Rose Belle

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 provider was in breach of the legal regulation in relation to the need for consent.

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.

Staff knew people well and considered people’s physical, mental health, communication and social needs, however, we found that care records were conflicting and it was not always clear what actions had been taken to ensure people’s needs were being met. For a person who was at risk of choking, a referral had not been submitted to the Speech and Language Therapy (SALT) team. This has been addressed with the provider who has now made the appropriate referral.

Feedback we received confirmed people and their relatives were kept up to date with any changes to the people’s needs. The registered manager told us they were in the process of transferring all information onto electronic formats and developing a clear reviewing tool for ongoing reviews of care plans and risk assessments.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care plans and risk assessments did not demonstrate how often they had been reviewed and updated. Some people had complex health conditions and regular reviews ensured the care provided met their changing needs.

Staff told us they were kept up to date with people’s needs via handovers and staff meetings; however, the provider was not ensuring care plans and risk assessments reflected this. Comments from staff included, “Any changes in health or risks are shared promptly. Care plans are updated regularly.”

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.

Professionals told us communication was clear and timely. One healthcare professional told us, “Staff will contact us if there are any changes or if they have any queries. Any information we request is always returned in a timely manner without the need for chasing.” We saw evidence of health passports in place for people. These are documents which contain information such as communication and health needs and any reasonable adjustments health and social care professionals need to be aware of, to ensure people get access to the right care and treatment.

We saw evidence of staff attending team meetings, and feedback we received from staff was positive around information sharing and the team working well together. Comments included, “There is good communication between staff.”

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

People had access to external healthcare professionals such as GP’s, dentists, and other community professionals; however, we did not always see if referrals were being made. For example, one person required a referral to the SALT team, but it was not clear that this had been done.

During our onsite inspection we did observe staff responding to people’s needs and activities were taking place. We observed staff out in the garden area with people and people were assisted with accessing the community.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff were aware of people’s needs; however, it was not always clear what monitoring was in place for some people. For example, 1 person with diabetes did not have a specific risk assessment in place for the management of their diabetes and what signs and symptoms staff should be aware of in the event of them experiencing complications relating to their diabetes.

Feedback we received from relatives with regards to raising any concerns was positive and relatives felt they were able to speak to management. Comments included, “I feel that management is approachable and they care about what we, the family, has to say.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider had completed Mental Capacity Assessments, and these had recently been updated and review dates were in place. However, it appeared that only the provider had been involved in the assessment, excluding other key stakeholders. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the capacity to do so for themselves. The Act requires that as far as possible; people make their own decisions and are helped to do so when needed. When they lack capacity, any decisions made on their behalf must be in their best interests and as least restrictive as possible.

Care plans we reviewed stated that the person’s representative had been consulted to obtain consent for aspects of care and support such as medication administration and personal care, however we did not see evidence of the signed forms referenced within the care plans and it was not clear when reviews of care plans had been completed.

We observed people being offered choices and staff sought consent from people prior to supporting people, during our onsite inspection.

Most staff had received training in the Mental Capacity Act 2005 (MCA); however, we did identify some gaps within the training matrix for 4 staff members. The provider is in the process of ensuring all staff training is up to date.