GFI@112

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 newly registered service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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.

The provider received referrals and carried out assessments of people’s physical and mental health needs, as well as their care and communication requirements. These assessments were informed by input and guidance from relevant healthcare professionals. Where appropriate, people’s relatives were involved to support a more holistic understanding of individual needs. A person’s relative told us, “[Manager] came out and did the assessment, and attempted to get information from [another provider],” this meant efforts were made to gather comprehensive background information to inform care planning.

People’s care plans were developed based on these assessments and included guidance for staff to support people’s communication and behaviour effectively. Reviews of care plans were conducted regularly, a staff member explained, “We go out every 6 months, or annually, depending on availability.”

Staff confirmed that they had access to people’s most recent care plans and were able to review updates as required, supporting consistency of care.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People were supported by staff trained in Positive Behaviour Support. Positive Behaviour Support (PBS) is aperson-centred approachdesigned to understand and address behaviours that communicate a need or emotion, while promoting positive skills and wellbeing. People’s care records showed that this approach was tailored around each person, with clear guidance in people’s care plans to reduce people’s distress.

The service had a designated PBS lead who facilitated debrief sessions and reflective discussions with staff following safety-related incidents. These sessions were used to identify learning opportunities and support continuous improvement in how situations were managed. The provider worked collaboratively with people’s relatives to ensure consistent approaches to behaviour support, including when care staff were not present.

A relative told us, “I feel they are equipped to deal with [person’s] needs,” reflecting confidence in staff capability.

Staff demonstrated confidence in recognising the signs of dehydration and malnutrition and understood how to monitor people’s nutrition and hydration needs. However, records did not always consistently reflect the offer or intake of fluids during care visits. This meant the provider could not always be assured that people’s hydration needs had been met.

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 demonstrated some positive practices in supporting continuity of care. Staff visited people in hospital settings to ensure familiarity across environments, and shadow shifts were used effectively to help people build relationships with new care staff. The provider also worked collaboratively with other healthcare professionals. They attended professional’s meetings to review and coordinate people’s care, supporting a joined-up approach to care delivery. Whilst documentation did not always fully reflect handover of care between providers, staff had received verbal information which was then handed over to people’s relatives.

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.

The provider worked in partnership with people and their relatives to support the management of their health and wellbeing. The registered manager told us they encouraged people’s relatives to support their loved ones to access healthcare services, such as the GP and dental assistance where this was identified as necessary.

The provider routinely monitored people’s care and treatment. They ensured that outcomes were positive and consistent, although worked in partnership with people’s relatives and professionals to ensure that they met clinical expectations.

People were supported to achieve positive outcomes, such as attending activities that were important to them. Although people’s expected health and quality of life outcomes were not always recorded in their care plans, a staff member told us they met with people and their relatives to discuss people’s expected outcomes.

People’s care plans directed staff to look out for signs of health deterioration and what action should be taken, for example, when a person was experiencing low blood sugars.

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

The provider worked in line with the Mental Capacity Act 2005 (MCA). Where people lacked capacity to make decisions, where appropriate their relatives were involved in best interest decisions. Staff were aware of the importance of involving relatives and professionals in decision making.

Records showed that consent to care had been obtained and documented. Staff described clear procedures to follow if a person declined care and confirmed they would respect individuals’ choices, including those considered to be unwise, in line with the principles of the MCA.