Choice Supported Living - East

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 changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
 

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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

There was no evidence of health action plans in place which incorporated assessments from other healthcare professionals for individuals with learning disabilities. This meant the provider could not demonstrate staff had access to the information needed to support people effectively.People’s care records contained some information about their communication methods. However, we did not observe any staff applying these techniques and methods during our visits.

Although staff were already supporting people with epilepsy, rescue medicines and people with learning disabilities, they told us they needed more support and training for this. This did not demonstrate a concise system and process was in place to ensure staff were supported to care for people with complex needs to ensure this was always done safely and according to people’s assessed individual needs.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We found 1 person required thickener. Staff did not demonstrate they recorded and monitored this on the person’s MAR chart. We reviewed these charts and found they were always blank. This did not evidence the thickener was given and monitored to ensure it was effective and consistent in use.

One person required their food to be pureed. We reviewed their daily notes and found several food items which were not suitable for puree were given to this person. This was not in line with the person’s Speech and Language Therapists (SaLT) guidance and assessed needs. This placed the person at risk of harm. Staff also confirmed to us this person experienced coughing during their meals.

Additionally, we found 1 person had an epilepsy monitor in place. We asked staff to locate the monitor they would use to identify if the person was experiencing a seizure. This took 3 staff and 20 minutes to locate the device. Staff could not readily locate the device, which meant they may not have been able to respond promptly if the person experienced a seizure.
 

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We found all people using the service were not supported to access annual health check appointments and medicine reviews with healthcare professionals. For example, we found 1 person’s last GP review of medicines was 6 years ago. Additionally, people’s PRN medicine protocols were not regularly reviewed and were not authorised by a healthcare professional. The provider could not demonstrate staff always had clear, authorised guidance available when administering PRN medicines.
 

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

We visited people and reviewed their care records. We found limited evidence staff and managers actively supported people to develop skills, independence and healthier lifestyles. For example, we found people were not encouraged to participate in different activities and develop their daily life skills.

During our visit, we found left over food bowls in the fridge which did not have a date on them. This put people at risk of harm by eating food which may not be suitable to eat anymore. One relative also told us, “I worry about dates find things out of date. Found things dated 2024. Pasta sauces.”

People’s care records did not demonstrate they were always supported in line with their needs. For example, 1 person’s care record showed there was no record of any oral care being provided for 14 days. The provider did not demonstrate how they maintained oversight of this to ensure people received good outcomes.

Relatives also told us people were not always supported to engage in meaningful activities. For example, 1 relative said, “I’ve been asking for two years to take [person] swimming. They cannot get the staff to do it. It’s about creating a normal life and better memories. All the time the TV is on.”
 

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People’s care records for managing risks were not clear. For example, 1 person’s record mentioned their falls risks in multiple sections, however, there was no detailed falls protocol in place. We reviewed the provider’s incident log and found this person experienced 28 falls within 9 months. The person also told us they would need to wake up during the night and go to a staff member for support when required. There was no detailed falls protocol in place to guide staff on how to respond when the person experienced a fall. The provider told us this person had a known high risk of falls, and they shared these incidents with the person’s physiotherapist and family each time.

People’s needs and risks were not effectively monitored. For example, on review of 1 person’s care notes, there were long gaps where they did not open their bowels. There was no evidence this had been escalated. This put the person at risk of potential deterioration of health and not ensuring treatment could be accessed if needed.

We also found for 1 person, their care record stated staff may fail to recognise when the person is unwell due to the person’s communication needs. To minimise this risk, staff must understand the person’s communication methods and be able to identify changes in presentation, behaviour or health. However, there were gaps in the person’s bowels charts and there was no evidence to demonstrate staff were monitoring when the person was constipated.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Although capacity assessments were in place for some decisions, these were not decision and time specific. This was therefore not in line with the principles of the Mental Capacity Act 2005. We also found for some decisions, the provider had not completed these assessments and necessary best interest decisions. Capacity assessments were also not reviewed regularly.

We found 2 people had access to their own mobility cars. However, staff told us these people were ‘paired up’ with people who did not have cars. We found the petrol costs were not split and the provider confirmed financial audits were not being completed. Therefore, some people were financially benefiting from other people using the service without their knowledge and consent.
The provider did not evidence they had identified this financial safeguarding concern and taken immediate action to rectify this. We shared these concerns with the provider at the time of the assessment.