Newgate Lane

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

This service scored 62 (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, well-being and communication needs with them.

Initial referral and assessment reports included detailed information about people’s care needs, which helped staff develop effective care plans. For example, people’s cultural and lifestyle preferences, their background, health and communication needs, any risks and their hopes for the future were included. Assessments were reviewed and updated when their needs changed and utilised to update their care plans.

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.

Policies and procedures supported the effective management of nutrition and hydration needs, in line with national guidance. Where appropriate, other specialist healthcare professionals were involved, including the Speech and Language Therapist (SALT), particularly for individuals with swallowing difficulties or communication needs.

Medication reviews were routinely undertaken, and adjustments were made in line with the principles of STOMP (Stopping Over-Medication of People with a Learning Disability, Autism or both). This included safe reduction or discontinuation of medicines where appropriate.

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.

Relatives told us that there was effective information sharing with them to keep them up to date and involve them in planning people’s care. Staff worked closely with a range of care professionals and multi-disciplinary teams including the Learning Disability Team and the local authority in the provision of people’s care. Support from specialist teams was sought when required, for example the Speech and Language team [SALT] and the Dementia pathway. People were supported by staff to maintain important relationships.

Staff responded proactively to changes in people’s health and well-being. For example, following a recent dementia diagnosis, one person received enhanced support through close collaboration with healthcare professionals. Staff also introduced a personalised memory book to aid orientation and offer reassurance. Another person who was experiencing distressing tremors benefited from a thorough review of their medication. Through multidisciplinary input, their treatment was adjusted and ultimately discontinued, resulting in a reduction in symptoms.

Staff told us “We work well together. Any updates are put on [the electronic system] and we can verbally communicate through handover at the beginning of the shift.” A professional told us “The home manager was always available to provide additional information and to share with the team the provided feedback and advises.”

The provider supported people to manage their health and well-being. Staff supported people to live healthier lives.

People were supported to attend their annual health checks with their GP. Support plans reflected individual’s choices to pursue healthier lifestyles, including support with menu planning, food shopping, and participation in community-based weight management programmes.

A relative told us “If I’m worried about [person’s] health, they contact the doctors, they’re really on top of it.”

The provider used effective monitoring systems to improve care quality and support outcomes that mattered to people. They ensured outcomes were both positive and consistent, aligning with best practice and each person’s individual goals and preferences.

Staff monitored people’s health and had risk management plans in place to support monitoring and improving people’s health outcomes. People had goals related to their health, such as weight loss where this increased a person’s risk. For people identified as being at risk of urinary tract infections, hydration monitoring was in place, with records used to reduce the risk of dehydration.

These responsive and personalised interventions contributed to improved emotional well-being and enhanced quality of life for people using the service.

The provider did not tell people about their rights around consent. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who lack capacity. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make a specific decision, any decisions made on their behalf must be in their best interests and as least restrictive as possible.

We found the service did not always support people in line with the MCA, and consent to care and treatment was not always sought in line with law and guidance. The provider was in breach of legal regulation in relation to need for consent.

Consent was not always obtained or recorded in line with relevant guidance and legislation. Some mental capacity assessments reviewed demonstrate a starting assumption of a lack of capacity. For example, in one person’s assessment where it asks, “what is the information which needs to be understood, it states “if [name] was asked why they live in a residential home, [name] would not have the capacity or understanding to answer the question.”

Where best interest decisions were made, there was no evidence of whether, other less restrictive options had been considered. For example, use of a sensor mat and limiting a person’s access to certain drinks. Although the provider told us the person was not restricted, we observed a staff member stop them from having a drink until prompted by a manager. We also saw an entry in their daily care notes which described an instance where they had become distressed when they were not allowed another drink. This meant that people were not consistently supported to make their own choices, and decisions made on their behalf did not always reflect the best interests or protect their rights.

Staff and leaders did not demonstrate a robust understanding of the Mental Capacity Act (MCA) 2005.