Oswestry Also known as Approved Care and Support

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 remained good.

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

This service scored 63 (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.

During our inspection, we identified 2 people had only initial care plans in place despite receiving care for several weeks. For example, in one case, the delay was attributed to the person being unable to provide consent; although a best interests decision was documented confirming care delivery was appropriate, we could not be assured the person’s full care needs had been assessed. All other care plans had been reviewed at six-month intervals, with people and their families actively involved in the assessment process. We noted care plans were task-focused, outlining actions staff should complete during care calls, both staff and people confirmed these tasks were being carried out. However, health specific care plans and risk assessments were not consistently in place, meaning we could not be assured that individuals’ care and treatment needs were always fully assessed.

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 the provider did not demonstrate care and treatment were delivered in line with evidence-based practice. For example, where a person had a diagnosis of autism, this was not recorded within their care plan, and staff supporting this person had not received autism awareness training. This placed the person people at risk of not receiving care and support which met their needs or promoted positive health and well-being outcomes. It also indicated the principles of Right Support, Right Care, Right Culture were not always fully considered when supporting people with learning disabilities.

In addition, we noted that while information relating to specific health needs had been printed from the NHS website and stored in people’s care files, this information had not been used to inform health specific care plans. We identified 6 care plans that lacked the necessary health care plans or risk assessments, meaning we could not be assured that people’s individual health needs were fully assessed or managed. The provider told us work was being completed to ensure appropriate care plans and risk assessments are implemented.

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.

There were systems in place to support effective teamwork and information sharing among staff. Information about people was communicated verbally, documented in written notes, and shared electronically via emails. In addition, face-to-face focus group meetings were held every four months, providing an opportunity for wider team discussions.

The provider demonstrated an understanding of their responsibility to work collaboratively with external stakeholders to ensure people received appropriate care, treatment, and support. Staff told us they had contact numbers for district nurses so they could contact the service directly if required on behalf of people. Records showed office staff followed up and linked with social services regarding best interests’ decisions. We saw Speech and Language Therapists (SALT) recommendations had been used to complete a choking risk assessment relating to 1 person.

However, we found records did not always contain adequate assessments of people’s needs and associated risks. This meant in the event of an emergency, essential information may not be fully available to other professionals, potentially impacting the quality and safety of care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff told us they would share concerns about people’s health with the office who would contact external professionals. Staff shared how information from external providers would be shared via the electronic app, so they are kept up to date regarding a person’s needs.

A person told us, “Staff listen to me and only do for me what I’m not able to do that day …sometimes my fingers don’t work well, I’ll try to do my buttons, staff give me the chance and if I’m struggling, they’ll happily do them for me.” This meant staff supported people’s overall health and wellbeing by promoting their independence.

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Although the provider had systems in place to monitor people’s care and treatment through 6 monthly care plan reviews, we did not see evidence that care plans recorded outcomes or goals to support individuals in maintaining independence. Staff told us they encourage people to do as much for themselves as possible, and people confirmed this, stating that staff only assist with tasks when needed.

We saw evidence people were referred to relevant external agencies, such as Speech and Language Therapy, when required. However, feedback from these agencies was not consistently incorporated into risk assessments or care plans.

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

There was evidence to show consent to care and treatment was obtained prior to delivering care. We saw where a person lacked capacity steps were taken to ensure best interests decisions were made with support of social workers and this was documented within care records.

Staff understood the importance of gaining consent prior to supporting people with care. A staff member told us, “I always explain what we’re doing as we go along and try to encourage people to do as much as they can themselves, when they are struggling, I’ll ask if they want me to help.” A person told us, “If I don’t consent to anything they wouldn’t do it, they do everything I ask of them.” This demonstrated staff understood and respected people’s human rights.