Albert 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 remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.
 

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People's needs were assessed in a detailed and holistic way. Records demonstrated a strong understanding of people's acquired brain injury, cognitive impairment, communication needs, mental health, behavioural presentation and dysphagia risks. Assessments identified risks, support needs and factors important to people's wellbeing, providing a foundation for person-centred care planning.

Care plans reflected people's assessed needs and included information about how staff should support them safely and effectively. Assessments helped staff understand people's individual circumstances and informed the planning and delivery of care.

However, we found some areas of care assessments could have been more detailed and comprehensive. There was less assurance regarding the assessment and recording of areas such as oral health, skin integrity, hearing, vision and continence. As a result, assessment processes were strongest in relation to behavioural, cognitive and support needs, with less assurance available regarding the assessment and recording of some physical health needs.
 

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

While advice provided by specialists was reflected within care planning and support arrangements, there was less evidence demonstrating how some dysphagia-related controls, assurance arrangements and post-incident learning were routinely monitored, reviewed and evaluated. This reduced assurance regarding how the provider satisfied itself that these measures remained effective and were consistently embedded in practice.

However, the service worked with a range of healthcare professionals and specialist services to help ensure care and treatment reflected recognised guidance and good practice. Positive Behaviour Support plans reflected recognised approaches to supporting people with behaviours of concern, and staff had access to training relevant to the complex needs of people living at Albert Road.

Detailed guidance was available regarding food preparation, supervision arrangements, dietary requirements and support during mealtimes. Specialist recommendations had generally been translated into practical instructions for staff, providing clear direction regarding how people should be supported safely and consistently.
 

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.

The provider had effective systems in place to support communication, information sharing and coordination of care. The service worked with a range of healthcare professionals and were able to explain how external professional guidance informed the support provided to people.

Information relating to hospital attendances, healthcare involvement, changing needs and follow-up actions was recorded and communicated through established systems. Staff demonstrated a good understanding of the people they supported and were able to describe individual needs, risks and support strategies. Care records reflected a coordinated approach between the service, healthcare professionals and other agencies involved in people's care.

Staff generally had access to the information required to support people safely and that arrangements were in place to promote effective communication, continuity of care and partnership working.
 

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Significant risks relating to dysphagia, dehydration and malnutrition had been recognised and detailed support arrangements were in place. There was limited evidence of nutritional screening, weight monitoring and trend analysis. As a result, there was reduced assurance that changes in nutritional health would be consistently identified, monitored and acted upon at the earliest opportunity.

However, the provider supported people to maintain their health and wellbeing through access to healthcare services. Staff were able to recognise changes in people's physical health, mood, behaviour and presentation, and understood when concerns should be escalated to healthcare professionals. Records demonstrated involvement from GPs, Speech and Language Therapists and other healthcare professionals where required, with specialist advice incorporated into support arrangements.

Staff were aware that changes in behaviour, mood or wellbeing could indicate underlying health concerns and were guided to seek appropriate medical input where risks were identified. People were supported to maintain existing skills, access meaningful activities and engage with their local communities, helping to promote wellbeing and reduce the risk of deterioration.
 

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.

Whilst people appeared to achieve positive outcomes, systems for measuring, evidencing and reviewing those outcomes were less developed. The provider could not consistently demonstrate how outcomes were measured, tracked and reviewed over extended periods.

This was particularly evident in relation to some health outcomes. There was limited evidence of monitoring records relating to diabetes, and records relating to nutrition, weight management and other health indicators were not consistently available within the evidence reviewed. As a result, whilst people's health needs were recognised and support arrangements were in place, there was limited evidence demonstrating how outcomes were routinely monitored, evaluated and used to inform ongoing improvements in care and treatment.

However, the provider supported people to achieve positive outcomes in areas including independence, rehabilitation, confidence, mobility, community access and behavioural stability. Care reviews demonstrated that support was adapted when people's needs, goals or aspirations changed, and staff were able to describe progress people had made over time. Records reflected a rehabilitative approach focused on helping people maintain and develop skills, maximise independence and participate in meaningful activities.
 

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

Care records reflected the principles of the Mental Capacity Act 2005 and emphasised the importance of assessing capacity on a decision-specific basis and supporting people to make their own decisions wherever possible.

Care planning referred to best-interest decision making, advocacy where required, Court of Protection involvement and financial appointeeship arrangements. Deprivation of Liberty Safeguards (DoLS) authorisations were in place and associated restrictions were reflected within support planning and day-to-day care arrangements.

People were supported to make choices about their daily lives and care plans promoted independence, choice and control. The provider's approach demonstrated that consent, capacity and legal decision-making considerations were embedded within care and support delivery.