Cartref House

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

This service scored 71 (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’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to their support starting. A healthcare professional told us, “Cartref have always sought information from several sources prior to considering offering a service to the people in their care.” We saw comprehensive pre-admission and ongoing assessments which informed person-centred care plans and risk assessments. These included assessments relating to physical health conditions, nutrition, medicines, emotional wellbeing, behavioural support needs, communication and independence skills. Managers described how referrals, assessments and reviews were used to ensure the service was able to continue to meet people’s needs.

We observed people received care in line with their assessments and care plans. Staff demonstrated a good understanding of people's individual needs and were able to explain how support had been adapted over time. Staff reviewed assessments regularly and when people's needs changed. For example, when people began new activities, these were risk assessed and guidance put in place on how staff should safely and effectively support people.

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 and current evidence-based good practice and standards.

The registered manager worked in line with the principles of our Right Support, Right Care, and Right Culture guidance to ensure people had a good quality of life and were supported to maximise their independence. Care plans and risk assessments contained guidance for staff based on recognised approaches to supporting people with learning disabilities, autism, and any psychological or emotional needs or behaviours. Care plans identified triggers, early warning signs and strategies that should be used to support people consistently. Staff used positive behaviour support principles, structured routines, sensory approaches and emotional regulation techniques to help people achieve positive outcomes.

People were supported to manage their health conditions and staff sought advice from healthcare professionals when needed. A person told us they completed daily physiotherapy exercises, with staff support, to maintain their mobility.

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.

The systems and processes in the service support staff to communicate effectively. Daily handovers, team meetings, monthly reviews and regular discussions helped ensure important information was shared across the staff team. We observed staff working effectively together throughout the inspection. Staff sought support and advice from colleagues when required and demonstrated a shared understanding of people's needs, preferences and risks.

Managers and staff worked closely with healthcare professionals, social workers, advocates and other agencies. Records showed referrals were made to a wide range of professionals including GPs, dentists, chiropodists, learning disability services and mental health professionals. Staff followed up referrals and advocated for people when support was delayed.

Feedback from professionals was positive. A professional told us, “Collaboration is the central reason why I would recommend Cartref as a service to go to."

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 were encouraged to access healthcare services and maintain healthy lifestyles. Staff monitored health conditions and supported people to follow treatment plans and attend reviews. For example, a person told us how staff supported them to maintain their oral care following a recent dental appointment.

Records contained information about people’s nutrition and hydration needs. Staff were aware of people’s risks related to nutrition and hydration management and offered appropriate advice and support in relation to this. They promoted healthy eating, exercise and independence. People were involved in planning meals, shopping, preparing food and undertaking daily living tasks. For example, a person told us they followed a healthy eating plan.

People were encouraged to develop practical life skills, maintain relationships and participate in activities they enjoyed supporting their health and emotional well-being. People spoke positively about activities and opportunities to develop independence.

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.

People’s progress, wellbeing and risks were regularly reviewed through care planning processes. Managers used audits, monthly reviews and incident analysis to identify trends and evaluate the effectiveness of support. Staff also frequently discussed progress against goals, health outcomes and risk management during team meetings and minutes from these demonstrated positive outcomes for people.

We saw examples of positive outcomes for people. A person proudly showed staff and inspectors their achievements and discussed plans for future education and activities. Staff described improvements in people’s independence, emotional regulation and community participation. For example, they us about a person who had recently been encouraged to increase their independence. They had discussed the transition to independence and staff were available to offer support when required. A professional told us the service had successfully supported an individual with complex emotional needs to reduce restrictions, develop coping skills and eventually move on from the service.

Although the provider told people about their rights around consent and respected these when delivering person-centred care and treatment, record keeping in relation to this required improvement.

The provider supported people to make decisions about their care and treatment in line with the Mental Capacity Act 2005. Care records contained assessments of people's capacity to make decisions, but the documentation was not always completed with full details to evidence the decision-making process had been followed or how the decision had been made.

Where it was deemed people lacked capacity, best interest decisions identified where support was needed. Best interest decision records did not always demonstrate that relevant others had been involved in decisions about people’s care. We raised this with the registered manager who told us they experienced difficulty getting input from relevant others. The registered manager told us this would be recorded in future.

Staff understood the principles of the Mental Capacity Act and were able to describe how they supported people to make their own choices wherever possible. Staff told us, “If someone has capacity, they can make their own decision and should be respected.” People were encouraged to make decisions about their daily lives, including meals, activities, personal care and healthcare. We observed staff offering and respecting people’s choices.

Where people were subject to restrictions, these were considered through appropriate legal frameworks. The service had Deprivation of Liberty Safeguards authorisations in place where required, and records showed these were reviewed. Managers discussed least restrictive approaches and were actively reviewing restrictions to ensure they remained necessary and proportionate.