Three C's Support

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment under the previous provider we rated this key question outstanding. At this assessment the rating has /changed to requires Improvement. This meant people’s needs were not always met

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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The support provided to people by individual staff was person-centred, however the structural and staffing issues within the service meant that some people were not supported to develop, grow and aspire.

There was little evidence that people and those close to them were involved in planning and developing their care and making shared decisions. Some people’s support plans had not been reviewed for at least 10 years and communication between staff was not always effective which meant staff were not always aware of current or changes in people’s care needs.

For example, one person required halal meat as they were Muslim. Staff did not support the person to purchase and cook halal meat until this was reported as a safeguarding concern.

Other people were not supported to undertake the activities of their choice or go on holidays as there were not enough staff to support them to do so.

However, one person told us about the holiday to Cyprus they had been on recently with staff support and excitedly showed us the pictures of them swimming in the sea. The person had severe epilepsy and was at significant risk while swimming, and two staff supported them to swim safely which they really enjoyed.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

There had been a high turnover of staff and people were not always getting consistent support from regular staff. There were staff in some services who did not know people well and directed us to other staff to answer queries about people’s care.

For the people living in two of the supported living settings we visited, their support provider had changed three times in recent years . People had no say, choice or control over who supported them, and which agency was contracted to employ their support staff. These frequent changes meant that people’s support had changed according to the different agencies providing the staff who supported them. This negatively impacted on their quality of life as staff, managers and the ethos and values of the providers changed.

One support worker told us, “The different providers come in with their own changes, it’s confusing and not in people’s best interests.” Another support worker said, “I am here for the people I support, I have to speak for them as they have no voice. I can’t care about the provider.”

A professional told us, “The provider has not demonstrated flexibility or responsiveness to changing needs. Concerns raised by external agencies persisted for months without formal escalation. Communication around care planning was inconsistent, and incident reporting lacked integrity. The repeated failure to recognise environmental neglect and dignity breaches as safety issues indicates a reactive rather than proactive approach to service delivery.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provider had an accessible information standard’s policy however the provider didnot consistently supply appropriate, accurate and up-to-date information in formats that were tailoredto individual needs. Some information was provided in a range of formats that metpeople’s communication needs, such as easy read, symbols and pictures. These included the complaintsguide, information about safeguarding and some support plans. Although people’s communication needs had been assessed and documented, the provider did not always facilitate access to the resources that staff and people needed to communicate effectively, such as picture cards. However, in one home we observed a picture board being used effectively. The person used the picture board to point to their choice, to tell the staff what theywant

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The structure of the service meant that people were not involved in how the service was run, or in developing the support they received. We saw weekly ‘tenant meeting’ records for few supported living settings and these were very similar from week to week, with the same people attending the meetings. The meetings were not structured in such a way as to provide effective feedback from people about the service they received.

Some people were not able to express their feelings about their support verbally, and the provider had not considered effective methods for them to be able to contribute or to be involved in the running of the service.

There were limited feedback surveys completed with people supported by the service although they were not robust and were completed by staff. There was no process in place to prompt feedback

The provider did not always make sure that people could access the care, support and treatment they needed when they needed .The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People had access to health professionals such as their GP when they needed to see them. Referrals were made to health care professionals where required. Staff supported people to access health and social care appointments when needed. However, A professional health worker said, “The lift breaks down all the time which meant people have to stayed indoors, they are restricted and given no real choices around opportunities.”

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Some people required reasonable adjustments to support them to communicate effectively about the service they received, however consideration had not been given to how this could be facilitated by the service.

The structural and staffing issues within the service meant that people living in different supported living settings experienced different levels of support. Some services had consistent, stable staff teams that worked well together even without the benefit of stable frontline management, however others did not and this affected the level of support that people received. Some people were provided with the staff they needed to be able to undertake activities of their choice, and receive day-to-day care that met their preferences, while others weren’t.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Some people had information about their plans and wishes for the end of their lives in their support plans, although these were generally arranged by the person’s family and not by the staff or the provider.

Care plans reviewed did not evidence that people's wishes for the future were explored. People did not have realistic, achievable goals in their support, or their plans for the future.