Rosekeys

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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

At our last assessment the provider was in breach of Regulation 11 The Need for Consent. At this assessment the provider was no longer in breach of Regulation 11.

This service scored 62 (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 made sure people’s care and treatment was assessed and reviewed their health, care, wellbeing, and communication needs, however, this was not always done with them or with those that were important to them to maximise its effectiveness.

Clinical assessment tools were in place but had not been used to support people at risk in relation to skin damage, particularly pressure damage. We noted care plans had been reviewed but information was not always presented in a way that reflected the person’s current care needs and abilities. This was addressed by the management team during the assessment and implemented.

Care plans did not evidence how people had been involved in their own assessments and reviews and their views and opinions were not effectively captured. From discussion with the registered manager about communication they explained people’s history and potential triggers had been considered but this was not reflected in their care planning in relation to communication. We reviewed a care plan relating to a person’s communication which was very detailed and provided strong guidance for staff on how to communicate with the person and the gestures and sounds they may use and what they were communicating.

Robust assessment and ongoing review and update of records pertaining to people’s care and treatment is vital to ensure they receive effective care that meets their needs and preferences.

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

We reviewed documentation relating to people’s care from professionals for people’s specific dietary needs and fluids, and moving and positioning, as well as care plans and daily records. Information was not consistently recorded which meant there was a lack of evidence that people received the care and treatment important to them to maintain their health and wellbeing. While there was no evidence that people had been harmed as a result this, indicated there was a risk of harm to people who required specific support with their diet, fluid intake and moving and positioning.

People’s care plans indicated the personal relationships they had and demonstrated that staff and leaders facilitated visits to support important relationships. People also told us about receiving visits and visiting family members.

The provider worked well across teams and services to support people. They coordinated and collaborated with others to meet people’s holistic care needs.

People’s goals, dreams and aspirations were not always effectively communicated through care planning documentation, so a consistent approach was maintained. This was discussed with the registered manager who provided assurances that this was being addressed.

We saw evidence that the provider had engaged with professionals to improve people’s care and support. For example, we saw letters from medical professionals in relation to visits they had made to a person further to the registered managers referral.

We saw evidence that the registered manager and management team had established a weekly heads of department meeting to ensure information was more effectively communicated to support better care for people.

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.

People had care plans in place which identified how changes in their presentation, emotional state, or distress, which may show a deterioration in their health or wellbeing, could be recognised. However, this documentation did not consistently provide a clear description of this person’s usual presentation which would make it harder to identify any changes which the registered manager said would be updated to make this information clearer. People could confidently access emergency health care if needed supported by staff that knew them to ensure their disability would not prevent them from accessing prompt care and treatment. One staff member told us about a person going into hospital and said, “Sometimes when [name] goes into hospital, they get upset about going into the ambulance, so I go with them as I work well with them and [name] does feel safe with me.”

We saw evidence of communication and engagement with a number of healthcare professionals who the team had contacted to support with people’s health and wellbeing needs. Staff told us about supporting people with changes to their diet including healthier meal and drink choices.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We observed gaps in records for people who required specific support to maintain their skin health, we also noted that there were gaps in records for fluid and food including for people who needed to maintain a specific diet to stay well. These gaps had not been identified by the management team through review which was required to ensure people experienced good outcomes from their care.

People’s care plans did contain some information regarding goals that people wished to achieve however there was a lack of information to indicate how goals were being progressed or how people were engaged to ensure their life ahead was a life they choose and to understand how people’s short, mid and long term life choices, goals, ambitions and outcomes could be planned and achieved.

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

We observed staff asking for consent before supporting people with care tasks and this was also reflected in daily records.

We found examples of capacity assessments where decisions had been made in a person’s best interests that did not follow the required 2 step assessment process. This was discussed with the registered manager who provided assurance around upskilling staff to be able to complete capacity assessments more robustly and engaging the right people to do this. The registered manager also provided the inspection team with an example of an assessment carried out further to feedback from the inspection team which clearly evidenced the right process and people had been engaged in this decision-making process.