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

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.

This service scored 63 (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 was based on a complete, up-to-date assessment of their needs.

The provider had not fully migrated or completed information on the new system. People’s records did not always have information about their life histories. One person’s support plan contained incomplete information about their medical conditions, as well as incomplete communication and needs assessments.

Some records contained conflicting or misplaced information. One person's recorded gluten intolerance conflicted with staff's account that no one required a special diet. Two people's respective care plans had identified behaviours of concern but gave staff no clear guidance on meeting those needs, and information about people's emotional needs and triggers was not consistently recorded, so staff lacked guidance on providing reassurance during distress.

This meant the provider could not always demonstrate that it translated assessed needs into clear care planning. Daily care records were not always sufficiently detailed and often focused on tasks rather than outcomes.

A family member told us, “At the moment we try to hold care plan meetings on zoom every three months to discuss staff changes, finance, health and holidays. It is time consuming but necessary, and it works. Previously I would be promised updates, but it would slide.” Another relative said, “I believe they follow the care plan and I am involved in reviews.”

Managers told us the new electronic care planning system had prompted a review of people's care records and that they planned to involve people and their relatives in regular reviews. Care plans were personalised and strengths-based, covering communication, routines, health conditions, dietary needs and personal care.

The provider planned and delivered people's care and treatment with them, based on good practice and specialist guidance.

People were supported to develop daily living skills and to communicate their preferences. A family member described how staff supported their relative to develop daily living skills, telling us staff prompted them to shower independently and made sure this happened consistently. Another family member told us, “Staff use picture cards, a white board and a tablet to help prompt [their loved one] when communicating their preferences. It is a work in progress and depends how staff understand them.”

Where people were at risk of choking, the provider sought Speech and Language Therapy (SALT) assessments and put eating and drinking care plans in place. We observed staff supporting people in line with this guidance, including preparing food and drink to the correct consistency, using adapted cups, and guiding people to use smaller cutlery to slow the pace of eating and remaining present at mealtimes. All the staff we spoke with knew people's SALT guidelines, and pictorial, easy-read versions were available.

Staff were now trained in Positive Behaviour Support (PBS) and physical interventions using an accredited model. Where required, people had PBS plans which staff reviewed to assess whether strategies remained effective, and one person's plan was developed by the local mental health trust.

The provider worked well across teams and services to support people, and made sure people only needed to tell their story once by sharing their assessment of needs when they moved between services.

Staff worked with a range of health and social care professionals, including GPs, speech and language therapists, psychology and psychiatry services, occupational therapy and community learning disability teams. People’s care records showed input from these professionals, and staff described working with them to manage changes in people's needs. One person said, "If I felt unwell, the staff would notice straight away."

Records showed the provider sought and acted on specialist input. One person's behaviour support arrangements were developed with the local mental health trust and social work teams, and staff received specialist training to support the person effectively. Following our last site visit, records confirmed staff referred one person to the provider's Positive Behaviour Support team, and documents showed the provider had taken up a previous offer of assessment and intervention from community health teams.

Where another agency supported people with activities, staff worked well with them to share information. Handovers and team meetings supported information sharing within staff teams, and monthly managers' meetings enabled managers to share ideas, good practice and information across the service.

The provider supported people to manage their health and wellbeing and make healthy choices.

At our previous assessment we identified concerns about how the provider monitored and managed people's health and associated risks. At this assessment we found improvements. Systems monitored people's health, including nutrition, hydration and clinical risks, and records showed people were offered well-balanced meals.

Staff supported people to attend routine and specialist health appointments, including GP, dentist, chiropodist and hospital appointments. Staff supported one person through ongoing specialist cardiology reviews and to lose weight, encouraging walking and monitoring their diet in line with their health risks. Staff supported another person through a dementia assessment, monitoring seasonal changes in their presentation, and their GP prescribed support for sleep difficulties. A desensitisation plan supported one person to access their GP surgery.

Hospital passports held current information about people's health conditions, medicines and communication needs, and annual local authority reviews confirmed people attended the health appointments they needed.

Where people declined health interventions, staff recorded this. One person refused an eye test and declined to speak with their GP about their mental health, and staff continued to encourage engagement.

Staff supported people to stay active through walks, cycling, bowling and other activities of their choice.

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

Care plans still required improvement to ensure they were fully person-centred and accurately reflected people's needs and risks. The manager, with the newly recruited management team, was reviewing all care plans to make the necessary improvements at the time of our assessment.

However, we did not see evidence the provider routinely monitored outcomes in other aspects of people's lives. Care plans did not record people's goals and aspirations, so it was not clear what outcomes people wanted or how the provider measured progress towards them. One person's daily activity plan was reviewed only annually.

Records of people's daily support contained gaps. For one person, staff recorded only a small number of activities over the previous month, and on some days did not record key areas of support. Similar gaps appeared in another person's records, and it was not always clear what activities they took part in or whether they had eaten dinner. We fed this back during our visit. Keyworker meeting records were more detailed and varied month to month, where previously they had been identical.

At one setting for two people, staff monitored expressions of distress and referred to the provider's positive behaviour support team and the local authority's intensive support team. For one person, analysis showed they needed more sensory stimulation to alleviate their distress, and staff provided music and sensory items. One support worker told us, “We are hoping to get approved for a 1:1 staff member to work with them. They need more than what we can give them in the current rota.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment, although record-keeping did not always follow the principles of the Mental Capacity Act 2005.

The provider had improved how staff supported people to understand and exercise their rights around consent. Staff respected people’s choices when delivering care and treatment. However, records did not always demonstrate consistent application of the Mental Capacity Act 2005.

For example, the provider recorded one best interests’ decision about five people contributing to a communal fund for household items as a single document. It did not record separate, decision-specific best interests’ decisions for each person.

Court of Protection authorisations were in place for most people who required them, and the provider used a tracker to monitor approved and pending applications. Some authorisations were overdue for review. The local authority had completed the relevant assessments, which were awaiting court determination following the recent Supreme Court judgment.

Staff understood the importance of seeking consent. We observed staff seeking consent and knocking on people’s doors before entering. Staff also understood how the Mental Capacity Act applied to their work.

The provider recorded information about people’s legal representatives and lasting powers of attorney and involved them in decisions. These improvements were evident in practice, but the provider needed further time to strengthen record keeping, embed consistent Mental Capacity Act processes and demonstrate that these improvements were sustained across settings.