Archived: Alderwood LLA Ltd Addington Road

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.



The service was in breach of legal regulation 9 in relation to person centred care.

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 were confident they would be informed about any changes in their family members health or support needs and described regular contact with staff and with the Registered Manager. However, evidence of people and their relatives being involved in the assessment and care planning process was limited.

People had an allocated ‘key worker’ to review their care and support. Key worker meetings took place monthly. Records showed these reviews did not always effectively explore people’s emotional and psychological needs or the underlying triggers and reasons for distress. Where incidents of distress were recorded in daily records, the reasons or triggers were not always established so that care and support could be changed in response.

Records showed staff did consider and discuss people’s health needs and took action such as referring to health care professionals and following their advice.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Positive behaviour plans were written and developed by the provider’s positive behaviour support (PBS) lead. However, the plans were developed using information provided by staff and from records and did not include direct observation or spending any time with the person. Each person had their own flat with a lounge but there was no communal area or staff office within the main house. This arrangement did not meet the needs of one person because of their sensory needs. A relative told us they were concerned about the accommodation provided because of noise levels created by staff, because their family member needed peace and quiet. Another relative told us their family member would benefit from a setting with a communal area to enable opportunities for friendships and social activities. The service was in the process of implementing significant changes to the way care and support was provided and working towards a more person-centred approach with the use of functional assessments to establish causes and triggers of distress in line with beast practice and national guidelines. Care records and risk assessments were being updated or had been updated but had not been fully embedded or understood by staff. There was a mixture of old style and new support plans in use. There was a lack of effective monitoring and recording of behaviour to support any continual development. Staff had attended training about supporting people with a learning disability and autism and had completed the care certificate training. This training is designed to ensure care staff are working to best practice guidance and standards within the sector. People’s fluid and nutrition needs were understood and met by staff.

The provider did not always work well across teams and services to support people. Relatives told us there was effective information sharing and they were updated about any changes. However, information recording regarding incidents of distress was not always effective and may result in professionals not having the required information for review. Staff may not have access to all the information they required to assess, plan deliver care and support. The Registered Manager told us they were developing ‘grab sheets’ to improve the accessibility of this information The service was following an action plan to implement changes required to improve, following a Local Authority quality monitoring visit. For example, ensuring staff knew who to contact if they identified a concern, improving support and risk management plans and safe medicine management.

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

Relatives told us about the activities their family members were supported to access such as going swimming and going for walks. One person told us they enjoyed going to the gym and bike riding.

Peoples’ health and physical wellbeing needs were a focus at key worker meetings. For example, dental health, healthy eating and the management and prevention of known health risks were discussed along with the promotion of healthy eating. This included menu planning with the use of ‘easy read’ formats to support the persons understanding and involvement.

Staff attended training with healthcare professionals to support the management of known health conditions and to prevent deterioration. Staff monitored people’s health and booked appointments with healthcare professionals and supported people to attend, this included annual health checks. Information about specific health conditions was available to staff.

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

People’s relatives were generally happy with the support their family members received. However, systems and processes for monitoring and improving outcomes for people were not always effective. Goals and aspirations were recorded, but these records lacked detail and there were no plans in place about how people would achieve or work towards their goals. Key worker review meetings were taking place with people. However, key worker meetings did not sufficiently involve or understand the views and experience of the person or consider actions to improve. There were no progression plans. There was no evidence of people accessing learning opportunities for skills or education. This meant outcomes for people may not be as positive as they could be or meet all expectations.

People’s health action plans did evidence effective monitoring and improvements regarding their physical health.

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

Relatives told us they were involved and consulted in decisions about their family member’s care and support. However, we were not assured people were fully protected by the Mental Capacity Act 2005 (MCA). People and their relatives had not been fully involved and consulted in all aspects of care and support decisions, where the person lacked capacity to consent to their care.

Care plans and positive behaviour plans did not provide sufficient detail about decision specific mental capacity assessments or best interest decisions. The section for recording mental capacity and best interest decisions for one person had not been completed.

Staff had received training about the MCA and deprivation of liberty safeguards. However, we were not assured this was effective because best practice guidance was not followed regarding the recording of mental capacity assessments.

The provider had a policy about mental capacity, consent and decision making. This policy was comprehensive and set out the tasks and processes staff had to follow if a person was deemed as lacking capacity to make any decisions. Evidence of staff adhering to this policy was limited. People’s support plans and risk assessments did not sufficiently follow expected processes to ensure staff were applying the principles of the MCA to obtain lawful consent and ensure the least restrictive support was provided.