43 Station 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 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 person centred care and good governance.

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 make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with others.

Relatives told us they were not routinely involved in care planning and had not always been given the opportunity to see care plans or contribute to discussions when people’s needs changed. The provider told us they were reviewing one-to-one hours ensure they were meeting people’s current needs.

Managers told us they had recently spoken with families to obtain more information about people’s life history, key information and organise meetings before the next annual reviews. Care plans contained detailed assessments that captured the full range of people’s physical, emotional and communication needs. This included health action plans and guidance within support plans to ensure staff followed best practice and minimised risk. This also included the use of equipment which was personalised to people.

Staff did not always deliver people’s care and treatment in line with best practice.Staff we spoke with were not aware of Right Support, Right Care, Right Culture guidance (RSRCRC). People’s preferred ways of spending their time were not fully understood or planned for.

There was little evidence of structured or planned opportunities for people to go out and do things they enjoyed. Records showed that one person took part in three structured community activities. On a further seven occasions, they were transported to locations where activities were taking place for others but were not supported to participate themselves. Although there was an activity schedule in place, records indicated that the remainder of the person’s time was largely spent watching television. There were only two recorded occasions where the person had been supported to take part in baking activities. This meant there was an increased risk of people experiencing social isolation and limited meaningful engagement.

One relative told us, “I would like [the person] to go more often. It's been over 2 years since [person’s] last meeting, and I have asked if I can attend one”. The manager recognised that opportunities to go out was limited and they were taking steps to explore more options to expand people’s opportunities to get involved in their local community or maintain local community connections.

However, a professional told us that the service had been open to exploring suggestions of new things for a person to do. They commented that over the past few years, through staff engagement, the person was spending less time in their bed and walking more. Staff understood people’s routines and worked with people to support their day-to-day needs.

Staff worked well across teams and services to support people.

Systems were in place to support effective staff communication, including timely sharing of changes to people’s needs. Staff had regular handover meetings to share information. Staff recorded daily interactions, including an overview of what had happened during the day. Staff collated information into a hospital passport to provide healthcare professionals with essential information about people’s needs, wishes and preferences. Records also included outcomes from appointments with healthcare professionals.

We saw staff communicated well with each other and planned what was happening with people. One staff member told us, “My colleagues have been amazing and I will always ask to confirm how to do things. They never mind and I see that as good teamwork.”

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.

We received mixed feedback from relatives regarding how people were supported to maintain their health and wellbeing. One relative told us their family member was not being supported to maintain a healthy weight and had repeatedly asked the provider to increase the person’s physical exercise. However, another relative said their family member had gained weight appropriately and was supported to follow a well-balanced diet. We found that whilst people’s weight was monitored, support plans did not always include what an ideal weight should be for people.

Since the visit, the manager has arranged meetings with relatives to discuss their concerns and clarify support plans with the aim of embedding consistent practice. Support plans clearly described each person’s health conditions and risks. These included guidance from healthcare professionals and preferences for meeting people’s needs.

People were supported to attend regular appointments with healthcare professionals, with outcomes included in their records. Medicine support plans were reviewed in line with best practice.

The provider did not always monitor people’s care and treatment to continuously improve it.

People were assigned a key worker to complete monthly reviews. These records contained ‘yes or no’ responses with limited explanation. There was little evidence of how staff worked together with people to review any changes in needs, risks or wishes. This meant people were not always supported to expand their opportunities and experiences that could improve outcomes for them. Since the visit, the manager has held a team meeting with staff to outline what records should include and the written standard expected.

Relatives also told us they were not involved when there were changes or reviews. One relative said, “We have annual reviews, but I do not know what the support plan is and they do not run things by me.” The manager told us that since our assessment, they had organised one-to-one meetings with relatives to build a relationship and prepare for annual reviews, which have been scheduled.

People had Health Action Plans, which outlined their healthcare needs and how they would be supported to achieve good health outcomes. This involved booking appointments when services would be quieter or organising home visits to improve people’s access to healthcare.

People were supported to make their own decisions and staff respected their choices. However, documentation did not always clearly record how people were informed of their rights.

Where people lacked capacity to make specific decisions, we found that documentation did not clearly demonstrate how decisions about care and treatment were made in the person’s best interests or how the person was involved. This meant it was not always clear how consent was determined when the person was unable to provide it.

Support plans included information about the level of support people needed to make decisions. These also highlighted when best interest decisions would need to be considered for people. Records showed how people were given choices of food, although this had not been applied to other areas of their records. However, staff understood that decisions must be made in people’s best interests and in the least restrictive way. We saw staff offered people choices and gained consent prior to supporting them.