TheSignLife Project

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.

This is the first assessment for this service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. Care plans lacked person-centred detail and did not consistently reflect individuals’ preferences, cultural or religious needs, or their own voice. Goals were present but lacked clarity on progress, review, or personal relevance. This oversight to deliver person-centred care risks undermining individuals’ autonomy, dignity, and wellbeing. The service was in breach of legal regulation in relation to person-centred care.

This service scored 58 (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 consistently check and discuss people’s health, care, wellbeing, and communication needs with them.

Care plans lacked personalised detail. For example, the daily routine was listed in bullet points in care plans, which made it easy to follow, but did not explain the level or type of support required or reflect their preferences. This limits person-centred planning and may affect the quality of care delivered. Mental health needs were not clearly documented. One person had a severe and enduring mental health condition managed by external professionals, but there was no guidance for staff on signs to look out for or who to contact if concerns arose. Although the condition was briefly mentioned in a risk assessment, it was not reflected in the “About Me” section or elsewhere in the care plan, which could impact emotional wellbeing. Staff had access to the care plans of the people they supported. However, a relative told us they no longer had access to the care plan since the service moved to an electronic system, which may limit their involvement in care planning. Care plans included a section for review dates, but all were marked as “ongoing,” making it unclear when reviews had taken place or were due. The manager stated reviews occurred every 3–6 months, but a relative reported that care was only reviewed annually. This inconsistency increases the risk of outdated care planning.

Communication needs were noted, but there was no guidance on how to support individuals, particularly those who are deafblind, in practical situations, such as alerting them when someone enters their home. While staff appeared to know people well and were able to describe how they would alert individuals, the lack of documentation poses a risk if unfamiliar staff attend or in emergencies.

Risk assessments referenced capacity but lacked detail on how staff should respond to specific behaviours. For example, one person was described as potentially “switching off” but there was no guidance on how to manage this safely or what this meant for the person or staff supporting them.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care plans lacked detail about people’s preferences and the type of support needed with nutrition and hydration. For example, while care plans noted tasks such as “support with breakfast,” they did not explain what this support involved or reflect individual choices. This limits the ability to deliver care that is tailored and person-centred. No individuals were identified as having specialised diets or risks of dehydration or malnutrition at the time of inspection.

Staff supported individuals to access the food and drinks they required, and one relative told us staff “just got on with it” and seemed confident in their role. Staff were aware of people’s eating habits and worked with them to encourage safe practices, such as reminding them to take their time when eating.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing assessments and coordinating care when people moved between services.

Staff supported individuals to attend medical appointments and ensured interpreters were present when needed. One daily log noted, “When we went into the appointment, there was an interpreter there waiting, she was a good signer.” Another entry described how the provider contacted a GP to book an appointment but then rearranged it to ensure a BSL interpreter was available, showing proactive coordination. Staff confirmed they help people with personal matters such as arranging doctor’s appointments. A relative told us, “Staff have supported [person] to the doctors to support them when I am not able to.” Updates from the office were shared with staff via text, video, or through the app, depending on relevance to their shifts or the people they support. This helped ensure staff were kept informed and could respond appropriately. While we were unable to obtain direct evidence of relationships with other healthcare professionals, staff appeared to work collaboratively and people looked well and supported.

The provider supported people to manage their health and wellbeing to maximise their independence, choice, and control. Staff encouraged people to make healthier choices and supported them to live active and fulfilling lives.

Staff promoted healthier habits by encouraging people to drink more water and make informed choices about food and fluid intake. One relative told us, “The staff encourage [the person] to drink more water and so now they carry a 2L water bottle everywhere they go.” Staff supported people to access the gym, swimming, college, and community activities. One staff member said, “ They [Person] loves to go out. I take them to college.” Another described how they supported a person with personal care by explaining the importance of hygiene and offering choices, such as whether to leave the door open or closed, helping the person feel more comfortable. People told us staff encouraged them to choose water over sugary drinks, and staff were able to describe how they supported individuals to take their time when eating.

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

Care plans lacked person-centred detail and did not consistently reflect individuals’ preferences, cultural or religious needs, or their own voice. Goals were present but lacked clarity on progress, review, or personal relevance. One relative told us they were unaware of any goals being set and felt that having clear goals would be beneficial. This raises concerns about whether goals are meaningful or tailored to the individual.

Feedback was gathered during reviews, but the manager confirmed this was done in sign language and not written down, limiting the ability to track and act on feedback. A relative confirmed they were asked for feedback during reviews. While documentation was lacking, staff appeared to be considerate of people’s wellbeing. One staff member said, “I encourage them to pursue their goals and ask them questions to help them make the right decisions... I listen to what they want and need and then find a way to make this happen.”

While staff demonstrated a commitment to improving people’s lives, the lack of structured monitoring and documentation limits the provider’s ability to consistently evaluate and improve outcomes.

The provider did not always document how to tell people about their rights around consent.

Care plans did not include enough detail about how people communicate. For example, one care plan mentioned that they use British Sign Language (BSL) and that staff should check their understanding, but it didn’t explain how to do this in practice. For example, it didn’t say that the person often repeats questions in BSL or that they respond better when given two clear choices instead of open-ended questions. Without this information, staff may not support the person in a way that helps them understand and feel comfortable. Although the person had been assessed as having capacity, there were some situations, like managing money or making healthy food choices, where they might not fully understand the risks. Staff followed the wishes of a relative, who said the person was independent in making choices. However, the person had limited communication and sometimes didn’t remember what had been discussed. This meant they might not always be able to make informed decisions, and could be at risk of decisions being made without the right support. Another care plan also didn’t explain how staff should get consent before giving medication. One staff member told us, “I will ask for consent through tactile signing. I will explain what the medicine is for and what I am giving.” While staff showed they were trying to support the person respectfully, this wasn’t clearly written in the care plan. This could lead to inconsistent practice or confusion for new staff.