Head Office Also known as Swindon

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 rated assessment for this registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Children and young people’s needs had not always been assessed in line with best practice guidance. For example, some people did not have individualised positive behaviour support plans or restraint care plans. This meant children and young people were at increased risk of inconsistent and potentially unsafe responses to behaviours of distress.

Staff were not trained in completing assessments to inform and develop positive behaviour support plans. This meant there was a risk of staff implementing plans that they may not fully understand. This also increased the likelihood of changing and emerging needs and risks remaining unidentified and unmet.

We received mixed feedbackfrom relatives in relation to the assessment process. Some relatives commented, “There was no assessment process. I sent over helpful documentation and information about my child. I assume a conversation happened with my social worker and Bespoke Guardians but I wasn’t involved in that” and “There was no assessment process. Bespoke Guardians were bought in via Children Services.” However, another relative told us, “A detailed assessment process took place with the manager, to ensure that the staff working with my [child] were the most appropriate and to fully understand his needs.”

However, we saw other assessments of young people’s needs such as personal care, money, daily routine, and eating and drinking.The manager told us that where possible, they conducted assessments prior to commencing care. However, the manager confirmed there were occasions when this was not possible due to support being required at short notice. The manager also told us they reviewed support plans for new clients weekly to ensure the information was current.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s behaviour related support had not always been assessed or delivered in accordance with best practice and legislation. This included the provider not taking account of the Right Support, Right Care, Right Culture guidance, the Mental Capacity Act and current national best practice guidance in relation to prevention and interventions for people with learning disabilities whose behaviour challenges. For example, people were at times supported in a reactive manner through restraint before staff exhausted pro-active strategies to de-escalate people’s anxieties as per good practice.

However, people’s care plans were regularly reviewed. One relative commented, “The reviews are comprehensive. They go into detail as to what is working and what is not and [leaders] do regular checks in person as well as attending regular meetings with the local authority.”

The manager told us staff were trained to ensure restraint was used as a last resort, however documents did not always evidence this. Following the assessment, the manager told us they had implemented further training in reporting and recording. The manager told us this would help to ensure staff understood what was expected of them and a more robust auditing process would be introduced to monitor this.

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.

There were regular team meetings with staff to ensure effective team working, and staff received regular supervisions. Staff told us they worked well together and as a team. One staff member commented, “I like the teamwork within the company, everyone is always there for one another. The friendliness from everyone has given me more confidence to grow throughout my time with Bespoke Guardians.”

The service worked well with external professionals. Leaders told us they liaised with multidisciplinary teams and we saw some evidence of these meetings. One professional also confirmed the manager engaged well with them.

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 had information in their care plans about how to support them to be healthy. For example, people had information about their health needs and how to support them with these. Care plans also directed staff to offer and encourage healthy food and drink options to support physical health. Comments from relatives included, “They encourage exercise and healthy eating”, and “They help him make lunch and encourage and record healthy choices.”

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.

Relatives told us their child’s wellbeing had improved since the service began supporting them. One relative commented, “A year later and I have a different child. He is thriving, is accessing opportunities in the community, is attending clubs and activities and there are times when I feel confident enough to take him out in the community alone. Bespoke Guardians’ support has been instrumental in achieving this.”

We saw people had set goals to work towards and these were being monitored and that some goals had been met. One staff member commented, “There is nothing more pleasing and rewarding to see a young person’s life improve and see them reaching their true potential.”

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

We reviewed 3 people’s care records as part of the assessment. 2 people were under the age of 16 and had appropriate consent forms in place regarding their care. However, one person who was over the age of 16 had decisions agreed which were not in line with the Mental Capacity Act. This included the use of physical restraint, locked cupboards and a locked door, which had been implemented by the person’s family for the person’s safety. However, staff were also carrying out these restrictive practices in the absence of decision specific mental capacity assessments. Best interest decisions were not recorded for these restrictions and therefore people’s rights and decision-making abilities were not appropriately assessed and respected. We raised this with the manager who told us mental capacity assessments would be completed by the provider in full going forward to ensure compliance.