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

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

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always consistently person centred.

This service scored 57 (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 did not always work in partnership with people to decide how to respond to changes in their needs.

At our previous inspection we identified concerns about person-centred care. At this assessment we found some improvements, but these were not consistently embedded across each setting. Staff demonstrated a good understanding of the people they supported and a commitment to person-centred care. One staff member told us, "When we support people, we try to tailor this support to them." Care plans contained some person-centred information including likes and dislikes, and we observed staff delivering care in line with people's preferences, such as leaving people to rest if they wished.

However, care plans did not consistently include people's aspirations or goals. This section was blank in some plans, and it was not clear the provider had taken time to establish what outcomes people wanted or to develop plans to achieve them. For one person, the record of their likes and interests was limited and their daily activity plan was reviewed only annually. Records of daily support contained gaps and were sometimes task-focused, so they did not consistently demonstrate the support people received. Staff had not updated one person's support plan in line with a recommendation made following an incident, although they had mitigated the underlying risk in practice.

Where people received support from another agency for activities, staff worked well with them. Correspondence between both teams supported one person to volunteer at a city farm. People and families were involved in decisions about meals, activities and holidays, and keyworker meetings were more detailed and individualised than at our previous assessment.

Managers told us they planned to introduce further person-centred approaches, including enhanced keyworker systems, but these were not yet embedded.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People were supported by more consistent staff teams who knew them well. Most staff had worked with the people they supported for a long time, which promoted familiarity and continuity. The provider had introduced agency staff to reduce the pressure on the existing team while recruiting for permanent staff.

Where people had significant physical or behavioural support needs, the provider ensured a core team of trained staff supported them. Staff worked across services where needed to maintain safe staffing and reduce the risk of closed cultures developing.

Staff demonstrated knowledge of people's needs, and records showed the provider coordinated care with input from healthcare professionals where required. Where people received support from another agency for activities, staff worked well with them to share information and support people to achieve their goals.

The provider worked in partnership with landlords and other organisations, which resolved long-standing issues including the repair of a lift that had restricted people's ability to move freely in and out of their home, and maintenance issues that meant people now lived in clean, comfortable and safe environments.

People accessed local community resources, including adult education, clubs, places of worship and leisure activities across different boroughs.

The provider did not always supply appropriate, accurate and up-to-date information in formats people could understand, although staff used accessible information well in some areas.

More information was available in accessible formats than at our previous visits. Some people used communication cards, and we observed a support worker helping a person use an app on a tablet to communicate their choice about food. However, we saw little evidence that the provider supplied people's care plans or other care documentation in formats they could understand across all settings. The provider will need to consider how the new electronic care management system can support this.

Staff provided some information in formats which met people's needs. Speech and language therapy guidance was available in pictorial, easy-read formats. One person's Positive Behaviour Support plan included accessible pictorial information, and information from an external agency was provided to one person in an easy-read version.

Staff understood people's individual communication needs and used appropriate strategies, including simple sentences, showing objects while talking about them and giving people time to respond.

The provider made it easy for people to share feedback and ideas, but people did not always feel involved in decisions about their care. At this assessment we found some improvements, but these were not consistently embedded across all settings.

Feedback from people and their relatives indicated the provider did not always ask them for their views or involve them in care planning. One family member told us, "I have never been asked to look at my care plan." Another relative said, “I need to be informed more." However, a third relative commented, "They [staff] want to listen to us about concerns." This showed people's experiences of involvement varied: while some people and relatives felt the provider listened to their views, others did not feel consistently informed or involved in decisions about their relative’s care and support. A person said, “I would like bigger print or something like that, or symbols in my support plan- I don’t get asked.”

Tenants' meetings took place regularly. Minutes showed people discussed activities and voted on what they wanted to do, resulting in a booked seaside trip. Other topics included health and safety, repairs, fire safety reminders and mealtime support. The provider facilitated repairs where people raised issues.

People told us they would raise concerns if they had any. One person said they would tell staff if they were worried about anything and would talk to staff if they needed to complain.

The provider made sure people could access the care, support and treatment they needed when they needed it.

Staff supported people to access health services, education and community facilities. The provider arranged transport where needed, including taxis to classes. One person travelled independently using their freedom pass. People attended adult education centres which provided a range of activities, and staff supported them to access services across different boroughs according to their preferences.

Staff supported people to attend health appointments and made referrals when people's needs changed. Where a person found it difficult to access their GP surgery, a desensitisation plan had been put in place to support them. Where people declined appointments, staff continued to encourage engagement.

Staff and leaders did not always actively listen to information about people who were most likely to experience inequality in experience or outcomes, or tailor care in response.

At our previous inspection we identified concerns about how the provider reviewed information to ensure people experienced equitable outcomes. At this assessment we found some improvements, but these were not consistently embedded.

People’s care plans included individual information but did not contain specifics about their goals and aspirations, or their views on what they would like to take part in. The provider did not always use systems effectively to review information about people, and care plans were not always clear or sufficiently detailed, which increased the risk of people receiving support that was not fully tailored to their needs. Managers were receptive to this feedback and were taking steps to address it.

Staff treated people equally and without discrimination and understood the importance of supporting people inclusively. Staff understood people's cultural and religious backgrounds and tailored their support accordingly. This included supporting people from Caribbean backgrounds to prepare Caribbean food and supporting one person to attend both a church and a mosque in line with their wishes. One person's background, including their experience of disruption, disadvantage and discrimination, was recorded in their behaviour support planning.

Staff supported people who could not communicate verbally through their knowledge of non-verbal communication.

The provider supported people 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, but did not always record these plans in sufficient detail.

Staff told us they had discussed end of life preferences with people and their families where appropriate and that funeral plans were in place. However, records indicated the chance to discuss end of life preferences had not consistently been offered to everyone.

The provider had recorded one person's resuscitation status inconsistently on the electronic care system. Staff corrected this during our visit and agreed to discuss future planning with the person's GP.

No one was receiving end of life care at the time of our assessment.