Archived: My Life Choice

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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The provider was in breach of the legal regulations relating to person-centred care and consent to care and treatment.

This service scored 25 (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’s care and treatment was effective. People’s care was not consistently delivered in line with their assessed needs. People and those important to them were not fully involved in assessments and reviews and it was not clear how their views and opinions were listened to and implemented. People’s past history and exposure to trauma had not always been considered when reviewing how people’s daily care was being delivered.

For example, 1 person’s care plan assessments clearly documented their preferred communication as Makaton [a system of signs and symbols that support communication]. Their care plan stated the person, ‘needs their staff to have Makaton training’. The provider was not able to evidence staff had completed Makaton training in line with the person’s assessed needs and preferences.

The care plan also noted, ‘Staff should be mindful that [Person] has lots of trauma regarding the use of restraint’ and stated physical interventions ‘should be used as a last resort’. Incident reports evidenced staff not being trained in Makaton was a cause for incidents, including those involving physical interventions. The provider was not able to evidence how they had addressed staff training needs to reduce the possibility of physical interventions and exposure to further trauma.

Relatives told us people’s agreed plans of care, made prior to them moving in, were not always followed. Relatives said they were not always consulted or included in meetings to review people’s care. Comments included, “There’s not been many meetings”, “I’m not involved in care plan meetings”, “Occasionally [named manager] speaks to me” and “There’s been no meetings. It would be so much easier if there were.”

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

People’s care did not meet the expectations outlined in the ‘Right support, right care, right culture’ guidelines in relation to supporting people with a learning disability and autistic people.

The provider did not demonstrate a focus on reducing restrictive practices to improve people’s quality of life.

People who were living away from family or the area they grew up in were not always supported to maintain important relationships and links to the area. Where people did not want to live in a specific area, it was not always clear how the provider was collaborating with the person, relatives and stakeholders to support them to move to the area they wanted to live in.

The provider did not work well across teams and services to support people. Information of concern and escalations in incidents such as self-injury and physical interventions were not always promptly shared with relevant health professionals. This meant changes in people’s needs and increased safety risks were not identified and addressed to ensure people’s care and support continued to meet their needs.

Health professionals told us the provider did not always respond promptly to information requests or provide detailed information or analysis about incidents of concern. Comments included, “The provider is not working in an open and transparent manner as would be expected to facilitate partnership working” and “They [the provider] tell me something has happened but they haven’t got all the information together. They don’t send investigation reports. They can’t tell me what they’re doing. They’re not providing a full story. There’s no context or learning.”

The provider did not support people to manage their health and wellbeing, live healthier lives, or reduce their future needs for care and support. Changes in people’s emotional state or distress, which may show a deterioration in their health or wellbeing, were not recognised or acted upon.

People’s relatives told us the provider did not work well with other health professionals to meet people’s physical and mental health needs. Comments included, “There’s a lack of mental health provision and possibly a lack of behaviour support”, “[Person] is missing appointments without transport to take them” and “There’s no psychological input and we were told there would be. [Person] has missed several appointments.”

We received mixed feedback about how promptly the provider identified and responded to concerns with people’s physical health. Comments included, “Person’s stoma care needs have not been met” and “[Person] ended up in hospital with a urine infection. [Person] hadn’t had it tested in 2 weeks.”

The provider’s incident management processes failed to evidence appropriate mental health input being sought when incidents of self-injury and distress had increased. Staff did not identify the risks of escalating self-injurious behaviour. Incident reports recorded attempts to self-harm as a ‘known behaviour’ without evidence of investigation or escalation to relevant external health professionals.

The provider did not routinely monitor people’s care and support to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider was not able to demonstrate how they engaged with people to ensure they were living life as they chose to. People and those important to them were not actively involved in planning and reviewing goals and ambitions.

Relatives told us people were not supported to achieve good outcomes. Comments included, “I couldn’t tell you what they’ve achieved. They’re not trying to develop [person’s] skills and there’s no goals to better [person’s] life”, “We would like [person] to be as independent as possible. Perhaps do some courses for socialising and finances”, “[Person] would like to get out and about – it frustrates them. There’s no willingness to take [person] out.”

People’s care plans and daily care records evidenced people were experiencing a lack of meaningful activities and engagement. The provider was not able to demonstrate how they were addressing this to ensure people were supported to do things that were important to them. One relative told us, “[Person] never goes out. It’s not the life I wanted for them.”

The provider had not acted in accordance with the requirements of the Mental Capacity Act 2005 and the associated code of practice. The Mental Capacity Assessments [MCAs] reviewed during the inspection were not decision specific and did not evidence how people’s communication needs were being fully supported. There was no detail about how communication aids were used to support people’s understanding and decision making. Information was inaccurately documented with sections copied and pasted from other MCA assessments. There was a lack of evidence of involvement from people’s relatives and other relevant health professionals.