The Gardens

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.

This is the first assessment for this newly registered service. This key question has been rated outstanding.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 96 (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 made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

The person’s transition into the service was exceptional. Staff had worked with the individual for several months, supporting them daily in their previous environment. They did this while they developed a bespoke individual service and environment to meet their needs. There was a detailed and robust transition plan in place, which adopted a multi-disciplinary approach and involved a variety of supporting professionals including a psychiatrist and community nurses. The transition plan looked at the holistic needs of the person and considered how risks, their wellbeing, and their health and psychological needs could be managed during this time. The transition plan was continually reviewed, adapted and developed, with family and professionals, to ensure a safe transition for the person into their new home. The plan was set at the person’s pace, meaning the plan and the person could adapt at the different stages and was guided by the person’s individual needs.

Staff spoke positively about the transition period for this person. One staff member told us that as part of the transition they identified that the turnover of staff, due to their shorter shift patterns, had a negative impact on the persons emotions. They told us that as a staff team they recognised this and used this as learning for the future. When the person moved into the home it was agreed that staff would work long days to support this person. The staff member told us, “The staff consistency has been so beneficial, seeing the same face all day has offered stability and reassurance.”

Staff spoke positively and proudly about the transition for this person. A professional told us, “Feedback from Multi-Disciplinary Teams has often commented on how well transitions have been managed compared to previous attempts”.

The person’s care plans and risk assessments that were developed as part of the transition were robust, detailed and individual to their needs. Care plans and risk assessments were adapted and developed with family members and by observing the person in their new environments. The person’s care was regularly reviewed to ensure it was up to date.

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

The registered manager was aware of and fully embedded the right support, right care, and right culture guidance. Staff were extremely well trained and confirmed they were provided with excellent support and training to meet the needs of the people they supported effectively. Staff were aware of national guidance and recommended approaches, and they were focused on delivering individualised person-centered care for the person. One staff member told us, “The homes approach to training is very good, it’s all specific to [Person], that way we can take scenarios and actual events that have happened and we can all work together to resolve this or make changes.”

There was an ongoing schedule of training which was regularly reviewed and updated dependent on the changing needs of the person. This included learning disability and autism training that was in line with the statutory requirement in the Oliver McGowan code of practice. Positive Behaviour Support and physical intervention training which had been specifically adapted to meet the needs of the person supported. This meant the person received care that was tailored to their individual needs and delivered consistently to them by a staff team who were trained to do so.

The person was always at the centre of any decisions that were made. They were in charge of their life. They shaped what they did, when this happened and at the pace they wanted. They made choices about where to go and what to do, whether that was in their home, their garden or their community. Staff encouraged the person to make these choices and decisions and encouraged them to complete this as independently as possible. The leadership and staff team were continually trying to improve things for this person.

The provider understood and followed the principles of STOMP (stopping over medication of people with learning disability, autism or both) They ensured the person and those important to them were involved with regular medication reviews with professionals. As reported on under supporting people to live healthier lives, this had many positive impacts on the person’s health. The registered manager told us and records demonstrated there had been a reduction in the number of health interventions that were needed for this person. One staff member told us, “It has had such a positive impact, there are less intrusive procedures and that means more and longer periods of calmness and stability for [Person].”

There was also a system in place which used evidence-based tools to assess the person’s needs. A variety of assessment tools were available if needed to ensure their needs were identified and met. Staff were aware of these outcomes to ensure they delivered the correct care.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

We saw staff worked together collectively to deliver effective care to the person. There were regular reviews, staff meetings and supervisions along with daily handovers, where the person’s needs were discussed. Staff felt involved with this and were encouraged to be part of this process. One staff member told us, “We have a team meeting where we specifically talk about [Person]. We talk about the service we are delivering, where it can improve and get better, where we can learn lessons and how we can make it more efficient and effective for [Person]”.

Staff demonstrated they knew people exceptionally well, they told us they worked together if they identified any changes in how the person was presenting. For example, the person had a health condition that may require an intervention, staff told us they knew the person so well it enabled them to look out for early signs that this may be causing the person distress. This meant they could take prompt action when needed and could monitor this between themselves before sharing with the district nurse team.

The staff team had been recruited at the transitional period of the person’s placement. Staff had been specifically recruited to meet the needs of the person and because of this, had consistently worked with them for a long period of time. Professionals praised how staff worked together and alongside the service to achieve positive outcomes for the person. One professional told us, “High reliability, staff follow through on commitments and maintain professional standards”.

All staff were knowledgeable about the person and shared with us what made them a good and effective team. One staff member said, “The team spirt and rapport we have.” Where needed specialist advice was sought from professionals to ensure the care the person received was adapted and tailored to their individual needs.

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The provider was committed to working with the person, their family and health professionals to ensure positive outcomes were achieved for them.

Staff had worked with the person and health professionals to ensure they had extremely positive outcomes. They worked with the person and those important to them. They had implemented plans and programmes over periods of time to work towards achieving better health for the person and in 1 instance this has resulted in a reduction in a weekly health intervention. With advice from health professionals, staff had recognised the potential causes for this intervention and agreed goals to help them achieve better outcomes. This included a more balanced diet and changes to the person’s medicines regime. Staff told us the positive effects this had. This included positive steps and independence around the person’s personal care routine, less incidents that related to this health need and overall, a better and less intrusive quality of life. The staff member said, “This has meant [Person] is treated in a much more dignified way”.

As part of this, the person had been encouraged to take the lead with their diet. A staff member said, “We have put [Person] in charge of this by supporting him to make the choices he needs to.” With the use of the menu boards and picture cards, the person now accessed the kitchen with staff support and chose which meals they made and had. This was a significant improvement as it had not been an option in their previous setting. With encouragement staff now told us the person was making some healthier choices. Staff members continued to promote choice, independence, and the maintenance of a balanced diet in line with the person’s preferences.

The person was encouraged to attend health checks and routine appointments as a preventative measure in managing and maintaining their health. Staff had identified the impact the specific health need was having on the persons health and worked alongside them, their family and professionals in the development of a plan to address this.

The registered manager and staff provided an analysis of a health condition the person had. Staff had closely observed changes in how the person presented. They had worked with health professionals to monitor their medicines, and a reduction had taken place, following this there was a significant reduction in this condition. Regular health observations continued to be maintained, and staff continued to coordinate with healthcare professionals, the neurology team, the learning disabilities team, opticians, and the dental practice to meet the person’s medical needs.

Care plans and risk assessments detailed what these changes meant for the person and the appropriate action to take during these times. The unique relationship staff had developed with the person meant that changes were detected early as staff knew how they presented.

The person had a hospital passport that detailed their needs including their communication style, mobility and health needs, along with their risks and presentation during periods of emotional distress. Staff told us they were aware of this passport and would take it to hospital with the person if needed.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Without doubt, the outcomes achieved for the person were exceptional. This included an overall improvement in their health needs and the use of medical interventions. This had resulted in more periods of stability for the person, which had meant they could become more involved with daily tasks, learning new skills and community visits.

The person’s journeys were tracked and staff worked collaboratively with them and those important to them to celebrate their journey with a placement journey tracker. This considered an overall view of the success of the placement and the individual milestones this person had achieved. This included visiting local football matches and taking part in simple cooking and baking activities. Along with taking responsibility for watering his scented plant daily, which has become an important personal routine and sensory activity for the person.

The leadership team and staff monitored the person’s periods of emotional distress and completed an analysis of this. The analysis focused on the triggers to the concerns, the strategies that were in place and recommendations moving forward. They identified that the continual changes to the strategies they implemented along with the consistency of staff had resulted in a reduction of these periods of distress for this person. We asked staff what this had meant for this person. One staff member said, “Just heaps of things, better quality of life, able to go out more, better relationships, happier person overall.”

Regular reviews of care, audits, reflective practices and goal setting ensured the person’s outcomes were consistently monitored. The registered manager and staff team were always striving to improve the service and make things better for the person. They supported the person to try new experiences.

There was an emphasis on how the person could be supported to maintain and develop new skills.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Capacity assessments and best interest decisions were in place when needed to ensure the Mental Capacity Act was applied. Staff were able to demonstrate an understanding in this area including the importance of gaining consent from the person. They had also received training in this area and were aware of the processes to follow.