Georgina House

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 requires improvement. At this assessment the rating has remained 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 58 (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.

It was evident from the care records that regular reviews took place. However, we identified people’s care records as not always current, with several risk assessments and personalised care plans missing. These included plans relating to cognition, sun protection, swimming, COVID-19, and elevated times of infection.

The registered manager could not provide any historic records regarding the assessment of people’s needs when 2 people moved into the home. However, we saw a record of the last local authority annual care review. (See monitoring and improving outcomes for more details).

We reviewed staff handover records for two months. Several handover records were missing. This meant that important information relating to people’s health or presentation had not been shared with the staff in charge to ensure the continuation of safe and effective care.

However, staff told us they would contact nominated professionals if they had any concerns about the people living at the service.

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

Not all staff had completed nutrition and hydration training, despite one person at the service requiring a modified diet, as defined by the Speech and Language Therapy team (SALT). This meant we could not be assured that staff had up-to-date knowledge of good practices and standards.

However, referrals were made to relevant professionals, including the SALT team, where there were concerns about people’s diet.

Care records included person-centred information about people’s nutrition and hydration needs, including preferred foods reflecting people’s cultural backgrounds. Daily notes included what food and drink people had each day.

The service had systems to monitor people’s health, including regular weight and body mass index (BMI) checks.

The provider worked well across teams and services to support people.

Evidence showed that people had been supported in accessing external healthcare professionals appropriately. For instance, staff took people to the pharmacy for minor complaints, and GPs attended the home to conduct blood tests.

Individuals also received support to attend regular reviews with the Intensive Support Team (IST). This team focuses on helping people with learning disabilities and/or autism manage physical and mental health and behavioural support needs. The IST helps in care planning, analysing themes and trends, and reviewing medicines that may impact people’s emotional wellbeing. This team supported the service in implementing a personalised ‘my communication’ care plan.

Staff recorded people’s health and social care appointments in the communication book as a reminder and ensured a staff member was available to support people to health appointments if necessary. The service’s care planning electronic system recorded actions and appointment follow-ups.

The provider did not always support people in managing their health and wellbeing, so people could not always maximise their independence, choice, and control.

A person's care records over a period of 3 months stated that each month, their goal was to improve their skills and become more independent with swimming. Another person living at the service within the same timeframe suggested having a swing in the garden to support their independence. However, there was no evidence that the service was working with these people to achieve these goals and support the individuals’ wishes.

However, we found that staff encouraged and supported people to understand and make healthier choices, including diet, lifestyle, and physical activity, such as participating in community walks.

Staff told us they supported people's access to their GPs and specialist teams that supported autistic people and those living with a learning disability. The service worked alongside all these professionals, who recommended ways for staff to support people safely. These scheduled appointments were listed within the services’ communication book.

We also reviewed evidence that people’s health was routinely monitored in blood monitoring, nail cutting, and eye tests.

The care and support plans in place were detailed and included information about their healthcare needs, including their preferences on how they would like their healthcare needs to be supported and their level of independence. For example, a step-by-step guide on how a person wishes to be supported in maintaining good oral health. The plans also gave clear information about what could cause people anxiety or distress and the signs and strategies to follow to prevent or mitigate that distress.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent.

Staff supported people living at the service in choosing hobbies and interests and communicating plans and ideas for the future. Keyworker records evidenced these discussions, but the registered manager did not take action to support people’s life choices. For example, a person’s record over a period of 3 months stated that each month they had not completed any new or different activities of their choice.

The provider addressed some of our concerns following our assessment. During recent key worker meetings, staff supported individuals in setting new goals and fun activities at home. New records showed that one person responded positively to new sensory experiences, showing an increased engagement in activities.

However, annual local authority care reviews were taking place. This external review aims to assess the quality of care provided to people living in the home and ensure the service promotes positive outcomes for people. We reviewed these reports, which showed outcomes had been partially improved. For example, a person living at the service had started to become more involved in doing their laundry.

Key workers met with people monthly to discuss their skills and strengths and set appropriate future life choices, goals, and ambitions. For example, switching on the television from the mains and using the remote control independently. These goals will be discussed monthly to see if they are going well, what support is required, and whether the goal is still relevant. Staff used the ‘Outcome Star - Life Star’ tool. This tool is designed to support individuals with a learning disability to achieve their goals and measure the progress towards greater independence and wellbeing.

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

People’s capacity to consent was assessed and documented. However, records of Mental Capacity Assessment (MCA) decisions needed further development, as the responses to whether people lacked capacity at the time of the MCA were completed and required a best interest decision that differed between people.

People’s care plans provided step-by-step guides on how people preferred staff to carry out specific tasks, such as showering, bathing, and nighttime routines.

People were included in the conversations in their homes about what was happening, and staff checked that they consented to the care offered before providing it.

Staff used different forms of communication, including visual aids and Makaton (a language program that uses speech, signs, and symbols to help people with learning or communication difficulties), to support people to make choices about their support.

A staff member said, “We use consent every day. When supporting personal care, I will always knock on the door and say it’s time to go for a bath. If the person jumps up, starts clapping, laughing, and is happy for you to provide care, they consent to you helping them.”