42 Twyford Gardens

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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were often good, and people’s feedback confirmed this.

The provider was previously in breach of the legal regulation in relation to Need for consent. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 71 (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.

The provider told us they had not correctly followed a person's preadmission assessment, as outlined in their policy when a new person came to live at the service and were making changes to the monitoring of future assessments. The preadmission assessment process failed to fully identify their needs and the support needed to meet these needs. There was a failure to recognise the complexity of a person’s support requirements around their anxiety, communication and understanding of pain, and these support needs were not reflected in the skills and competencies of the staff team. This resulted in a number of safeguarding alerts being raised with the local authority and a number of contacts with the emergency services, at the start of our assessment the provider was unclear whether they were able to meet the person’s needs, by the end of our assessment The provider confirmed they were unable to continue to meet the person needs. Other people and families told us they participated in the preadmission assessments conducted by the manager.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Peoples care and support documents were created by involving them in the process, they included personal details such as wants, likes, dislikes and goals. One person told us, “I get offered choice about what I want to do and my support including what I want to eat.” The staff understood the principles of the mental capacity act and respected people's choices around their life. Staff used tools to inform the care and support provided to people such as the MUST tool (Malnutrition Universal Screening Tool).

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.

During the inspection we observed the provider respond to an emergency around a person’s needs by supporting people and staff with extra resources, they involved an in-house PBS team (positive behavioural specialist) to try to better understand how to support them as well as providing additional staff including an interim manager. Staff worked well together as a team to deliver consistent support to people, accessing healthcare professionals when needed. The Staff worked with another service which had the use of a minibus under the same provider to support a person who had challenges with their mobility to visit their friends.

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.

Staff understood people had the right to make choices about their care and life, staff respected people's choices acknowledging that people with mental capacity can make an unwise decision if they wish to. People had goals around independence in their care plans which were focused on daily living skills. People were supported around their specific health needs including attending routine health checks for specific conditions. People received support from staff to monitor their conditions with clear guidance on actions to take to support people depending on the situation. Staff told us they were exploring ways to effectively meet people’s health needs to support their specific conditions such as providing healthy alternatives for food and having these readily available.

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.

Peoples care and support was reviewed with them on a regular basis, staff met with people every month to get their feedback, check progression on individual goals and set new goals during key worker meetings. Staff had recently identified equipment to better support people's health monitoring and achieve their personal outcomes. One person told us, “They are helping me regain my independence.”

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

People were supported to exercise choice where they were able and best interest decisions were in place where people found it difficult. Staff understood the principles of the mental capacity act and care documents contained details to inform staff of people’s capacity. One staff member said, “We give choices and people the information they need so they can be informed about decisions, if you have capacity, you can make your own choices.” People who needed it were referred for a deprivation of liberty assessment. Staff were able to talk about their role in supporting people to meaningfully consent or not to care. A staff member said, “I always ask for consent from people before I support them.”