Wharfdale Extra Care Scheme

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 good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 check and discuss people’s health, care, wellbeing and communication needs with them.

People’s initial assessments which the provider completed with the housing provider were limited and did not identify certain information including the person’s religion, their culture, their routines for personal care or their preferences for staff members; this information would be helpful in ensuring care plans were person centred. Leaders from the service explained how they relied on the local authority assessments to populate the care plans; we stressed these may lack certain information and how it was the providers’ regulatory responsibility to carry out their own robust assessments, risk assessments and care planning.

People’s local authority needs assessments often included details which had not been incorporated into their service level care plan. For example, the local authority needs assessment contained details of various risks which people presented with which were not risk assessed. Furthermore, historical information and information regarding people’s hobbies and interests were included and not transferred over appropriately, for example, for one person it stated, “I like colouring and to look at pictures in books…I like listening to bands and 70’s and 80’s music,” but this was not incorporated into their current care record.

For another person, the provider had not ensured care records included relevant background information necessary to support staff in managing identified risks safely. For example, care plans did not always consider people’s potential vulnerabilities to guide staff practice effectively.

People’s communication needs were not always appropriately assessed. For example, in a person’s local authority needs assessment it stated the person required support with letters and correspondence and how they have a stutter when anxious, but this level of detail was not included in the persons care plan. Furthermore, for the same person, communication needs had not been comprehensively considered in relation to their identified risks.

The provider had not considered obtaining information on people’s hearing, sight, comprehension or expression impairments. A member of staff said there was a person who “Gets very frustrated when [they are] not understood,” and that staff “…Get to know [their] cues and what to say.” They confirmed this person’s communication requirements were not documented in their care plan.

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

People being supported, presented with a range of different diagnoses. For example, a person presented with Chronic Obstructive Pulmonary Disease (COPD) but there was no recognition within the care plan regarding this. There was no information of breathlessness triggers, signs of deterioration, smoking status or escalation guidance. The same person had a diagnosis in relation to their mental health but there was limited information regarding emotional wellbeing, self-neglect strategies, relapse indicators and support strategies. The provider responded to this feedback immediately and included documentation within people’s care records for staff to read to have a better understanding of people’s medical conditions.

People presented with symptoms associated with depression but there was no guidance within the care plans regarding how to best support people’s emotional needs.

Staff did not appear to have a thorough understanding of the diagnoses of autism and learning difficulties and how care may need to be adapted, despite this being identified as their ‘Primary service user group type’ in their local authority needs assessment. The provider explained how they had acknowledged CQC feedback and would book staff onto advanced autism and learning disability training at the earliest opportunity.

In addition, some staff had not considered and did not have the appropriate risk assessments in place by the provider to consider the impact of supporting someone to take their medication when under the influence of alcohol. When asked about how confident staff were identifying a pressure sore or a urinary tract infection starting, a staff member said, “Not very, I think we probably need more training around this.”

Most people and relatives felt staff were well trained.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us they had good working relationships with other professionals, including occupational therapists, district nurses and GPs.

Professionals told us they had a good relationship with the service and the staff and were confident they would be contacted if concerns were identified. A further professional who we spoke to onsite, explained how they worked collaboratively with the service lead and staff to support people’s health and wellbeing. Another professional stated, “The service works cohesively with partner agencies to meet individuals’ needs. There is clear evidence of collaboration with health professionals, social care, and advocacy services.”

Staff told us they felt supported by their colleagues and were able to seek advice when required. A staff member said, “We work closely as a team and communicate well to ensure people receive good care.”

People had hospital passports; a hospital passport is a document which the service provided to professionals such as paramedics in case of an emergency. The document contained the most crucial and relevant information for the professional to know. However, these were not always up to date.

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

The provider had produced a document called ‘Looking after my health’ which included details of health professionals in the person’s life and appointment details, a yearly overview of appointments and screenings, any refused appointments and records of health visits and consultations.

The provider worked in close partnership with the housing partner who arranged for health checks to be completed regularly at the service in the communal area. In addition to this, speakers had attended the service to provide discussions on health topics including musculoskeletal conditions and sepsis.

The service had access to a range of self-help guides and leaflets for people on a variety of health conditions if they required information and supported people to attend medical appointments if they were unable to do this independently.

Staff supported some people to complete their weekly shopping, providing advice and guidance on healthier foods for the person to consider.

People explained how since arriving at the service, they had started exercising. There was a ‘Zumba’ class held weekly in the communal area and a person mentioned how they continued to access the gym.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider ensured outcomes were positive and consistent, and that they met the expectations of people themselves. Most people felt their quality of life was much better since they had moved to the service.

Staff said people, overall, had made vast improvements by the support provided at the service. A staff member explained how they had seen so much progress in a particular person and how they had improved their lives in every domain possible.

The provider had produced case studies which demonstrated people’s improvement journey’s since accessing the service. People’s mental health and personal hygiene had improved, some described feeling much safer, some had come from a place of isolation to developing robust friendships, whilst others had developed life skills such as being able to cook for themselves.

Staff were regularly monitoring people’s blood pressure, fluid, dietary intake and stools when required. However, more clarity for staff on exactly what to record was required.

Staff did not always consistently follow up with appropriate updates to body maps, so changes in people’s skin was not always fully monitored or documented appropriately. This meant there was a risk that skin deterioration would not be observed or escalated promptly.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People had a good understanding around their rights around consent and felt these were respected by staff.

Staff understood the importance of ensuring people fully understood what they were consenting to and the importance of obtaining consent before they supported the person.

We observed staff and leaders asking people for their consent before making decisions, for example the service lead asked staff if they would be happy for us to talk to them and if they wanted to meet with us in their apartments or in a communal area.

People were supported to complete easy read consent forms which covered all aspects of their care and enabled people to consent where they were able to and supported staff to act in best interests where required.

The service carried out assessments to determine when people could take responsibility for their own medication. However, we found documentation was generic and not tailored to each person.