Choice Supported Living - East

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 assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs. The service was in breach of legal regulation in relation to person-centred care.
 

This service scored 36 (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.

People did not receive person-centred care. The concerns we found throughout this assessment demonstrated the provider was not working in line with Right Support, Right Care, Right Culture. People were not consistently supported in a way that reflected their individual preferences, needs and lifestyles. Care was organised around staffing availability and group routines rather than people's individual choices. We found due to the short staffing available; people were not receiving person-centred care. People were taken out in groups and given group menus because they could not be supported by additional number of staff. This did not demonstrate individualised and person-centred care. For example, 1 staff told they had to cook the same meal for everyone because of staffing numbers. They said, “It’s always been like that, otherwise we would have to cook 5 different meals and types of food, and we don’t have a cook here. We do have meal planning.”

The model of care and environment did not always maximise people’s independence, choice and control or reflect a personalised supported living approach. We found areas within some people’s homes were designated for the exclusive use of staff, including a bedroom being used as an office and staff facilities within communal living areas. This reduced the space available for people to use within their own homes and did not demonstrate that the available environment was consistently being used to maximise people’s individual needs, choices and independence. Care and support were also not always sufficiently tailored to people’s individual needs, preferences, choices and preferred daily routines.

Additionally, we found in 1 house where 4 people lived, 1 person had a religious need which meant they could not eat beef. We found there was a ‘house menu’ which stated the meals which would be cooked for everyone in the house. We found no beef was available to anyone else, despite not having a religious need. This did not demonstrate people were consistently supported to make individual choices about their meals and lifestyles.
 

The provider told us they had systems intended to promote continuity of care, including dedicated staff teams, rota planning around people’s assessed needs, person-specific training, handover arrangements and access to on-call management support. However, the evidence we gathered demonstrated these arrangements were not always effective in practice.

Staff told us people were regularly supported to access the community together because of the staffing available. This meant activities and time in the community could be cut short when 1 person became distressed, as everyone being supported together then had to return home. This restricted other people’s choice and control over how they spent their time.

Staff also raised concerns about the effectiveness of arrangements for obtaining additional support. Relatives described changes in the staff supporting their family members and raised concerns about whether staff knew people well. The evidence therefore did not demonstrate that staffing arrangements consistently provided people with individualised support, choice and continuity of care.

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

Relatives told us communication in the service was not always positive. For example, 1 relative said, “I have no idea what goes on communication wise. The only one I like to speak to is house manager…she knows what is going on. But she has been taken out and only there now one day a week. I don’t think communication is particularly brilliant.” Another relative told us, “Communication between staff is one of the biggest issues. You tell staff one thing and it doesn’t get fed back. If something works, they don’t tell their colleagues.”

During our visit to people’s homes, we did not see information being provided in a person-centred way. We did not see people’s individual communication methods being applied in formats which was tailored to individual needs. We also found outdated information was displayed in people’s homes, for example there was a staff board which was not up to date.

In another house, someone who did not have any religious needs was left sitting in their lounge with religious music playing very loudly on their television. Staff later confirmed the person did not have this religious need. It was therefore unclear why the person was not supported to engage in watching something which was aligned to their individual needs. The person’s care plan stated they had preferred TV programmes they enjoyed watching.
 

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.

We received mixed feedback from relatives about sharing feedback and raising concerns. One relative told us, “[Registered manager] is available by email or phone and she is responsive back.” However, another relative told us, “The last 2 annual reviews have been cancelled on the day it was due to take place. I put forward ideas, but nothing ever comes of it. I don’t know why I bother.” Another relative told us, “I have raised the concerns about the movement of staff. There isn’t anything else I can do. They didn’t do anything. They were respectful but not going to do anything about it.”

The provider demonstrated an annual survey was completed for feedback from staff, people and relatives.
 

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We found people did not always have timely access to care, support and community opportunities due to staffing and support arrangements.. For example, we found staff were undertaking sleep-in shifts, and people were moving independently around the home during the night, including people who were at high risk of falls. The provider did not demonstrate an effective on call system was in place for people and staff.

Staff told us the on-call system to seek support from other colleagues did not work as it should have. This meant people did not have clear access to care and support when they needed it.
We also found there was no driver available for people in 1 house after 4pm and on weekends. This meant people were limited in accessing the community including 1 person who enjoyed going on evening drives.

Relatives told us the provider was not always responsive to their concerns. One relative said, “If I push it eventually someone gets back to me. But don’t get the answers want. Too exhausting to fight all the time.”
 

People who are most likely to experience inequality in experience or outcomes did not have tailored care.

This assessment identified clear safety concerns about people’s compatibility and the ongoing risks that were presented between them. One person told us, “We do get on but with [other person], it’s not easy as [person] sometimes goes in my room. I say, ‘get out of my room’ but [person] doesn’t listen.” This did not demonstrate people were supported to maintain their privacy and dignity.
We found one person's privacy had been compromised when another person repeatedly entered the bathroom whilst they were bathing. This did not demonstrate people always experienced positive outcomes and experiences. However, the provider demonstrated they implemented new measures to reduce the risk of this recurrence.

In several locations, we found all people were contributing to food shopping, yet they were not able to access equal shares of food.Additionally, although people’s care plans stated they communicated through Makaton, we did not observe any of these communication tools being used. Staff also confirmed visual aids were not really used.
 

People were not always supported to ensure they had enough time to make informed decisions about their future, including at the end of their life.

We reviewed people’s care plans; however, we did not always find supporting evidence of meaningful future planning to support people with goals and major life changes.Although some people had information about their wishes after death, we found care records did not contain any information around people’s resuscitation status. This put people at risk of not receiving person centred care or experiencing positive outcomes if their health changed for the worse.