Plean Dene

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 the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to person centred care.

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 effective because they did not always assess and review people’s health, care, wellbeing and communication needs with them. We found that some parts of people’s care plans were detailed and person centred but this was not consistent, and we could not be assured information was always relevant and up to date. For example, when people needed support to manage their mental health and prevent distress, care plans contained limited information to enable staff to recognise the potential causes of distress, how to recognise the person was becoming distressed and the action to support the person to de-escalate.

Although people’s support plan contained information of how the person communicates. We found information on how to support people was inconsistent. For example, a person’s communication plan described them as “non-verbal”, but also gave some examples of verbal communication used. A staff member told us, “only 3 are verbal, everyone else is non-verbal”. This was not accurate as most people used at least some verbal communication. A person’s records stated they used some Makaton, which is a language system that uses signs, symbols and speech to support communication. Although we saw this was a recommended area of development, staff training had not been provided, staff sometimes failed to recognise the person was using Makaton to communicate. This meant we could not be assured people were always supported to communicate in line with their needs.

The provider was responsive to our concerns and was taking action to ensure people’s bespoke needs were recognised and met.

The provider did not always plan and deliver people's care and treatment in line with best practice guidance or ensure care was based on a complete assessment of their needs. opportunities to assess, monitor and review some risks were missed, which reduced the provider's ability to deliver consistently effective care and treatment.

People’s experience of being able to choose how they wished to be supported, maintain and develop skills and lead fulfilled lives was restricted by staff. This was not in line with the principles of the statutory guidance of Right Support, Right Care, Right Culture and best practice guidance for people with a learning disability. For example, people could not choose when they had their meals and where they spent time during the day whilst at home.

People had enough to eat and drink, and systems were in place to monitor food and fluid intake where required. People had access to the local community where they participated in activities they enjoyed.

The provider worked well across teams and services to support people. They worked effectively with a range of external professionals, including the learning disability team, district nurses, advocacy services and GP practices. This helped ensure people received coordinated care and support that met their needs.

Professionals spoke positively about the service's approach to joint working. One professional told us, “The staff there work very effectively with me. The concerns they raise are always well directed and informed”.

Staff felt the team worked well together. For example, a staff member said, “I feel the team work very well together, we always help each other when needed and communicate very well as a team”.

The provider supported people to manage their health, and where possible, reduce their future needs for care and support.

People were supported to access healthcare services as required and had robust plans in place to manage their physical health needs. Staff supported people to eat healthy, nutritious and balanced diets, for example a person had diabetes, staff supported them to eat at regular times of the day and to avoid food that posed a risk, the person’s weight had reduced and their blood sugars were within the recommended range.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Each person had regular meetings with their key worker, where support plans were reviewed. People’s health was monitored and support plans were updated to reflect any changes in need. Staff demonstrated they were able to recognise a deterioration when a person became unwell and seek immediate professional support.

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

Where people lacked capacity to make specific decisions, Mental Capacity Act assessments and Deprivation of Liberty Safeguards applications were in place, however the provider had not ensured people were always provided information in line with their needs, as only verbal information was used. People were not always included in deciding where they spent their time, staff moved people into different areas of the home without gaining their consent or considering if this was in their best interest.