Dalesview Partnership Supported Living

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• 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 changed to 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 92 (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.

Relatives were involved in the support planning process and subsequent reviews. A relative explained, “The support plan is changed when needed and we have big support plan reviews annually.”

Staff confirmed there was enough information in support plans, and they were made aware of people’s changing needs via a handover book, and communication book. We saw evidence changes to people’s health, mobility and behaviours were discussed in team meetings.

People’s communication needs were assessed and met, to maximise the effectiveness of their care. Staff had access to individualised communication guides which thoroughly detailed people’s communication needs. Some guides explained how intensive interactions could be used to better relate to people with limited communication skills. A relative had recently fed back to the service, “(The communication guide) looks fantastic and we love that it has been bound in a book so that staff can refer to it easily. We really appreciate all the time you have spent on this; it’s a really valuable resource which will enormously benefit [person]."

Substantial effort was being made to implement service-wide communication goals, and support staff development and people’s skills in this area. This work had contributed to people being able to communicate more effectively, with improved signing and support to develop other methods of communication. This meant, people were able to contribute to their assessments and any reviews. A relative told is, “[Staff] are using ‘Talking Tiles’ now to help [person] make choices.” Talking Tiles are electronic communication aids which can be used to record and play back messages.

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 explained the service stayed up to date with legislation and good practice by taking part in various forums, networks, conferences and training. The service employed a private physiotherapist and a communication lead; and senior managers had additional roles, providing support and advice to teams. The communication lead told us, “I have had recent intervener training (which taught me how to work with people who are deaf or blind). It was a really good course, and I can use learning to offer guidance.”

Staff gave detailed accounts of people’s nutrition and hydration needs and how these were met in line with current guidance; and relative’s confirmed people were supported appropriately with dietary needs.

Dieticians were involved where necessary. Staff were assessed prior to independently supporting people with eating and drinking, due to their complex needs and associated risks. We observed staff supporting people with meals of various consistencies, using appropriate aids and following specific guidance. Staff were focussed on each person being supported, were mindful of distractions whilst people were eating, and of potential choking risks.

This comprehensive support with eating and drinking had resulted to several improvements in people’s diet, weight and enjoyment of food. A relative explained, “[Person] needed to put on weight and now has done. (Following an illness) they lost their ability to drink which has now returned. Support with eating is now good and there have been no more chest infections.”

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.

Staff told us information was shared amongst the team and with other services effectively, to ensure people had continuity of care. Frequent contact with healthcare partners was recorded and shared; including details of agreed treatment or medication, and any follow up actions.

The registered manager gave several examples about the service coordinating and collaborating with others involved in people’s care. Relatives were involved as much or as little as they wished in coordinating medical appointments and treatment; but were always kept informed of ongoing arrangements and outcomes. A relative said, “There is permanent, open communication.” Another added, “Communication is 12 out of 10.”

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 service focused on identifying risks to people’s health early, and regular entries to people’s records evidenced partners were consulted when people’s health showed deterioration. People were supported to attend emergency or routine appointments, and staff facilitated treatment when required. One relative said, “[Person] needs physio everyday which the staff support with.”

Several people had complex health needs and had been or continued to be severely ill. Staff and relatives gave examples of the exceptional support and commitment people received during their illness, and rehabilitation. One person had recently suffered a health set back and their mobility had declined as a result. The service had worked very closely with the housing provider and occupational therapist to ensure they had the right equipment agreed. This meant the person could maintain an element of independence and their outcomes were improved.

Staff told us how they were focused on promoting healthier living with people. Relatives spoke about the significant improvements this had made to people’s health and wellbeing. One relative had recently fed back directly to the service, “I can’t believe how much weight [person] has lost. They look fab and is much better in themselves. As you know I’ve been going on about their weight for years and am so pleased with the progress.”

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.

Relatives gave examples of people’s health, independence or quality of life significantly improving as a result of the high-quality care provided. A relative told us, “[Staff] understand now how [person] communicates. At first [person] didn’t join in but is already coming out of their room, I’ve seen it. My relative is happy and now showing their true colours.” Another added, “[Person] has learned to trampoline on their own, standing up. They have made progress in other ways too. They now take your hand to lead you to somewhere (or something they want), which they didn’t do at home.”

Staff spoke about the agreed expectations for people and the importance of supporting them to achieve these. One person’s communication skills had developed since moving into the service, they were also moving around more independently, and staff were working closely with them to improve their fine motor skills. This led to significantly improved outcomes for them, such as being able to brush their teeth independently.

People’s outcomes were monitored in annual reviews. We saw evidence comprehensive and person-centred reviews were conducted by the lifestyle team around what was working, not working or could be further developed. People and relatives were fully involved.

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

People’s capacity and ability to consent was considered and relatives lawfully acting on their behalf were involved in planning, managing and reviewing care and treatment. A relative told us, “We have best interest meetings organised by the nurse. Everything is done that needs to be done.” Other relatives explained how staff supported decision making and contacted them for their consent around vaccinations. Best interest decisions were in place where appropriate.

Communication guides offered staff person-centred information around promoting choice, and staff were able to describe how they sought consent. For example, talking people through care interventions, giving people time to respond and observing for non-verbal cues.