Harp Place

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 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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
Staff did not always review or update people’s assessments and care plans when people’s needs changed. This meant staff may not always have had current information to guide care. A person told us they had been involved in their initial care plan. However, they also said no review had taken place with them since. This meant the provider had not always checked with the person whether their care plan continued to reflect their current needs, goals and outcomes.
The service supported people with learning disabilities. Assessments and reviews should have shown how people’s communication, sensory needs, routines, aspirations and quality of life outcomes were understood, reviewed in ways that worked for them. The providers records did not always show how people’s views had been reviewed and implemented in day-to-day support.
However, the provider had completed pre-assessments before care started and gathered information about people’s communication, disability-related, cultural, religious, sensory and emotional needs. Leaders used information from people, relatives, advocates, commissioners and professionals to inform care plans. Relatives said the provider was “diligent” before care started.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.
Leaders described using recognised tools and guidance, including moving and handling guidance, falls guidance, behaviour monitoring and health monitoring. However, we did not find consistent evidence that these tools had been completed, reviewed or used to inform people’s care. This meant the provider could not always demonstrate that care was delivered in line with current evidence-based good practice and standards.
The provider’s records did not always evidence how nutritional needs, hydration needs, health conditions or related risks were monitored through structured tools or reviewed against recognised guidance. This was important because the service supported people with learning disabilities, and staff needed clear guidance to deliver consistent care.
However, people received some effective support in practice. An advocate said staff understood dietary needs and supported a person to manage their diabetes, including encouraging lower sugar options. A person also said, “staff support me to eat more fruit and vegetables and reduce unhealthy food choices”. This showed staff promoted healthier choices during day-to-day care.
 

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing assessments of needs when people moved between different services.
The provider worked with relatives, advocates, commissioners and healthcare professionals to coordinate people’s care. Leaders shared information with professionals when people’s needs changed, including contacting GPs, pharmacies, community nurses, social workers and mental health professionals where required. This supported continuity of care and helped staff respond when people’s needs changed.
Feedback from people and those important to them supported this. A relative said “the service completed reviews with external professionals and regularly contacted the family”. An advocate said, “the service keeps me informed and acts on any concerns”.
 

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 and those important to them described positive health and wellbeing outcomes. A person said, “my hygiene has improved and I have started showering independently, sometimes I will shower before staff arrive”. This showed staff promoted independence and encouraged the person to take more control over their personal care.
An advocate told us, “staff notice changes in the health and wellbeing of the person they are caring for and act when concerns arise”. They said staff were vigilant and people were comfortable to share concerns with staff. One person said they raised a personal health concern with staff because they trusted them, and subsequently, staff booked an appointment with a relevant healthcare professional. This demonstrated that staff supported access to healthcare when needed, and people using the service trusted staff to act appropriately when informed of personal health concerns.
Staff encouraged healthier lifestyles. One person told us, “staff support me to make healthier food choices; this is not something I would be very good at without my carer”. An advocate told us staff supported a person with meals, increasing fruit and vegetables, and diabetes management. These examples showed staff promoted healthier choices in a way that reflected people’s needs.
 

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 both clinical expectations and the expectations of people themselves.
The provider did not always evidence a robust approach to monitoring and reviewing outcomes. One person told us, “I have not had a review and have not been asked for feedback”. An advocate also said they “had not really been asked for feedback”, although they wanted to share positive feedback about the care. This meant the provider did not always seek and use people’s feedback to monitor outcomes and improve care.
Relatives also raised concerns about how information was recorded and monitored. One relative told us, “the service needs to improve communication about what people do during the day”. This showed the provider did not always have effective systems to evidence how staff monitored people’s quality of life, daily experiences and outcomes.
However, there was evidence that people’s lives had improved. One professional told us, “the service has had a big impact in improving a person’s hygiene, confidence and social life”. Although people gave positive feedback about outcomes, the provider’s monitoring systems were not robust enough to demonstrate continuous improvement.
 

The provider did not always tell people about their rights around consent and did not always evidence that their rights were respected when delivering care and treatment.
Mental capacity assessments were not embedded into people’s care plans. This meant staff did not always have recorded guidance about people’s capacity to make specific decisions or how staff should support decision-making. This created a risk that staff may not consistently know when people could make decisions independently, when they needed additional support, or when best-interest processes should be followed. The potential outcome was that people’s legal rights and protections under the Mental Capacity Act may not always be promoted or protected.
For a service supporting people with learning disabilities, records needed to clearly show how staff supported people to consent, refuse or make decisions using communication methods that worked for them. This was not consistently evidenced.
However, staff demonstrated understanding of consent in practice. A staff member said a person they supported had capacity and made decisions for themselves. Another staff member supporting a person without capacity demonstrated how they could communicate with the person to understand what they wanted to do and respected their decision. Where a person did not want to do something, staff were able to understand this and offer alternative choices in a way the person could understand.