Pathways of Hope

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 Assessment Service Group since its registration. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Systems were effective in assessing people’s needs.

Each person had a full and completed initial assessment in place, which people confirmed that they, and their relatives, were involved in. Each assessment included a review of their capacity and ability to communicate their needs and wishes. There was detailed information taken from people on how they express these wishes. The registered manager described a thorough review of the information they received from partners and professionals when they commenced a new package of care.

Peoples’ needs, and choices, were assessed and took account of preferences for their support. Protected characteristics and diverse needs under the Equality Act formed part of this process. For example, people’s religious needs and preferences were captured. The needs of carers were addressed by the provider. A lone working policy was in place to support staff needs and ensure they could provide safe and effective care.

The management team completed detailed and regular audits of the quality of people’s initial assessments. These reviewed the timeliness of completed assessments, and whether all relevant and appropriate information about the person had been included. Where there were actions, these had been allocated to staff for completion.

People received care, treatment and support that was evidence-based and in line with good practice standards. Each person had a full and complete initial assessment in place, an assessment that they confirmed they had been involved in.

Staff monitored people’s care and support needs using good practice tools. For example, one person with a specific mental health disorder had a recognised and specific care plan in place to support them to manage symptoms and improve their wellbeing. This included any therapies, lifestyle adjustments and support systems.

Systems supported staff and services to work together effectively. Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Information was shared between teams and services to ensure continuity of care, for example when clinical tasks are delegated or when people are referred between services. When people received care from a range of different staff, teams or services, it was co-ordinated effectively. Appropriate and timely referrals were made to specialist health services when needed.

Systems were effective in supporting people to live healthier lives. Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Peoples medical and health requirements were supported by staff, while promoting independence and balancing risk. For example, staff prompted one person with medical appointments but ensured that scheduling and follow up appointments and tests were planned and carried out. One person said, “They are good at booking and getting my medicines and my appointments.”

People’s mental health was supported and managed effectively. Detailed assessments, positive behaviour support plans, training and guidance for staff, as well as partnership working with external mental health practitioners all contributed to promoting mental health of people at the service

People were supported to build independent living skills like cooking healthy meals and eating healthy. Where people found it difficult to discuss and maintain a healthy lifestyle, detailed care plans and strategies were in place to manage this. One person said, “They (staff) do particularly well in asking if I need support during cooking and things like that.” Another person said, “They do like food menus, what I’m going to eat. I cook on my own. There’s always someone in the kitchen that watches. If I do need help it’s there.” One staff member said, “During meal preparation, I follow food safety guidelines, checking expiry dates and ensuring meals align with their dietary needs. I encourage them to make choices about their meals while providing gentle reminders about balanced nutrition.”

People experienced positive outcomes to the care they received. The monitoring of people’s care and health needs used evidence-based guidance and tools to monitor outcomes effectively, such as positive behaviour support plans, key worker meetings and outcome planning. The provider was proactive with communication with, and timely referrals to, external professionals and stakeholders to ensure that outcomes remained positive for the people they supported.

Systems ensured that staff sought consent from people for care and treatment. People were supported in accordance with the Mental Capacity Act. Each care plan included an assessment and review of people’s capacity and ability to communicate their needs and wishes. There was detailed information and guidance on how people expressed those wishes. People confirmed that their views and wishes are taken into account when their care is planned.

Staff received training on the Mental Capacity Act and understood their responsibilities regarding MCA, and the importance of people being involved and making their own decisions. Staff also received training in communication and mental health awareness. One staff member said, “I actively seek consent before every task, breaking down each step to facilitate understanding. This allows the client to make an informed decision, whether to accept or decline assistance.” Another staff member said, “I always give them choices, for example, when they want to have their meals. I always offer choices so they can make theirown choices.”