not clear if other less restrictive measures had been considered or tried. In another example, we were told of a person having time-limited use of an activity and the rationale for this was not clear, so they felt the person was being restricted. However, the service showed us records that the person was able to partake in this activity regularly but were encouraged to partake in a range of different activities too.

Staff were able to tell us about mental capacity and the restrictions on people from their Deprivation of Liberty Safeguards in place. However, staff were partaking in imposing restrictions on communal spaces to people which they felt was in a person's best interest, but they had not fully considered all people living there.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty.

We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met.

People had decision-specific mental capacity assessments in place and checklists to determine if people needed a DoLS referral due to restrictions. DoLS applications had been made, when necessary. However, due to the feedback in relation to possible restrictions such as people not being able to access communal spaces at certain times, and this was not always documented as being considered, we could not be sure all restrictions were being assessed and authorised.