Thomas Edward Mitton House

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 inspection we rated this key question good. At this inspection 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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People went for long periods of time without meaningful engagement from staff. Staff did not always record how people were feeling in care records. Records indicated how people were feeling between a number of 0 to 3 but not specifically what this meant. The provider and management team were not effectively reviewing care records to help ensure people were receiving care in line with their support needs and preferences. There was a lack of information about people’s personal preferences and the way they would like to be treated in their care plans. People’s care plans for support needs such as specific health conditions lacked person centred detail. They did not contain information about people’s backgrounds or cultural needs. We observed several occasions where 1 person who had 1:1 staff support was left without support. One person was left alone to watch television when this was known to potentially cause them distress. A relative told us, ’The service is very small so we were hopeful [family member] would be right at home. Unfortunately, this is not the case, and I do worry about them.’’

However, people and other relatives told us they were satisfied with their support. One person said, ‘‘[Staff] are a friendly bunch. Always have time for you.’’ A relative told us, ‘‘All in all I would say [family member] is getting on well and the experiences we are having are positive overall.’

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

People’s care plans did not contain information about people’s religious and cultural backgrounds. The poor detail and lack of guidance in care plans made it difficult for staff to support people with continuity. People were not supported effectively in relation to their rehabilitations. Their goals and objectives were not discussed with them or made clear and when people refused their rehabilitation sessions, it was not clear what support was given to them to help them understand the importance of this. Other options were also not considered. Daily and rehabilitation records were not being effectively reviewed. This limited the opportunity for people to integrate back to the community after their rehabilitation. One relative said, ‘‘We have to try and work out how [family member’s] support is going based on what they tell us. We have never seen any records or been told what the aims of therapy sessions are.’’

However, in some cases people had been supported to rehabilitate effectively at the service and regain lost skills and independence. One person told us, ‘‘I could not speak when I came in but have got all my skill back. I am very happy.’’ The service and regional manager showed us how they were going to implement audits of people’s aims and goals to make sure they were being supported with these.

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

People’s care plans identified that signs and certain phrases could be used to support people and help them understand what was communicated with them. However, the care plans did not then detail what these signs and phrases were or how staff should support people with them. We did not see staff using other methods of communication such as pictures or signs to help people communicate. Methods available such as pictorial staff boards or boards about what was happening during the day were not kept up to date. We were not sent any evidence of information such as policies, care plans or meeting minutes being available in easy read or accessible formats. Relatives told us they did not hear from the service to be given information updates regularly. One relative said, ‘‘We get no feedback from the service unless we ask.’’

Staff spoke with people in a calm and relaxed manner for the most part to help them understand what was being communicated with them. One person said, ‘‘[Staff] will chat with me about what is going on here if I ask them to.’’

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.

There was little evidence of people and relatives being asked for feedback about the service other than monthly communal meetings for people. People were not being asked for individual feedback in line with their individual support needs. There was no evidence how feedback was being used to identify and drive changes or improvements at the service. There was little evidence people, or their relatives had been asked to be a part of discussions about people’s care plans and risk assessments. A relative said, ‘‘I have never been asked to look at care plans or records and have not been asked what I think about the service properly.’’

However, staff sat and listened to people through the day when they could. People who were able to do so attended meetings to discuss the service. Whilst there was no evidence or records, the provider and staff told us people were asked for feedback in 1 to 1 discussion. One person said, ‘‘[Staff] ask me how I am and if I need anything through the day.’’ A relative told us, ‘‘I feel any thoughts or ideas I have would be listened to by [staff and management team].’’

The provider made sure that people could access the care, support and treatment they needed when they needed it. The service had been designed to be accessible for people, including those with mobility support needs. Staff supported people to contact health professionals such as GP’s if necessary and supported them to attend appointments with these professionals. People had access to clinical staff such as physiotherapists and speech and language therapists at the service. Professionals were positive about how the staff team worked with them to support people.

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.

As a result of sometimes going longer periods of time without staff interaction, people’s experience at the service was sometimes not as positive as it could be. There was no evidence to show how people were being supported to discuss their goals and ambitions and then achieve these. This put people at increased risk of having poorer outcomes at the service. People had not all been supported to achieve positive outcomes in relation to their rehabilitation. Although a timetable of social engagement activities was in place at the service, our observations showed that this was not consistentlyfollowed.There was little social engagement for people throughout the day. One relative explained, ‘‘[Family member] has a weekly schedule but [staff] don’t do it with them, and it is never followed.’’

Some people had been supported to have good outcomes and experiences at the service. For example, people had been supported to regain their independence and return home after using the service. People were happy with their support and experiences for the most part. People’s comments included, ‘‘No problems here. I really like it.’’ and ‘‘I have made friends here with the other people and with the staff team.’’

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.

There was no evidence people had been supported to discuss plans for the future in areas such as how they would like to spend time at the service or in relation to what they wanted to achieve during their rehabilitation. A relative said, ‘‘We have never been sure what the overall aim of [family members rehabilitation] has been.’’

The management and staff team had the capacity to put plans in place for people at the end of their life if necessary. One relative said, ‘‘It has been great [family member] has been able to use the service for a longer period of time.’’