Complete Care and Enablement Services

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 remained the same. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 83 (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. People’s risks were considered within support plans and for each risk identified, actions staff should take to mitigate those risks were identified.

The provider ensured people, who displayed behaviours which challenged or put themselves, or others at risk, had positive behaviour support (PBS) plans in place which were completed by the PBS team. Care records were updated regularly. Most care records we reviewed had been updated earlier that month.

Fluid intake charts were not always consistently completed; we identified gaps in the recording of fluids given to some people and errors in the total amount of fluids taken by a person on a given day. This did not negatively impact on people, and we were assured that people received adequate amounts to drink. We brought these recording errors to the registered manager’s attention, and we were assured this would be addressed. Staff were completing regular checks on urinary output for people identified as requiring this level of monitoring.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider worked extremely 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 workforce embraced partnership working to continuously drive improvement in relation to people’s care. Consistently positive feedback from external partners reflected the effectiveness of the relationships both managers and staff established with people, their relatives and also with their related professionals. Information and guidance from external partners was utilised, expanded and disseminated to internal staff teams in learning sessions prior to people moving into any new placements. This specific, person-centred approach helped one young person successfully transition from a long stay hospital placement into their own home, with individualised support.

Staff ensured appropriate professionals were involved in people’s care and explained how referrals were made to specialist services when required. One person had been referred to SALT following 3 separate choking episodes, another to audiology for ear syringing. A person’s mobility had recently deteriorated due to ageing and acquired infections. We identified timely referrals had been made to appropriate services to assist improve the person’s quality of life.

People were supported to access support from specialist teams including the learning disability service, physiotherapy and the GP. The provider employed a national team of behavioural specialists whose input with local services was vital for frontline staff providing support; staff we spoke with told us how they valued this important resource. The whole multi-disciplinary team approach meant that the staff team were fully involved, fully informed and could focus on providing person-centred support topeople using the service.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People’s care records considered their health and well-being. Details of people’s needs such as continence support, mental health or pain were outlined. These sections were person centred and there were regular reviews of hearing, eyesight, oral health, skin and personal hygiene, even if this was to note no concerns.

People were encouraged and supported by staff to attend health appointments as needed. We saw detailed documentation in some services about people’s appointments with external professionals, including the rationale for the appointment, who attended and visit outcomes, with any actions noted.

People were aware of support plans and risk assessments associated with their identified health needs and requirements. Staff ensured people’s oral health support needs were recorded in their support plans. Staff supported people with arranging appointments with opticians and audiologists when required. Staff also supported people with any instructions or advice from external professionals; for example, one person was reminded and encouraged to do strengthening exercises recommended by the physiotherapist.Health action plans outlining a person’s health needs and how needs would be met were in place.

The provider consistently 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.

We saw numerous examples of people improving and achieving positive outcomes due to the support mechanisms in place, excellent care planning and consistent staff approach. One person had an intolerance for wearing clothes prior to moving to a new placement with this service. With input from relevant professionals and encouragement from the staff team they were now wearing clothing and footwear all the time, accessing the community and spending quality time with family which had not been previously possible.

Another person disclosed that they had always wanted to sky dive but did not think this was possible to achieve this goal as they used a wheelchair to mobilise. The staff team contacted and worked with a local company to help the person fulfil their dream and enjoy a simulated sky diving experience. Two people were supported to attend the session and had an amazing time. There were photos around their home, and they had lovely memories of the day which they shared with us during our visit. They consented to the provider sharing a video made on the day and the enjoyment from both was obvious to see.

Staff ensured positive outcome records were completed which provided an overview of the goals achieved and the steps taken to achieve such goals. For one person, they had reached their goals of eating independently using a fork, scanning their own items whilst out shopping and supported to draft and send a thank you letter to relatives. Another person had attended a group activity to Chester Zoo, visited a farm shop and had received a new wheelchair which had enhanced their quality of life.

A social worker we contacted for feedback said, “As a result of the ongoing support the service user has lost weight, due to staff providing healthy choices and an increased level of activity.This has helped the service user participate in activities they were not able to before.The service user appears happier.”

Staff were completing routine monitoring of people’s health needs. For example, staff were completing seizure monitoring charts for a person who had regular epileptic seizures. These documents were used to update health and social care professionals and to ensure support remained valid and met the person’s needs.

Staff regularly reviewed the weight of people to spot signs of underlying health issues, unintentional weight loss and whether nutrition and meal support were appropriate. The provider ensured there were monthly one to one key worker sessions; reviews of people’s support plans along with the progress people had made were mapped during these sessions and any required changes made.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported people in making decisions regarding their care, treatment and overall life. For those people who had capacity and in staff’s opinion were making unwise decisions, they would offer advice and guidance but would not force their views on them. For example, a person had made an unwise decision, despite advice from staff not to. Staff completed a de-brief following the event to discuss any potential learning.