Pathway House

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 inspection we rated this key question Requires improvement. At this inspection the rating has changed to Outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s experiences showed the service as exceptional and distinctive.

The way in which people’s needs had been assessed and reassessed was exceptional and had led to some extremely good experiences and outcomes for people. The management and staff team used best practice guidance to support people to have the best experiences of support they could have. Staff supported people to live healthy lives in innovative ways, whilst maintaining and respecting their choices. This had a hugely positive impact for people. People were supported in line with the Mental Capacity Act (MCA).

This service scored 92 (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 always made sure people’s care and treatment were effective because they assessed their needs when they started using the service and reassessed these regularly. As a result of this people had outstanding support. The management and staff team had supported people who had historically found it very difficult to live at services for extended periods of time, to successfully move into the service. It was clear the support people had when their needs were assessed had led to positive outcomes enabling people to settle in to the home for the long term.

One person found transition difficult, so moving to a new service was particularly challenging for them. The registered manager explained how staff from the service had visited the person where they currently lived. The registered manager told us they empowered the staff to complete the assessment of the persons needs and spend time with them, to make sure they knew how they liked to be supported. One staff member said, ‘‘We were the ones who went to visit [person], and we were the ones who made all the decisions. It makes sense as we are the ones who will be supporting them on a day-to-day basis. It was really good to be trusted with this and brilliant [person] has settled into the service so well.’’ By working with the person staff identified the best way to support the person to move into their new home. This involved supporting the person to move in without any visits to their new home in advance (as this would have caused them a lot of upset and anxiety), and to have all of their belongings already laid out for them when they arrived. Staff had also already identified the person’s interests. This meant they had a detailed plan on how to support the person to move into the service enabling them to see straight away that they would be supported to follow these interests. This had not been happening for the person in their previous placement. As a result of this the person had a fantastic experience and has been living at the service for an extended period of time. The person’s relative said, ‘‘[Family member] has finds even going to a place for a short time quite difficult so they fact they have settled into [service] so well is testament to how well the staff have supported them. It is lovely to see them living at the service and they are very happy.’’

Another person’s assessment of their needs had shown they needed a high number of staff to support them both in the service and when out in the community. When they moved in the management and staff team ensured they had enough personal space at the service as this was important to them. They also made sure the person had staff available to support them to leave the service at any time they chose to do so. As a result of effectively identifying these needs via assessment, the person had successfully started living at the service and had lived there for a very extended period of time. The impact this had for the person was exceptionally positive as previously they had found it difficult to stay at a service for any length of time.

The management and staff team reassessed people’s needs regularly or when they changed.

The provider was exceptional in planning people’s care and treatment with them, including what was important and mattered to them. They always did this in line with legislation and current evidence-based good practice and standards.

The management and staff team were passionate about supporting people in line with currently recognised best practice. A key value of the provider was supporting people to live the best lives they could and making sure staff were up to date with evidence based best practice to best support people. For example, in the past people had needed physical support to stay safe when they felt upset or anxious. As a result of staff training and understanding of people, the times where physical support was needed had reduced significantly and stopped in some cases. The registered manager said, ‘‘Physical intervention is a last resort at all times. We make sure staff know how to support people in other ways, such as talking to them and taking every measure can to make them feel better.’’ On the rare occasions where physical support was needed, a thorough investigation took place to see if anything could be done differently and to reduce future occurrences. These investigations were very detailed, and staff were encouraged to feed back and speak about their experiences. Learning from these occurrences was used to inform best practice and reduce the need for physical support. As a result, people had far fewer occasions where they needed physical support to feel safer. One relative said, ‘‘The service is very good. [Family member] feels 100% safe and no longer needs constant physical support to stay safe. This was the case for a long time so a massive well done to the staff team.’’

The management and staff team fully understood the importance of STOMP (Stopping Over Medication of People with a learning disability, autism or both with Psychotropic Medicines). This was a key value of the provider. People were living with support needs which could be quite complex, putting themselves or others at risk. They were therefore prescribed medicines to help them feel better when they were anxious or upset. Historically these medicines had been administered frequently, however staff were aware that it was more beneficial to support people in other ways. Due to the relationships staff had built with people, the need for these medicines to be administered had reduced significantly. People felt safe and well supported at the service and staff were proud to be able to support them without the need for these medicines. This had an extremely positive outcome for people. One relative said, ‘‘[Family member] has gone from strength to strength and staff know them so well now. They are able to help them out without the need for medicines. This has been great and [family member] is so much happier and much less tired.’’

The management team kept up to date with best practice by attending forums and learning events. They shared this with the staff team. The staff team spoke knowledgably about their training in area such as supporting people living with a learning disability and the MCA. This meant people could be supported with best practice. One person said, ‘‘Staff are good. Know their stuff.’’

The provider worked well across teams and services to support people. Staff were positive and complimentary about their colleagues and how well they worked together. They told us they pulled together to support each other to help ensure people received the best care possible. People were visibly happy being supported by the staff team and knew each of the staff who supported them well. Staff worked well with other professionals such as GP’s and nurses and followed their advice when it came to supporting people.

The provider always supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff consistently supported people to live healthier lives and where possible, reduce their future needs for care and support.

Without exception, people had been supported to become healthier whilst living at the service in all areas of their support. People, had in the past, been reluctant to take part in exercise or make healthier food choices to support them to have better physical health. The management and staff team recognised the importance of people having better physical health, whilst still making sure they were fully in control of their choices in relation to this. One person had been supported to chooses how they would like to exercise and had chosen to do what they called ‘laps’ around the local community. This had been discussed and agreed with the person over a long period of time. As a result, the person had become much healthier. They told us, ‘‘Went for a walk, 2 miles. Got out of puff (breath). Feeling good!’’ Another person had been supported to walk and use public transport to travel and as a result had also gained a lot of positive health benefits. This had involved a lot of support from the staff team, starting with small steps of walking a short distance, eventually building up to the person walking long distances and using public transport. The person was now feeling much healthier and visibly looked forward to, and was happy to be out and about using public transport on a daily basis.

The staff team had also supported people to try healthier food choices and have healthier diets. This required a lot of intensive support and work with people who found it more difficult to make healthier choices and were very particular about the food they would eat. By slowly introducing new foods to people, or incorporating healthier choices into their preferred foods, people had been supported to become healthier but also maintain and be in control of their food choices. We observed people happily helping to cook meals and documents had been produced for people to explain and help them understand what made food choices healthy. One relative said, ‘‘When I think of how [family member] would only eat [food] all the time and what they eat now it is nothing short of astounding. Its great that they are looking and feeling better too.’’

Staff had also worked with people to greatly improve their mental and emotional health and wellbeing. People were living with support needs that could be described as complex and as a result were at high risk of social isolation or refusing to take part in day to day life and living skills. Thanks to the support of the staff team, people no longer isolated themselves as frequently and took part in more day to day living skills both in and out of the service. One person was now actively seeking out staff to speak and interact with them and were visibly very happy and relaxed. They happily showed us around the service for short periods of time and were happy and relaxed doing so. The person was also no longer reliant on medication to help them feel better when they were upset. The support staff had given the person had changed and hugely improved their life.

Another person had been supported to discuss how they were feeling with the staff team and agree some actions they could take to feel better. This had a very positive impact for the person who now went out into the community to pursue their interests on a daily basis, which is something they had found more difficult to do in the past. A relative said, ‘‘The service has gone from strength to strength. [Family member] is out and about all the time now and the difference in their [mental health] has been incredible.’’

The provider consistently monitored people’s care and treatment to continuously improve it. They always ensured that outcomes were positive and consistent, and they met the expectations of people and their relatives.

People living at the service had been supported to achieve incredibly positive outcomes. People were living with support needs which made it more difficult for them to manage how they were feeling when upset or anxious. Completing daily living tasks and going out into the community had in the past been a very difficult thing for people to do. In previous services, people had not been supported with this and as a result had become isolated and withdrawn. This was no longer the case and as a result people were happier and were living lives in they ways they chose and made sense to them.

Staff had worked with people to identify their favourite past times and how they would like to spend their time. They had then used their knowledge and understanding of people’s individual needs to help them achieve their outcomes. One person had found it difficult to go out of the service where they were living. Staff identified the reasons for this and worked with the person, giving them full control of when and how they left the service, whilst also adhering to some guidelines to support them to understand the importance of not isolating at home all of the time. As a result, the person’s mental and emotional health had improved, and they were steadily increasing their confidence in leaving the service and exploring the community. They now independently went shopping and out for meals. A staff member said, ‘‘When [person] moved in they found it hard to tell us what they wanted to do and where they wanted to go. They are a different person now. They still need their space but we are always on hand whenever they choose to head out. We do not have any incidents anymore. It does make you feel proud and that you are making a difference.’’

Another person had historically found it more difficult to leave the service as they found being in the community overwhelming. Thanks to the support of the staff team the person was now accessing the community on a daily basis and were a lot happier as a result of this. Newer staff were surprised when they found out the person did not previously leave the service, as they were now much more active and involved in the local community. For example, they travelled on public transport and went to a gym and swimming pool. They told us, ‘‘I am out all the time. I go to [places] with the staff team. Its always good. I really enjoy it.’’

Another person had been supported to take part in daily living skills such as cooking and cleaning, something they had not been supported to do for many years in other services. Staff had supported and worked with the person, and they now took part in cooking and cleaning. We were shown pictorial evidence of the person doing this and they were clearly very happy and relaxed. This meant a lot to the person. A relative said, ‘‘The staff are tireless in their efforts to help [family member] do what they want to do when they want to do it. Even if it takes a long time they get there eventually. It is brilliant.’’

Staff worked with health professionals to help improve people’s outcomes in relation to their physical and mental health and wellbeing. Advice from professionals was recorded in care plans and monitored by the management team.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff were trained in the MCA and knew the importance of this legislation and making sure people were asked for consent whilst being supported. The management team completed assessments and made decisions in people’s best interests if they lacked the full capacity to make decisions themselves. We observed staff asking people for consent and offering them choices in all aspects of their lives as they supported them.