Leicester & Leicestershire Supported Living

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. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs are comprehensively assessed and included consideration of their physical, mental health, sensory, social and communication needs. Care plans were developed with people and included all assessed needs. For example, information about what was important to the person, how best to support them, their unique life history, psychological needs and health needs were assessed and developed into a plan of care.

People told us staff understood and met their needs. Staff we spoke with were extremely knowledgeable about people’s needs, they gave examples of support provided and how this had a positive impact of people’s wellbeing and quality of life. Where appropriate, people’s families were involved and included in the assessment process. A relative told us they were fully involved and always consulted about their family members care and support. Another relative said, “My engagement is regular, they keep me up to date with everything going on, I get called in periodically to discuss the care plan.”

Care plans were reviewed in 6 monthly cycles. Monthly audits were carried out to ensure care and support plans contained all the required information, were up to date and were understood and followed by staff. This included people’s communication needs and positive behaviour plans if this was required. For example, some people used objects of reference and cards with images of items and actions.

Staff told us they were always informed when people’s needs changed. A staff member told us, “There are constant reminders, we have chats to drop messages to remind people, we do proper handovers, both verbal and add them to electronic records in case the person misses something from the verbal handover. You see it as a pop up when you login. We might also add reminders to people's fridges. With the two people we support being close they often go over to each other's homes to see one another, the staff also get to see each other and update each other then. We look out for one another; no one wants any incidents or to put people at risk.”

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 and current evidence-based good practice and standards.

Staff and leaders demonstrated a thorough and up-to-date understanding of current legislation, national standards and evidence-based best practice relevant to the service. This knowledge was not only well embedded but consistently applied in practice, ensuring people received high-quality, safe and effective care. Robust systems were in place to monitor changes in guidance and legislation, and there was a clear commitment to continuous learning, ensuring best practice was proactively adopted and sustained across the service.

The provider had invested in a dedicated learning and development team, alongside a specialist Positive Behaviour Support (PBS) lead, who provided expert guidance and oversight to ensure staff delivered care in line with recognised best practice within the sector. This strong infrastructure supported staff to continually enhance their skills and knowledge, resulting in improved outcomes for people. Examples of improved outcomes and greater independence achieved through positive behaviour support are described in more detail within the treating people as individuals and independence, choice and control quality statements within this report. They included an increase in the skills people had to manage their own homes.

Staff benefited from a comprehensive and well-structured training programme, with access to a wide range of learning opportunities, including nationally recognised qualifications relevant to their roles. This approach ensured staff were highly skilled, confident and competent in meeting people’s diverse needs, and reflected the provider’s clear commitment to workforce development and excellence in care delivery.

A staff member said, “In the past I requested Autism training and have been on 2 courses for this. Also, I have passed my level 4 positive behaviour support training (PBS). The PBS was not something on my list, this was offered to me through my management team. So, in my experience, as long as you are willing to grow there is a lot of opportunities available.”

Another staff member told us they had requested training about attention deficit hyperactive disorder, and this had been provided.

Team meetings and national conferences took place to keep staff updated with any changes to evidence-based practice within the sector.

The provider’s care plans and risk assessments for nutrition and hydration were comprehensive, with a clear focus on promoting people’s independence and enhancing their quality of life in relation to the preparation and enjoyment of meals and mealtimes.

People’s nutritional and hydration needs were understood and met in line with current standards and evidence-based guidance. People had enough to eat and drink to prevent malnutrition or dehydration and were supported to manage their dietary needs and associated risks. This included where people have complex needs, from the risk of poor nutrition, dehydration, swallowing problems and other medical conditions that affect their health. Where risk was identified, daily food and fluid intakes were monitored.

Staff consulted with healthcare professionals and followed their advice and guidance. Staff told us about a person with swallowing difficulties and how they followed a specialist diet prescribed by a speech and language therapist. They told us. “We did training about dysphagia (swallowing difficulties). We were trained that when you prepare the food you need to blend it to a certain level, you have to prepare food differently.”

A relative explained how staff managed their family members nutrition through a feeding tube. Staff worked closely with healthcare professionals. The relative told us staff were competent and fully understood how to safely manage the process and understood the associated risks.

People had their risk of malnutrition and dehydration assessed. Where risk was identified a detailed eating and drinking care plan was developed. This set out how to support the person with nutrition and hydration and how to manage any associated risks. Care plans were person centred and focused on the persons needs and preferences. For example, a care plan stated. ‘I need my food cut into bite size pieces as I am unable to do this myself and I like it (food) cut in a particular way as this is more appealing to me.’

Some people independently managed their nutrition and hydration needs. Others were supported to plan their weekly menus and to shop for and prepare their meals. One person said “We decide together and put it on the list on the fridge in the kitchen. We go shopping for the food. Staff do the cooking for us.”

We looked at menu planners and saw there was a variety of meals and snacks available to people. We observed people being supported to prepare their own meals and drinks.

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

Plans for transition, referral and discharge considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Additional staff were deployed to support a person during their first 24 hours following hospital discharge to ensure their needs could be met safely. The progress made by the person was celebrated and staff worked together to plan a smooth and safe transition.

Staff could access all required information via an electronic record system. Communication between staff teams and external professionals was good and information was effectively shared. There was one example of a communication breakdown between staff and an external healthcare professional. However, the registered manager had identified this shortfall and took action to ensure that all information was effectively shared and followed.

The provider ensured staff had received the required training regarding delegated healthcare tasks before clinical tasks were carried out.

For a person who had required frequent hospital admission because of their health needs, staff fully understood the parameters of when to seek medical attention. This had resulted in fewer hospital admissions over time.

Staff were consistently positive about communication systems with external professionals, between teams and with managers. They told us teams worked well together and support was always available. A member of staff told us, “District nurses come to see [person] and the GP come’s annually. Prior to them coming it’s communicated to our manager so we can prepare. The district nurses are fantastic and understanding of learning disabilities. Sometimes service users might decline intervention, for example, the district nurse might attend to do a blood test but then the service user decides they don't want the blood test. They are flexible and help us to arrange a different time, we then prepare in advance again with the service user and explain there will be a blood test.”

An external professional gave positive feedback about how staff had supported a person who had recently moved into the service. They said, “The transition forthis person was done very well and the support staff and the manager where pivotalin this.”

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

People were supported to understand the importance of physical, mental and oral health and encouraged to complete healthcare passports.

People told us they were supported to stay active, to eat a healthy balanced diet and when required, to access healthcare services. Some people took regular exercise such as walking or attending a gym. One person said, “The staff go with me if I need to go there (GP surgery). Staff make the appointment for me.” Team meeting minutes showed discussions between staff had taken place regarding the positive impact on health and wellbeing experienced by one person through consistent gym attendance.

A relative told us,” They [staff] have been fighting to get [family members] eyes sorted along with me. [Family member] goes to the GP when they need to.” Another said, “[Family member] has a food plan, goes to the dentist and to the GP. The staff notice wounds before I do and let me know about it.” They told us staff knew how to do their family members hair in a certain way to protect a known skin problem.

People were encouraged and supported to access annual health checks and follow up actions from their health action plans. When people attended hospital appointments or were admitted to hospital, staff advocated for learning disability nurse involvement to ensure effective communication about health about individual needs

People had comprehensive and highly personalised health care plans which clearly set out how their individual health needs were to be met in line with their preferences. These plans provided detailed guidance for staff on supporting people to access healthcare services and maintain good health and wellbeing, including promoting physical activity, good hydration and a balanced diet.

Where people experienced difficulties with communication, additional guidance was in place to ensure their health needs were fully understood. This included clear, detailed information to help staff recognise subtle signs that a person may be unwell, alongside explicit instructions on the action they should take. This proactive approach helped to ensure any changes in people’s health were identified and responded to promptly.

Staff demonstrated a strong, in-depth knowledge of people’s health needs and were confident in supporting them to achieve the best possible health outcomes. They spoke with insight about how individual non-verbal cues could indicate when a person was feeling unwell, enabling them to respond quickly and appropriately. This resulted in people receiving timely, responsive and highly effective support to maintain their health and wellbeing.

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

People we spoke with were consistently positive about the care and support they received.

Service leaders were assigned to people and staff teams. They had oversight of people’s day to day experience and provided support to people and the staff team.

Service leaders spent time with people and with staff. They checked electronic care records daily to ensure all care and support plans were completed correctly. The system showed a clear timeline of events of the day and altered managers and staff if key tasks were not completed, for example if a person with an identified support need for fluids did not receive enough fluid, the system would alert staff and managers.

Staff understood people’s expectations about the care they received and what positive outcomes looked like for them. People’s care plans recorded their aspirations and what a good day looked like for each person. This information was broken down into specific outcomes for people who may not be able to verbally communicate their needs. For example, one person’s care plan described how they liked to start their day, what was important to them and how to get the best out of their day.

Managers carried out monthly audits of peoples care and support. This included care records to ensure staff were following the plans and understood how to meet people’s needs. Manager audits always included spending time with people using the service to get their feedback about their experience of care and support.

Where shortfalls were identified, action plans were developed to promote continual improvement and better outcomes for people.

The provider carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

People were actively involved in decisions about their care and support, with their rights, choices and preferences consistently respected. Staff took all practicable steps to enable people to make their own decisions, ensuring they were provided with the appropriate information, support and time needed to make informed choices. People consistently told us they felt in control of their day-to-day lives and were able to make meaningful decisions about how they spent their time. They also confirmed they could refuse care and support, and that staff respected their wishes without judgement.

Staff demonstrated a strong commitment to promoting inclusive communication and ensuring people’s voices were heard, regardless of how they communicated. Where people did not use verbal communication, staff used a range of tailored approaches, including sign language, visual aids and other communication tools, to support them to express their preferences and make decisions. This person-centred approach ensured people were empowered to have maximum choice and control over their lives, in line with best practice and legislative frameworks.

People had their capacity to make decisions assessed. Where assessments identified support was required, ‘best interest’ decisions were put in place. These considered the person’s abilities and preferences, included others involved in their care and used the least restrictive option. For one person who was reluctant to receive personal care, strategies were put in place to reduce any distress for the person. This included singing to the person and engaging them in conversations they were known to enjoy.

Mental capacity assessments were recorded in detail and were specific to each decision.

Staff had training about the Mental Capacity Act (MCA) and understood their responsibilities to respect people’s choices and always seek consent. A staff member said. "It's based on 5 principles including not presuming someone does not have capacity, giving people informed choices and using the least restrictive measures possible. The staff member gave us an example of a person with capacity making decisions about what they had to drink. They told us “We did an assessment and had the positive behaviour team involved to help staff understand that [person] has the choice. If you or I wanted to make this choice then we could, we wouldn't need to ask anyone, it's thinking about that."

Relatives we spoke with confirmed they were fully involved and consulted when the person lacked capacity to make a decision.

A person who used the service had completed restrictive practice training. They told us, “I have shared my experiences to help people understand more about the smaller restrictions. This training has been shared across the whole organisation. To be part of the training made me feel special as they were interested in my experience to improve things for other people.”

The provider had a restrictive practice policy. Any deprivation of liberty restriction in place was legally authorised and always applied in the least restrictive way. The provider did not use physical restraint for any person using the service.