ivolve Suffolk Supported Living

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 newly registered 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.

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 assessed and reviewed people’s health, care, wellbeing and communication needs as part of care planning. However, we received inconsistent feedback from relatives about the care plans with some telling us that they had not seen the care plan or did not feel actively involved in its development.

Care records included comprehensive assessments and plans. Care plans were clear and gave guidance to staff about people’s individual needs and preferences. These were regularly reviewed and reassessed. Staff told us they received clear information about people’s needs and demonstrated through discussion that they knew people well. Hospital passports were in place to ensure a smooth transition to hospital.

The manager assessed people’s needs before they started using the service to ensure their needs could be met. People’s compatibility was reviewed as part of the initial assessment and on an ongoing basis.

In line with best practice, greater ambition is needed to ensure that people fulfil their aspirations and thrive in a supported living environment. There was not always agreement about what was in people’s best interest and how goals should be achieved.There were gaps in the setting of short and longer term goals and there was not always agreement about what was in people’s best interest.

The provider routinely monitored people’s physical needs and treatment to ensure good outcomes. People with specific health needs had care plans which reflected national legislation. People were supported to participate in national screening programmes such as bowel screening.

Staff knew people well and supported them to maintain relationships which were important to them. For example, staff facilitated regular pub lunches for one person with a family member who lived some distance from their home.

Visiting professionals who were contacted as part of the assessment process did not raise any concerns about how the service interacted with them.

The service worked with a range of health and social care professionals to ensure people received safe, joined-up and effective care. This included social workers, physiotherapists and dietitians. We saw from documentation viewed that staff made appropriate referrals to professionals as and when needed.

Professionals were enabled to visit people in their own home where people were more comfortable with this. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Care plans were accessible for staff and the provider used a mobile phone app so that information and updates could be checked at any time. However, we received inconsistent feedback from relatives about how this worked in practice, and they told us that communication between the staff team was not always effective which impacted on their family member. For example,one relative told us that information was not always passed over to new staff coming on duty, so they didn’t know what was going on. Another relative told us that when they provided information it was acknowledged but not always responded to.

The service supported people to live healthier lives. People’s records included important information about their health conditions and instructions for staff on how to reduce risks and support people’s health and wellbeing. Staff kept clear records of health appointments and advocated on behalf of people where necessary. One member of staff for example had changed their working pattern to support one person attend the optician.

One relative told us, “Yes, they support [my relative] very well, they always have staff with them who know [my relatives] anxieties when visiting the hospital. They organised a chiropodist to come to the house as well.”

People were supported by a consistent team of staff who knew people well and they were alert to changes in their wellbeing. Staff consulted with other professionals and incorporated their guidance into support plans.

People’s care was reviewed on ongoing basis and care plans were in place. Staff knew people well and understood how to support people in situations which may cause them anxiety. However, it was not always clear how people were supported to identify and work towards short, mid and long term goals. A number of relatives thought that the support could be more ambitious, and their loved ones could lead more active and fulfilling lives. They did not always feel that their contributions to their family members plans were welcomed.

The provider told us that they were looking at goal planning as part of their review of care planning.

There was some evidence of consultation with people’s relatives when people were unable to make decisions, however we received inconsistent feedback about how meaningful this involvement was. There were also gaps in the completion of mental capacity assessments and best interest decisions when they had cause to suspect that a person could not consent to their care and support. We raised this with the manager, and they told us they had sought advocacy support and were taking immediate steps to address the shortfalls.

Staff completed relevant training and had a good understanding of the importance of involving people in decisions about their day to day care. Staff showed us the visual aids and the Makaton signs that they used when communicating with one person to gain their consent. Care plans contained detailed information about how one person communicated and what they were conveying when they took various actions, such as removing their shoes.