The Laurels

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 was inconsistent.

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

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 always make sure people’s care and treatment were effective because they did not always ensure their needs and preferences were reviewed regularly. Whilst people’s needs were assessed and included consideration of their physical, mental health, sensory, social and communication needs, we found the information was not always sufficiently detailed, or up to date. Where reviews had taken place, these were not always meaningful, for example many stated, ‘no change’ but there was no other detail to evidence care plans were thoroughly reviewed to ensure they were effectively meeting people’s needs and individual outcomes as expected. They often included the same protocols or targets as previous versions. Review dates were inconsistent, and some areas of people’s care plans were not reviewed for several months. Staff did not always keep clear, detailed daily care records to support reviews, or monitor for changes. This included where people were prescribed a particular food type, notes did not evidence that foods were prepared inline with their assessed needs. There was limited evidence that people were supported in shared decision-making and goal setting to determine the plan of action they needed to move forward or achieve goals.

Nationally recognised assessment tools were used to assess and monitor people’s needs, for example, MUST (malnutrition universal screening tool) and Waterlow (a risk assessment tool to identify individuals at risk of developing pressure ulcers). However, people’s records did not always show that these were reviewed at regular intervals when they had these assessment tools in place. People had enough to eat and drink to prevent malnutrition or dehydration. Records showed people had choice in what they wanted to eat. However, where one person was having foods in line with IDDSI (International Dysphagia Diet Standardisation Initiative) staff did not always record this accurately to show the food prepared was in line with their assessed needs and IDDSI levels.

Where people had more complex health needs we found these were recorded accurately within their care plans, and we saw that people attended hospital appointments and had specific treatments when needed. The service supported a person who used advanced seizure detection technology which reflected best practice and specialist input. This enhanced the person’s safety during sleep and periods when the person was less supervised. There were letters from health professionals praising staff and the way they recorded specific events such as seizure logs, which helped health professionals formulate on-going treatment plans. Other letters from professionals included reference to the positive relationships staff had with the people they supported.

The provider worked well across teams and services to support people.Staff worked with a wide range of health and care professionals including community learning disability nurses, speech and language therapists, and hospital specialists. People had hospital passports but several required updating because some of the information was not clear. These are documents that contain vital information about a person’s health, well being, and communication needs. They are used if a person is admitted to hospital so that hospital staff can meet the person’s needs appropriately. The deputy manager began updating these on day 1 of the assessment. A health professional told us, “They seem to know when to refer people for further assessment, and the main core staff know people well.” Another told us, “There have been some issues with having up to date information, certainly earlier in the year, but I think things are improving now.”

Whilst documentation was lacking in some areas of people’s care records, staff supported people to live healthier lives. People accessed healthcare when they needed it and were supported by staff who knew them well. Some people had very complex health conditions and disabilities, but these aspects of people’s care were described well within their care plans.The service identified risks to people’s health and well being and prioritised support to prevent deterioration as much as possible. For example, supporting people to remain as active and mobile as possible. One person required daily walks to maintain their mobility and records showed this was provided daily. While formal reviews within activity planners were not always recorded, people’s activities were routinely reviewed using alternative documented systems, such as people's response to certain activities, and their level of engagement.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. For example, care plans were not always reviewed robustly to evidence they were meeting people’s needs and that they were still relevant. Care plans contained limited detail on people’s goals or longer-term aspirations and therefore there were no measurable achievements to track progress. There was limited evidence that people’s skills and strengths were discussed with them and those involved in their care, to understand how people’s short, mid and long-term life choices, goals, ambitions and outcomes could be planned and achieved. The registered manager told us that some people were getting older, and they liked a quieter life, but there was no evidence of discussion about people’s preferences. People accessed healthcare services for their physical and mental well being.

The provider did not always tell people about their rights around consent. On reviewing people’s care records, we found the quality of completed mental capacity assessments (MCA) varied greatly. Some MCA’s were reflective of good practice, for example, outlining different options and why each one was discounted or agreed. Others contained irrelevant information or did not show that they were person-centred, for example, incorrect name of the person documented. Some had not been reviewed for over a year. Where the MCA asked if less restrictive options had been considered, or how the person may feel or react about the decision,‘not applicable’ was sometimes documented. This did not reflect the principles of the Mental Capacity Act 2005.We found that for some people who had restrictive measures in place, such as movement sensors,there was no MCA in place to ensure this was the least restrictive option.

We also observed good practices. People chose where they wanted to have their meals, where they wanted to relax, and what activities they wanted to do.Records showed people chose what time they got up in the morning, staff would check if they were still sleeping, and if so,they returned later.A staff member told us,“We always let the people we support choose what they want to do.”