Mr 'C's

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to people’s safe care and treatment, person-centred care, safeguarding, good governance and staffing.

This service scored 36 (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 consistently place people at the centre of decisions about their care and treatment. Care planning and review processes did not demonstrate people, or those important to them, were routinely involved in developing, reviewing or agreeing care arrangements, particularly where people lacked capacity to express their needs and wishes independently.

Care plans were often incomplete, inaccurate or out of date and did not consistently reflect people's preferences, choices, goals or changing needs. Significant incidents, changes in health and emerging risks were not routinely incorporated into care plans, reducing assurance care remained responsive and person-centred.

There was limited evidence relatives were involved in care planning and review processes. One relative reported they had never been consulted about their family member's care despite concerns relating to falls, diet and medicines management. Inspection findings also identified gaps in decision-making records, behaviour monitoring documentation and care plan reviews.

While people described staff as kind and caring and staff demonstrated a good knowledge of some people's individual needs, the provider could not demonstrate care planning processes consistently involved people and those important to them or care records accurately reflected people's preferences, wishes and current needs. As a result, people could not always be assured they were at the centre of decisions about their care and support.

The provider did not consistently understand, assess or respond to the diverse and complex needs of the people using the service. People were living with a range of conditions, including alcohol dependency, acquired brain injury, dementia and end of life care needs.

Inspection findings demonstrated limited understanding of some people's health and behavioural needs across all levels of the organisation. Training provision was inadequate, and staff had not consistently completed training relevant to the needs of the people they supported. As a result, care was not always responsive, coordinated or based on an informed understanding of people's conditions and associated risks.

The provider did not consistently recognise when specialist input, additional support or healthcare intervention was required. Opportunities to make timely referrals, seek professional advice and implement enhanced monitoring arrangements were missed, including where safeguarding concerns and behaviours presented risks to people or others. There was insufficient evidence that identified concerns were escalated appropriately or that specialist assessment and support were sought when people's needs changed.

These failings meant people could not be assured their care was joined-up, responsive to changing needs, or informed by a comprehensive understanding of their individual health and support requirements.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service did not consistently provide information in ways that supported people to understand and access information about their care, in line with the Accessible Information Standard (AIS). The AIS places a legal duty on providers to identify, record, share and meet the information and communication needs of people with a disability, impairment or sensory loss.

Care records did not consistently identify people's preferred methods of communication or provide clear guidance on how they should be supported to access and understand information. Although managers described the use of large-print documents and plans to introduce more visual formats, such as pictorial menus, these measures were not evident during the assessment.

The provider did not ensure people and their relatives received clear, accessible and up-to-date information about their care and support. People and their relatives were not routinely involved in care planning or reviews and were unaware they could access care records. This reduced opportunities for them to understand, contribute to and influence how care was delivered.

Relatives also reported poor communication regarding their family members' health and wellbeing. For example, one relative told us they had not been informed when their family member required hospital treatment following a fall. Another relative described difficulties obtaining information about their family member's welfare because staff were unaware, they held Lasting Power of Attorney.

Confidential records were not always stored securely, increasing the risk of unauthorised access to personal information.

These issues meant people and those important to them could not always be assured information was accurate, accessible, appropriately shared or used effectively to support safe and person-centred care.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The service did not consistently listen to and involve people, relatives and representatives in decisions about care and support. There was limited evidence to demonstrate people, relatives or representatives were routinely involved in care reviews or the development of care plans. For example, one relative told us they had not been consulted about their family member's care despite raising ongoing concerns. This meant opportunities to gather feedback were not always translated into meaningful involvement in care planning and review processes.

There was also limited evidence to demonstrate how people were supported to have control over their lives or actively participate in decisions about the care and support they received. People were not routinely encouraged to share their views through structured reviews, meetings or other engagement opportunities, which reduced opportunities for them to influence how support was planned and delivered.

Managers told us monthly reviews and resident meetings took place. People generally felt comfortable raising concerns and speaking openly with staff. During the assessment, people told us, “I feel able to say if I don't like something” and, “If I have any worries, I will speak to the manager.” However, systems for capturing, analysing and acting on feedback were not consistently effective. As a result, people and those important to them were not always fully involved as equal partners in the planning, review and delivery of care.

These issues meant the provider could not always demonstrate people's views, experiences and preferences were consistently sought, listened to and used to drive improvements in the care and support they received.

The provider did not make sure people could access the care, support and treatment they needed when they needed it.

The service did not consistently ensure people could access care, support and opportunities equitably. Inconsistencies in both initial and ongoing assessments meant people's needs were not always fully identified, assessed or reflected in their care and support plans. For example, pre-admission assessments did not consistently capture the level of support people required, resulting in care plans that did not always provide staff with sufficient guidance to meet people's needs safely and effectively.

Although district nurses visited regularly and staff made efforts to support people to access healthcare services, this was not always delivered consistently. Changes in people's health and wellbeing, including signs of illness or deterioration, were not always recognised, monitored or responded to promptly. Referrals for specialist support were not always made when required. As a result, people did not always receive care and support that was responsive to their changing needs or tailored to their individual circumstances.

A prolonged lift failure had a significant impact on people living on the upper floors of the building, particularly those with mobility needs. Some people experienced considerable barriers in accessing healthcare appointments, activities and areas of the service. One person who used a wheelchair told us they had been unable to attend an eye appointment because of the lift being out of service. Another person said, “I have to go to the doctors today. I have to do it on my own. I don't feel safe on the stairs going up and down.”

While staff worked to support people where possible, people's experiences varied and equitable access to care, support and external services was not consistently achieved. As a result, people could not always be assured they would receive the right support, at the right time, to meet their needs and promote their wellbeing.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Poor care planning, incomplete documentation and inconsistent risk management meant staff did not always have access to accurate information about people's needs. Care delivery often relied on individual staff knowledge rather than robust systems, increasing the risk of variation in the quality and consistency of support provided.

The service could not demonstrate staff and leaders consistently listened to or acted upon information about people who may be at greater risk of experiencing inequality. In addition, staff did not receive the training necessary to recognise and respond to individual barriers, protected characteristics or diverse support needs. This limited the service's ability to ensure consistently equitable outcomes for all people.

Some people told us staff treated them with dignity, kindness and respect and spoke positively about the care they received. Staff supported some people to maintain family relationships, community connections and aspirations for greater independence. Emotional support was also provided where staff knew people well and understood their preferences. However, positive outcomes were not experienced consistently across the service.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The service did not consistently support people to plan for their future care, support and changing needs. Although managers described discussions relating to future wishes, end of life care and treatment escalation planning, there was limited evidence these conversations were taking place consistently or resulting in effective, person-centred plans.

Records showed some people had future care planning documents in place, and staff worked with external professionals to support rehabilitation goals, discharge planning and future accommodation arrangements where appropriate. However, this approach was not consistently embedded across the service. For example, one person who had been living at the service for several months following a hospital admission had no personal belongings or clothing from home and was unclear about how long they would remain at the service or whether they would return to their own home. This demonstrated a lack of clear planning and communication regarding their future care and living arrangements.

Further concerns were identified in relation to decision-making and recording processes. Gaps in mental capacity assessments, best-interest decision records and care planning documentation meant people's wishes, preferences, future goals and changing needs were not always clearly documented, reviewed or acted upon. As a result, the provider could not demonstrate people were consistently involved in planning for their future or care and support arrangements were regularly reviewed to reflect their evolving circumstances.