Three C's Support

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

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

This service scored 70 (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 always treated people with kindness, empathy and compassion, and respected their privacy and dignity.

Staff were kind, caring and knew people very well. We observed warm, friendly interactions between people and staff throughout our visits. Most staff had worked with the people they supported for a long time and understood their needs and communication. Staff shared jokes and conversation about things people were interested in, and people were clearly comfortable in their company. One person told us, “The staff are nice. Get on well.” Another said, “Staff are kind.”

Staff supported people at a pace they were comfortable with. We observed a staff member hold a door open for a person returning to their room, chatting in a relaxed manner so they did not feel rushed. More staff were available to support people to do activities of their choice and spend 1:1 time with them. At one setting the provider now rostered two staff for most of each day where previously there was one.

Staff described the practical steps they took to protect people's privacy and dignity, including keeping doors and curtains closed during personal care, minimising how exposed a person was when supporting them to wash and dress. We observed staff knocking and waiting for a response before entering. A staff member said, “Having the same faces [staff] around is so important for people. They value consistency so much and you have to get to know the people we support and understand them so you can do the best things for them.”

The provider treated people as individuals and made sure their care, support and treatment met their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds.

Staff knew people very well and recognised their individuality. Care plans had improved and were more person-centred, setting out more clearly where people needed support. People personalised their rooms in both décor and furniture. One support worker told us, “My job is about supporting [name] the way he feels comfortable. I can see on his face when he is not happy to do something and I do respect that.”

Staff took account of people's cultural and religious needs. Staff supported people to attend places of worship of their choice and to celebrate religious festivals, and supported people from Caribbean backgrounds to prepare Caribbean food. One person's hospital passport recorded their faith-based wishes regarding treatment, and staff supported one person to attend both a church and a mosque in line with their expressed wishes.

The provider did not always promote people's independence in a consistent, person-centred way, although people had choice and control over much of their daily lives.

At our previous inspection, we identified concerns about how the provider supported people to make decisions about their care. At this assessment, we found improvements, but these were not yet consistently embedded in practice.

The provider had improved how it supported people’s independence, choice and control, and people exercised choice in many areas of their daily lives. However, the provider had not yet embedded a consistently person-centred approach across all care planning records and settings.

Care plans did not always give staff enough detail to promote independence and choice. Information was often generic and focused on encouraging independence without clearly identifying what people could do for themselves or how staff should support them. As a result, staff did not always have clear written guidance to help people remain independent or make safe and meaningful decisions.

The new management team had identified the need to improve care planning documents and included this work in its structured staff development programme.

In practice, staff supported people to be as independent as possible. One person told us, “I don’t need much help. I can go out whenever I want and I spend most of my time out seeing friends.” Another person travelled independently across London using a freedom pass. One person was learning to feed their pet fish, and staff rotas supported people to cook and shop for their own food each week. People chose their meals, including a weekly takeaway, and chose activities such as bowling, day trips, adult education, clubs and holidays. A group holiday was booked at the time of our visit. We also observed staff supporting three people to speak with loved ones by phone or video call. These examples showed positive practice, but the provider needed further time to ensure this approach was consistently reflected in care plans, embedded in staff practice and sustained across all settings.

The provider listened to and understood people's needs, views and wishes, and responded to these in that moment.

People were supported to make everyday choices and staff involved them in daily routines. A family member said, “My relative is asked and chooses what to eat. Staff try and include them, for example, help them make a cup of tea safely with his poor sight.”

Staff recognised and responded quickly to people's non-verbal communication. We observed multiple examples of staff picking up on non-verbal signs that people needed help and responding accordingly. Staff supporting one person who is non-verbal recognised their communication and responded, and the person reacted positively.

When one person became anxious after eating their meal, staff spoke soothingly and calmly and provided sensory toys to alleviate their anxiety. The person appeared comfortable and relaxed while playing with them. When another person looked to a familiar staff member for support rather than engaging with us, staff recognised this and we respected the person's wishes.

Although some care plans could have contained more detailed information about people's health conditions, this did not appear to impact the provider's ability to respond promptly and effectively to people's immediate needs.

The provider cared about and promoted the wellbeing of their staff, and supported and enabled staff to deliver person-centred care.

At our previous inspection we identified concerns about staff support and its impact on care delivery. At this assessment we found improvements. Most staff spoke positively about support from the new management team and described improvements in communication. Managers told us they had implemented a structured programme of staff development.

Staff described the difference the recent management changes had made. One support worker said, "You had to be really tough, there were no managers to support us or they didn't stay long. It is much better now." Another said, "We work as such a strong team. You can't get stressed out otherwise we stress out the people we support." Records showed staff no longer worked extended hours without breaks, and staffing arrangements gave staff the breaks they needed.

Staff told us they felt supported by the new managers, described them as approachable and easy to speak with, and said managers were keen to ensure staff did not overwork. Staff now received regular supervision and told us it gave them the opportunity to discuss issues and consider training that might support them in their roles.