Turning Point - Parkview

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• 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 good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to person centred care.

This service scored 32 (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 make sure people were at the centre of their care and treatment choices. The culture of the service was task focused, and staff prioritised cleaning and household tasks over engaging with people. The systems in the service compounded this. For example, a shift planning document only identified tasks such as cleaning and cooking and did not include engagement with people or plans for going out. The new team leader said they were aware of this and recognised the change in culture would be better supported if documentation placed emphasis on engagement with people and meaningful occupation. However, action had not been taken to address this. The team leader was modelling good practice and encouraging staff to document engagement with people. Although we saw some individual staff were making steps towards the change in culture, this was going to take time to make the significant improvements required across the whole team. The locality manager confirmed they had plans to provide training and coaching to staff with support from a national organisation that promotes inclusion and choice.

There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. People did not have sufficient opportunities to develop links with their community and most people spent much of their time on the premises. People were sometimes unable to attend their day service because staff or transport was not available. On our first site visit, staff told us this was because the minibus required repair, then there were not enough staff who had passed the test to drive the minibus. Following our assessment, the provider told us the reason for non attendance could be due to how a person was feeling on the day and on those occasions alternative activities were provided. However, evidence provided did not provide details of what people did instead in some instances. Relatives also commented that people did not have enough opportunities to go out, despite them enjoying trips out when they did have the chance to go.

People were mostly supported by a consistent staff team to promote continuity of care. People were supported to attend appointments and the staff team shared information appropriately with others involved in their care.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Most people’s care plans identified their communication needs including the need for aids such as visual planners, pictures or signs. However, we did not observe these being used at any time during our site visits. An activity planner displayed on the wall showed no up to date options for people to do and just contained photographs from a craft activity that took place months earlier. There were no pictorial menus offered to people to help them make choices about meals, although staff did tell us they offered a choice to people. However, we observed staff appeared to guess which option people would like. The team leader confirmed work was in progress to develop visual communication aids and for staff to be encouraged to use these when supporting people.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. Although care plans provided guidance to staff about how to communicate with people effectively, they did not follow this during our site visits. Feedback about communication with the service was mixed. A relative said they were, “Not generally contacted by the home except for one review a couple of years ago – but in general no. No regular updates.” Another relative said, “I sent a couple of emails, not had anything back – just need a little update - never had phone call”. However, another relative said, “They do keep me in touch with any of [Family Member’s] requirements.” Where relatives had raised concerns, they did not always feel they were listened to and acted on. A relative said, “Lots and lots of other things we are unhappy with and have told them time and time again please don’t do this…but they don’t take any notice or don’t pass it on. “

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. The people living at the service had complex support needs and most of them had lived for many years within a health and social care environment. There was a lack of curiosity driving the delivery of their support which resulted in expectations of their quality of life being poor. As a result, the service had not always done everything they could to address barriers to good care and a high quality of life.

The premises were accessible and met people’s physical needs.

Staff did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. All the people using the service were at risk of inequality in experience and outcomes. They relied very much on staff to understand their needs, how they communicated their preferences and emotions and how support responded to this. Support was task focused and did not consider fully the preferences of those using the service. People were not supported in line with the Right Support, Right Care, Right Culture guidance which lays out the expectations of services for people with a learning disability and autistic people. This meant people were not experiencing the equity in experience they had a right to expect along with all people using this type of service. Although staff had received training in equality, diversity and inclusion and work was planned to develop the culture of the service as well as staff skills, this had not taken place yet, and people continued to experience inequity at the time of our assessment.

People were not 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. Only 1 person living at the service had an end of life support plan. This had been completed by staff at their previous service several years ago and had not been updated. The provider had developed guidance for staff in relation to person centred end of life care. However, this had not been implemented yet at the service. This meant people were at risk of having care at the end of their life that did not meet their needs or preferences or bring them comfort in a way that was meaningful for them. Following the assessment the provider confirmed they had started work with families to develop end of life plans for people.