United Response - 66 & 66a Lemsford Road

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 inspection 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 consent to care and treatment.

This service scored 46 (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.

There was a lack of clear and comprehensive care plans in place. The plans that were available did not consistently cover all aspects of people’s assessed needs, which meant staff did not have the necessary guidance to deliver person-centred care. This posed a risk that people may not receive the support they require in line with their preferences and needs.

The manager acknowledged that there were gaps in knowledge about the people using the service and they were contacting people that were important to them to get historical information about what is important to them. They were actively working to address this by engaging with staff who knew individuals well, to build a more complete and accurate picture of each person’s needs and preferences.

The provider planned and delivered people’s care and treatment. Where people had specific needs around nutrition and hydration, staff were knowledgeable and able to describe how they supported individuals appropriately, although this was not always reflected in care documentation and as a result where new staff came in this may pose a risk to individuals.

The provider started to work across teams and services to support people.

Staff told us they worked well together to support people, and we observed positive teamwork during the inspection, reflecting a shared commitment to delivering care. The manager acknowledged gaps in staff knowledge about individuals and was working with staff who knew people well to build a clearer picture of each person’s needs.

Peoples care plans lacked information about their long-term aspirations and dreams, as a result people did not have clear plans in place to share with services to help them achieve their goals.

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 were supported by staff who actively involved health professionals when people needed them. Staff described what they would look out for if the person needed health intervention. During the inspection the management team were actively consulting with professionals to review their health and wellbeing, with the hope that having up to date assessment of peoples health needs will help with having more positive outcomes for people.

The provider did not 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.

Care and support plans failed to reflect people's aspirations and future goals or focus on people's quality of life outcomes. This was evident when observing staff taking an active role in people's day to day life and not encouraging independence. For example, staff were doing household chores and making drinks without involving the person.

Although some people were supported to take part in activities they enjoyed, there was a clear disparity in experiences across the service. Not everyone had access to meaningful or fulfilling activities, and there were several occasions where individuals were not engaged in anything purposeful throughout the day. This inconsistency meant that some people were at risk of social isolation and lacked opportunities to develop skills or pursue personal interests.

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

People were not always empowered to make their own decisions about their care and support. Records showed that staff were not always actively encouraging people to be involved in their care and choices were not always offered. We observed some staff giving choices to individuals; however this was not always the case. We found examples where one person did not leave their house in a number of days.

While some MCA assessments were in place and demonstrated a good level of detail, there were several instances where assessments were missing. This meant that decisions may not have been made in line with legal requirements.

Restrictive practices were observed without clear evidence that they had been considered in the context of the individual's best interests. There was a lack of documentation and oversight to ensure that such practices were necessary, proportionate, and legally justified.