Welcome House - Leeza Court

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 Inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to consent.

This service scored 29 (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’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. People’s needs were assessed when they first moved to the service, and we were informed people’s care plans were reviewed every 3 months or sooner if there were any significant changes. However, we found this was not always the case and people’s care plans were not always reflective of their current needs. Several high-risk health conditions had not been assessed and there was no clear plan for how staff would support people with these. Where people’s mental health had declined learning was not taken from any incidents to ensure there was a clear plan and up to date reflection of how staff should support people’s mental health and respond if people were to become distressed or anxious.

The provider did not plan and deliver people’s care and treatment with them, including what was important and mattered to them. We observed people’s care plans lacked sufficient detail about how staff should deliver support in line with clinical advice and best practice. People had complex mental health conditions, but staff were not provided with clear guidance about potential triggers, for example in relation to distress, how they could prevent this, and how to respond if a person became distressed or anxious. There wasn’t a clear or cohesive plan around people’s mental health despite some people putting themselves at regular risk of harm. People lived with extreme risks as a result of their mental health, but the service were not reflecting current best practice expectations for a service of this nature and there was a lack of focus on rehabilitation. Where people lived with other complex physical conditions there was no clear guidance or information for staff on what evidence based practice would be for supporting people safely.

Some elements of people’s care plans provided greater detail which was needed more consistently across all care records. For example, one person was prescribed antipsychotic medication which was to be taken only in extreme distress. There was a clear protocol in placed about when this medication should be offered, and staff were able to confidently describe how they would reassure this person and only used medication as a last resort. A staff member told us, “I would try and talk to them and reassure them. I would only give the medication if they were distressed for 2 days or longer. But I think this is well controlled at the moment”. We could see from this person’s care records that their medication was being managed in line with best practice which focussed on least restrictive interventions first.

The provider did not work well across teams and services to support people. When we asked about how staff would support people around specific risks, we heard differing accounts. This meant we could not be assured people would be supported consistently by all staff. We also received feedback from some staff that they felt not all staff engaged with people in a positive or consistent manner. One member of staff told us, “There are some staff who support (person name) but don’t really engage with them. I have to remind them to speak and talk to them”. We found that guidance and training in place for staff around how to support people was insufficient, meaning we could not be assured people would receive the same support depending on which staff member was working with them or that appropriate professional advice was being sought when required.

The provider did not 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’s care plans did not detail all their health conditions or how staff should support people to manage these safely to ensure they stayed healthy and well. There was also a lack of detail or consistent approach to how individual people’s mental health would be managed. There was a reactive rather than proactive approach to mental health that did not focus on wider wellbeing or provide clear guidance on how staff should respond if somebody were to become distressed. Where people were placed at risk such as through alcohol addiction, physical aggression by people they lived with or experiencing a mental health crisis there was a lack of knowledge or training to consistently support people.

There were some steps taken to promote healthy lifestyles, and the service had worked with people to produce a menu which included healthier options. We also observed people being encouraged and supported to keep mobile and go out into the community. However there needed to be clearer goals and guidance for staff around how specifically people would be supported to have better health outcomes.

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. People had informal weekly meetings with their key worker to discuss their care and a more formal meeting every month. However, we found that some of the key worker reports were almost identical and copied and pasted from one month to the next. There wasn’t always clear evidence of people being actively involved in these discussions or had been engaged to share their thoughts on their care, to ensure it was delivering the outcomes they expected. Some people had clear outcomes set of what ambitions or life goals they wanted to achieve. For example, one person regularly visited their family and was aiming to take part in more tasks for themselves. However clearer detail of how staff could specifically support people to achieve their goals, and how this would be monitored, was required.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. Restrictions in place had not been clearly assessed to demonstrate how a person had been identified as not having capacity to make a decision for themself, or how a decision was in somebody’s best interests. For instance, all the people we reviewed had been assessed as not having capacity to manage their own medication. People had been recorded as not having capacity but then had also been recorded as also having signed a consent form agreeing for staff to do this for them. It wasn’t expressly clear how a person who did not have capacity in this regard could sign such as form, or whether any representatives or advocates had been involved in the decision making. Some documents contained statements referring to people as having fluctuating capacity (which means they could sometimes make decisions for themselves and sometimes could not). However, these were written as personal opinions with no clear evidence of how this had been determined. One such document referred to a person as having fluctuating capacity, despite us being told that other professionals involved in their care disagreed with this statement.

There were some blanket restrictions in place which had not been assessed on an individual basis or respects people as human beings with their own rights. At a recent meeting, people were informed that a management decision had been made that no alcohol could be drunk on the premises for safety reasons. We were not assured this was proportional as not all people were assessed as being at risk in this area. Neither did it appear to respect people’s individual rights and choices to drink alcohol in their place of residence.