Three C's Support

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 under the previous provider we rated this key question Good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 46 (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 who had started receiving support from the provider recently had comprehensive and detailed assessments that reflected their needs and preferences. Where people did not have the capacity to understand and make decisions about their support, relatives had been involved in their assessments in their best interests. However, thorough assessments did not always result in effective and current support plans

Each person had a support plan that documented their needs and preferences about their support. However, we saw that in some supported living settings people’s support plans had not been reviewed and updated for a very long time and contained out of date and superseded information. Two support plans we reviewed referred to a government programme that had stopped in 2012. Support staff did not have access to support plans in some supported living settings. One support worker told us, “I was looking for [a person’s support plan] a few days ago as they had a social worker review but I couldn’t find it. I haven’t read it.”

In other supported living settings, support plans were detailed and comprehensive and had been updated regularly as the person’s needs and preferences changed.

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

There was some information in place and covered health needs. However, care plans were not outcome-focused or person-centred. This meant that care plans lacked detail necessary to ensure each person's preferences and choices were respected, and they were enabled to live in a way that reflected their values, routines, and individual goals.

Although staff were clearly well-intentioned, there was little evidence that people’s support was based on evidence and current good practice.

People’s support did not always meet their needs and preferences as there were too few staff, and staff did not have access to information about innovative practices and new developments to improve the support they provided to people.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. The provider did not always take timely action to advocate on people’s behalf with their landlords, when there were issues with the physical environment of their supported living setting.

However for some people, staff worked well with professionals to improve their quality of life. For example, records showed that one person had not left their bed after having a stroke in 2020. Staff worked closely with the physiotherapist to source a suitable wheelchair and patiently encouraged the person to gradually spend more time in the wheelchair. The person was now going out for walks in their wheelchair in the local community and to activities and their facial expressions and vocalisations demonstrated they enjoyed this. One support worker told us, “The whole team worked together [with the physiotherapist] to get [person] out as much as possible, gradually more and more time. It was amazing to do.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Staff supported people to attend medical appointments when this was required, and medical advice was sought when people were unwell.In some supported living homes, the lack of staff meant that people were not always supported with stimulating activities or to be able to leave their supported living home to exercise or get fresh food. This varied between the different supported living homes depending on people’s capacity, wishes and preferences. In one supported living home, people made decisions about their food and were supported by staff to cook. In other supported living homes, where people did not have the capacity to understand and make their own decisions about the food they ate, staff supported them to eat a well-balanced, nutritious diet.

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

There was limited evidence to demonstrate the provider was meeting people’s personal expectations. This was due, in part, to a lack of involving people to establish meaningful goals or outcomes. Support plans did not always reflect person-centred objectives or agreed aspirations, and therefore there were no measurable achievements to track progress or evaluate the effectiveness of care. As a result, it was unclear how the provider ensured that people’s expectations, were being understood or met. Some people’s support plans had goals for their support, however there weren’t clear steps described for how to achieve these or realistic timescales. Some people’s goals had timescales to achieve that were years out of date, with no explanation of why these were still detailed as people’s goals or how much had been achieved towards them. For example, one person’s support plan which said it was updated in April 2025 detailed their ambition to travel to Europe for a holiday, to be achieved by August 2015. There was no other information about this. Another person’s support plan detailed their goal to bake a cake, two months from January 2015. There were no other details about this.

Other people’s support plans did not detail any goals or aspirations for staff to support them to work towards. These sections of their support plans were blank, stated “n/a” or “[Person] cannot participate.” A staff member told us, “We are looking at activities and support plans for [one of the homes]. I’ve been saying that things need working on for a long time. We need a team leader for each home so that they can be”.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The service produced some documentation in formats that met people’s different communication needs, such as easy read and pictorial. These supported people to understand information about safeguarding and options for their support, to assist them to make decisions.

Some people’s support plans included assessments of their capacity to understand and make decisions about their support, while others didn’t. Where people had been assessed as not having capacity to understand and make decisions, their support plans detailed who needed to be involved in decisions made in their best interests. And there was a lack of oversight for court of protection DoLS.