Sturbridge

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.

This is the first assessment for this service. This key question has been rated 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 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 effectively assessed. Although people’s relatives were involved in the assessment process, there was no evidence that people themselves were involved in a meaningful way. One relative told us, “[They] aren’t involved in the assessment process.” However, another relative said, “[Person] was involved (in assessment)”. This meant the provider did not always capture people’s own views, preferences or priorities when planning their care.

Not all of people’s health and care needs had been assessed, leaving gaps in documentation and limiting the information available to staff. As a result, staff did not always have sufficient guidance to provide safe, person-centred support that met people’s full range of needs.

We saw that some people had good levels of detail recorded about their daily routines and preferences, but this was not consistent across all care plans. The inconsistent approach to assessment increased the risk of people receiving care that did not fully reflect their individual needs or circumstances.

The provider did not always plan and deliver people’s care and support in line with best practice guidance or recognised standards. Care and support were not planned with regard to the principles of the right support, right care, right culture guidance. People were not supported to be meaningfully involved in their own care planning. This meant care was not always shaped around people’s preferences, aspirations or what mattered most to them.

Nationally recognised assessment tools, such as the Malnutrition Universal Screening Tool (MUST) and the Waterlow pressure area assessment, were not being used. Although people did not appear to have needs relating to malnutrition, at least one person could have been at risk of skin deterioration due to reduced mobility, and the absence of recognised assessment tools meant this risk had not been formally evaluated.

The provider worked well across staff teams to support people and ensure care was delivered consistently. Relatives told us that communication between staff and themselves was good, and that they were kept informed and involved in matters relating to people’s care.

One relative described the positive camaraderie demonstrated between staff during a recent personalised training session. They told us that staff supported one another well and worked collaboratively, which helped build confidence and ensure people received coordinated and reliable care.

Overall, effective communication and strong teamwork helped ensure people experienced a consistent and joined up service.

The provider did not always support people to manage their health and wellbeing in a way that maximised their independence, choice and control. One person’s care plan stated that no salt should be added to their food; however, there was no evidence that the person had been involved in this decision, nor any explanation of why this restriction had been put in place. This meant the provider had not demonstrated that decisions about people’s health related needs were made in partnership with them or explained in a way that upheld their choice and control.

Specific health risk factors had been identified for another person, and although there were gaps in the level of detail recorded, we saw that staff supported them to maintain good hygiene practices that helped reduce the likelihood of these risks occurring. This demonstrated some understanding of how to promote healthier outcomes. However, the lack of comprehensive written guidance meant staff did not always have a full picture of how to support the person proactively or consistently.

Overall, the provider did not consistently promote healthier lives or ensure that people were fully involved in decisions about their health and wellbeing

The provider did not always monitor people’s care and support in a way that enabled continuous improvement. Whilst there was some evidence that aspects of people’s care had been reviewed, changes identified during these reviews were not consistently updated in people’s care plans. This meant that care records did not always reflect people’s current needs or the support they required.

There was no evidence that people themselves had been involved in their reviews, nor that any steps had been taken to make the review process accessible or meaningful to them. As a result, people were not supported to understand their care, share their views or contribute to decisions about changes to their support.

It was also unclear whether people had been supported to identify their own desired outcomes or what they wanted to achieve through the care they received. Without this, the provider could not demonstrate that outcomes were based on people’s goals, aspirations or preferences.

Overall, gaps in the review process and in the provider’s approach to capturing and acting on people’s desired outcomes meant opportunities to improve care were missed.

The provider did not always ensure that people’s rights around consent were understood, assessed or respected in line with the Mental Capacity Act (MCA). Not everyone who required it had a mental capacity assessment in place to determine whether they were able to consent to their care.

The one mental capacity assessment we reviewed contained insufficient detail to demonstrate that the person lacked capacity to consent, despite them being deemed to lack mental capacity. There was no evidence that information about consent had been presented to the person in a way they could understand before concluding that they were unable to make the decision. Once the person had been assessed as lacking capacity, a best interests decision had not been documented to show how decisions about their care were made on their behalf.

Another person did not have a mental capacity assessment in place, despite having a cognitive impairment and a learning disability that gave reason to suspect they may have lacked capacity to consent to aspects of their care. It was not clear that the person overseeing the service understood their responsibilities under the MCA, as they stated that because this individual had a Power of Attorney in place, their mental capacity would have already been considered by the Court of Protection. There was no evidence that the service had seen a copy of this Power of Attorney or verified its scope. This demonstrated a misunderstanding of the legal requirements around assessing capacity and decision specific consent.

Staff told us how they applied the principles of the MCA in practice. One staff member said, “I understand the principles of the mental capacity act, including assuming capacity, supporting individuals to make decisions, and acting in their best interests when necessary. If someone refuses care I respect their choice, assess capacity, and follow the correct procedures.”