DLS SW England Regional Office

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

This service scored 75 (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 effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Care records reviewed detailed people’s needs, and these had been assessed prior to people using the service. People’s care needs were reviewed regularly and any changes updated and communicated to staff. There was a clear effective referrals process in place.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Care records detailed what support was needed for example, if there was at risk of dehydration or malnutrition. These risks were recorded and guidance was in place for staff to follow. The provider shared several examples of how risks to people’s health and wellbeing were managed. Care records evidenced that a range of health care professionals were involved in peoples care and support. Staff recorded information in care notes to reflect recommendations made by health care professionals. For example, if a person was on a restricted diet or a soft diet due to medical conditions, information about the impact of this condition was recorded in care records. Guidance in place was reflective of best practice.

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. The provider shared multiple examples of teams working together. For example, people being discharged from hospitals or a community setting back to their own homes. Information was shared between services which was kept up to date and accurate. In some cases, people had a hospital passport which gave hospital staff key information about them. Staff were proactive when working with multi-disciplinary teams and actions were followed up when needed.

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. Care plans showed information about people’s health and wellbeing was detailed for staff, to ensure they had a good understanding of health needs. The provider shared several examples of how staff supported people to live a healthy life. For example, one person who was unable to weight-bear independently was initially scheduled for single-staff support. The provider referred them to an occupational therapist (OT) and attended the assessment, supporting the individual to express preferences. Following the review, the care package was increased to 2:1 support, and appropriate mobility equipment was provided.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Care records showed that staff supported people to achieve their goals. The provider shared several examples of how outcomes were monitored to support people to achieve their goals. For example, staff supporting people to walk with the use of mobility aids as a regular activity. In another example, a person wanted to increase independence and social engagement. Staff supported them to use public transport safely, attend community events, and explore suitable work opportunities. Progress was recorded in the digital system, noting achievements such as attending social groups, managing journeys independently, and participating in volunteering or paid work. Regular reviews ensured that outcomes were met and any additional support was provided as needed.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Care records reviewed showed people had been involved in their care plans. In cases where people may lack the capacity to make decisions, appropriate arrangements were in place.Staff understood the principles of the Mental Capacity Act 2005. In some cases, a best interest decision was made. These were documented and evidence was recorded in people assessments and care plans.