The Cotswolds

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

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 good, and people’s feedback confirmed this. The provider was working to ensure good outcomes were experienced consistently for everyone.

This service scored 62 (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 ensured that relevant information to people was present in their care plans and assessments. These were based off their pre-admission assessment, and knowledge built up about a person after they had moved in.

Their pre-admission assessment considered all expected aspects which would enable them to care for people effectively, but also considered other additional aspects such as technology requirements, to ensure a more person-centred experience.

People’s care plans and assessments were regularly reviewed, however some staff felt that these needed to be updated more regularly.

There was room for improvement around the content of information recorded on people’s daily records. These were sometimes incomplete and not detailed. The provider had already identified issues surrounding this prior to our assessment and implemented development and changes to their documentation. This was still under review.

Staff had good knowledge of people’s needs, such as dietary and communication need, and information provided for conditions such as epilepsy was thorough and detailed. There was room for improvement with language used in some plans and assessments, particularly the use of the word “staff” as there are many varying levels and qualified professionals, it was not always clear who should be completing specific health and care tasks.

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

The provider used nationally recognised tools to meet people’s needs. This included tools that had been adapted for neurorehabilitation services, to ensure it reflected the needs of the group of people using the service. The provider remained up to date with new and developing tools and information was available for staff on these tools and evidence-based good practice guidelines.

Care plans and assessments included information on tools used and reflected how this related and looked for that person. They also utilised tools for other conditions such as dementia. For example, dementia care mapping, which enabled them to adapt their model of care to meet those needs.

The provider used tools around focusing on nutrition and hydration, and there was a system in place for staff to record people’s intake, however, there was room for improvement around oversight of these as it was not always identified or addressed when these systems were not used effectively in practice.

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 ample documentation available which detailed information about people, including forms which contained succinct, vital and key parts of someone, their needs and preferences.

The provider employed a multi-disciplinary team (MDT) which consisted of people from varying professions, able to bring their experiences and qualifications to people using the service. They met regularly, and we were able to see clear records of their meetings, planned and executed actions.

The provider worked with other external organisations such as the Integrated Care Board (ICB) and the local authority. Both organisations had recently visited and provided feedback. The provider had developed an action plan from these visits, and we were able to see that many actions had been completed. The provider was receptive to our feedback during the assessment and took prompt action where needed.

Staff reported that they feel there is a good team within the services, including leaders. One staff member told us “The staff are very hard working, there’s some really good teamwork, and most people are absolutely amazing.”

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.

The provider had systems in place to encourage a healthier lifestyle, for example, a rotating seasonal menu consisting of home cooked meals. There was room for improvement in encouragement and recording around hydration as we found most recorded fluid intake was hot drinks. Whilst this is down to personal choice of people using the service, it was not clear if people were being offered a range of drinks, including drinks to better maintain good levels of hydration.

The provider facilitated a range of activities, including day trips, and a festival called ‘Oakfest’ which included live music, games and food which people using the service attended. Some people felt there was not a wide enough range of activities and that they were not adapted enough for everyone to join in.

People are supported and encouraged to take part in routine health screening programmes with the NHS, and we saw evidence that people are supported to attend routine dental appointments, and health check reviews.

It was not always evident how people were supported to be involved in decisions about their health, care and healthier lifestyle choices, and there was room for improvement in this aspect. Additionally, there was room for improvement to ensure that preventative measures were included in all care plans and assessments, as this was not consistent.

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 the expectations of people themselves.

The provider had systems and processes in place to monitor peoples care, to aid improvement and increase of positive outcomes for people. However, these were not always consistently used in practice, and oversight was not always robust. For example, nurses review daily paperwork completed by care staff, but these reviews had not identified issues we found during our assessment, and therefore they were not escalated to leaders.

There was room for improvement for the provider to ascertain people’s expectations about their care and what positive outcomes look like for them. This was not consistent across the service, particularly where someone had additional communication needs, however the provider did take steps such as involving relatives and the person’s past to attempt to ascertain this.

The provider had systems in place to monitor people’s behaviours that communicate, analyse this and ascertain what can be done differently for that person. They were about to switch to a new monitoring system which they feel will enable them to do this to a better standard.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider made sure people had information about some of their rights, and utilised local advocacy services when needed if someone was unable to understand and advocate for themselves.

Where people could consent to aspects of their care and treatment, there was clear documentation in place. Some people did not have the ability to consent to certain aspects of their care, and there was room for improvement around the providers documentation and process, ensuring it fully adhered to the Mental Capacity Act (MCA, 2005) and other relevant legislation.

Mental capacity assessments were completed by different members of staff across the service, which reflected inconsistency of quality. Some were not detailed, very vague, and others were clear in how they applied the 5 key principles of the MCA (2005) and involved the person and their relatives or representatives.

Staff at all levels within the organisation were provided with relevant training. However, through talking to staff during our assessment, it was clear there was a gap in knowledge and understanding around mental capacity and consent. This was shared with the provider, and they shared with us their plans to improve knowledge across the service, including their Social Worker running drop-in sessions.