Affinity Trust - South West

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 people’s outcomes were not consistently good.

This service scored 46 (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 was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s changing needs had not always been assessed appropriately. For example, 1 person with a new health need had not been supported well with this. The person’s relative told us concerns had been raised but they were not promptly acted upon. We discussed this with the registered manager who addressed the concerns during the assessment. Where people’s needs had changed, care plans and records were not always updated to reflect this.

The service had a process in place to ensure people had their needs assessed before moving into the service. Assessments were completed with people and their relatives and formed the basis of people’s care plans. Areas covered included communication, risks of harm, health needs, goals and recruitment of suitable staff. However, we found a risk of harm on 1 person’s assessment was not detailed in their care plan. We discussed this with the registered manager who told us they would address this.

The service did not always plan and deliver people’s care and treatment in line with current evidence-based good practice and standards.

Staff were not always aware of and supporting people in line with plans implemented by health professionals. For example, staff told us they were not supporting 1 person in line with their speech and language therapy eating and drinking plan. Staff were also unaware of physiotherapy guidance which was detailed within this person’s support plan. Another person’s health professional plan was not detailed in their care plan. The provider addressed these concerns during the assessment.

We received mixed feedback from relatives on how their family members were supported with nutrition and hydration. One relative told us, “They [staff] do communicate with [name of person] and they make [meal] choices.” Another relative told us how they had to do their family members food shopping as staff had not supported their family member with this. They also raised concerns about out-of-date food in their family members flat. We discussed this with the support manager who gave us assurances this had been addressed.

The provider did not always work well across teams and services to support people. People living in different supported living services had different experiences relating to the support they received. Where people had health professional guidance for staff to follow, staff were not always aware of or following this.

We received mixed feedback from professionals regarding their involvement with the services. One professional raised concerns about the use of agency staff and staff skills. The registered manager was aware of this and gave assurances they were addressing the concerns. Another professional told us about concerns they had about the service; they went on to say that things had improved since a new support manager had been in post. A third professional told us the staff worked well with them. A professional told us they were, “Confident that if they had a problem, they [staff] know who to talk to and escalate and would be able to discuss professionally and in a timely manner.”

Staff and the management team provided us with examples of how they worked with health and social care professionals to support people’s needs.

The service did not always support people to live healthier lives and reduce their future needs for care and support. They did not always support people to seek medical care when required. For example, 1 person’s daily notes included information relating to a health concern, staff had not contacted a medical professional regarding this. We found contradicting information in 1 person’s care documentation relating to their health condition.

We received mixed feedback from relatives relating to staff supporting their family members with health appointments. One relative raised a concern about their family member missing health appointments, another raised concerns about a delay in seeking medical assistance. They also told us the family wanted staff to support appointments, but they were concerned that staff did not fully understand their relative’s health needs. Other comments from relatives were positive. Comments included, “Yes they do support medical appointments” and “Yes definitely.”

Staff told us how they encouraged people to exercise and eat healthily. They told us how they were working with a dietician to support 1 person to eat healthier foods and reduce their weight.

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

Although the provider had systems in place to monitor people’s care and treatment, these were not fully effective in ensuring outcomes were consistently positive. We identified concerns relating to health professional plans not being followed and staff not being aware of these, delays in medical assistance and health professional input being sought, and people’s medicines not always being available when needed.

We received mixed feedback from people’s relatives relating to improving outcomes. One relative told us they thought their family member had, “Deteriorated” and “Gone backwards” since being supported by the service. Another relative told us of a negative outcome due to staff not acting promptly and escalating a change in their family member’s needs. A third relative told us, “All carers seem confident and not out of their depth, they’re doing something right from what I’ve seen.”

Some evidence of positive outcomes was provided during the assessment. For example, staff told us how 1 person had a reduction in incidents, and how they had worked with the person to meet their sensory needs. Staff also told us how they had successfully supported 1 person who was anxious to have a medical intervention, using social stories. Staff had spent time with people, finding out what people’s aspirations and goals were.

The provider did not always tell people about their rights around consent. The Mental Capacity Act 2005 (MCA) which provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves, was not always being followed.

Capacity assessments and best interest’s decisions were not in place for all restrictions and where they were in place they have not always been regularly reviewed. One person’s care plan contained conflicting information relating to their capacity to make decisions. We discussed this with the registered manager who took immediate action to address the concerns.

Communication plans provided guidance for staff on how to communicate with people which enabled them to support people to make decisions.