Miles House - 4 Hentland Close

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

The service was in breach of legal regulation in relation to consent to care and treatment.

This service scored 54 (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.Relatives we spoke with told us they were involved in the annual reviews of their relative’s care needs, and some felt they were kept informed about day‑to‑day matters regarding their loved one. However, this view was not shared by all family members. One person’s views had not been considered regarding an aspect of their care. Inspectors discussed this with the registered manager. When we returned, changes had been made to the person’s care to reflect their wishes. Records showed staff shared information at shift handovers, and updates were recorded on the electronic care system, helping staff maintain awareness of people’s daily routines. Staff also sought specialist support when needed, including input from external healthcare professionals.
While some assessments contained detailed information about people’s needs, others lacked depth or did not reflect changes in their presentation or health. The provider had not ensured that assessments always translated into clear, personalised guidance in care plans. This contributed to inconsistencies in how staff supported people, how they applied de escalation guidance, and how they helped people take part in meaningful activities.
 

The provider did not always deliver care and treatment in line with evidence based practice. Staff did not consistently follow guidance set out in people’s care plans. We found policies and care practices were not aligned with current guidance, including ‘Right Support, Right Care, Right Culture’ principles, which meant people were at risk of receiving inconsistent or ineffective care. Staff did not always work with people to identify and meet their goals or aspirations. Staff had not received the required training necessary to deliver evidence based care, including autism awareness and learning disability training, which contributed to inconsistent practice. Staff had only completed basic training, which did not meet the requirements for their job roles. This training is mandatory for all staff to ensure they have the skills and knowledge required to provide safe, effective and evidence based support.

The provider had established working relationships with external partners. One healthcare practitioner told us they had a positive working relationship with staff and felt they knew people well. Staff told us they worked well as a team. One staff member told us, “The team ethic is brilliant. There’s a real willingness to work together and get things done”. Handover meetings took place at the start of each shift, and updates were recorded on the electronic care system, which helped staff share information about people. People had hospital passports in place, which contained information to support smooth transitions when attending health appointments or moving between services.

The provider did not consistently support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff encouraged people to make choices about their daily routines, and, where people were able, they involved them in decisions about how they spent their time; however, this support was not always consistent. For example, 1 person experienced weight gain but was not always supported to choose healthier meals or snacks. Activity records also showed gaps, and staff missed some opportunities to promote meaningful engagement and stimulation. People had access to healthcare professionals, and records showed they received visits or attended appointments with external services that monitored their health needs.

The provider did not always record or monitor people’s health needs in a clear or comprehensive way. Health action plans were in place but were not always fully completed, which meant important information about people’s health needs or planned actions was not always documented. Despite these gaps, staff generally monitored people’s care and treatment and completed incident forms when incidents occurred. For 1 person, staff shared incident records with healthcare professionals to support a change in their needs. A healthcare professional told us the service worked well with them to achieve positive outcomes. Where people required ongoing health monitoring, records mostly set out what support they needed, and we saw evidence that staff followed this.
 

The provider did not always ensure people gave informed consent to their care and treatment. Consent documentation was incomplete or missing, including parts of people’s care records and specific consent forms, such as consent to photography. This meant the provider could not demonstrate that people had agreed to aspects of their care or understood how their information would be used. The registered manager told us that some of this information existed elsewhere but had not been uploaded to the electronic care system, which reduced staff’s ability to access accurate and up to date consent records. When we returned, we saw some evidence of this information. Staff did not always evidence how they supported people to understand their options, for example through easy read materials or adapted communication approaches, and where people were able to consent, their wishes were not always considered and acted upon. These shortfalls meant the provider could not demonstrate that consent processes were robust or that care was always delivered in line with people’s informed choices.