42 Twyford Gardens

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Requires improvement. At this assessment the rating has remained Requires improvement. This meant people’s needs were not always met.

The provider was previously in breach of the legal regulation in relation to Person-centred care. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 61 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s experiences of person-centred care were mixed for example, not all care plans reflected people’s needs accurately and staff did not always understand all the needs of the people they were supporting. Senior managers responded to concerns we raised around a person’s care planning and took prompt action during our assessment including updating care documents for the person to better reflect their needs. When speaking about a person-centred approach a staff member said, “It's about tailoring the support to the person you are caring for, do it their way for example the people we support have different needs and wants.” Another staff member said, “It’s supporting the person in the way they want not just treating everybody the same.” Staff prioritised what was important for people by listening to them and keeping them at the heart of their care and support and respected their choices and preferences. Care documents focused on people's strengths, independence and abilities with details of preferred communication methods.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The provider had not understood the health and care needs of a person and was unable to support them safely, for example, a specific diagnosis had not been considered when developing support guidance resulting in staff not being fully aware of the implications of the persons condition. However, the provider was supporting other people to consistently meet their health needs by working alongside specific health care services. For example, working closely with the diabetic nurse and health clinics.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People told us and we observed staff using augmented communication systems and British sign language. People told us they were kept informed and were told when things or information changed. People had choice in all aspects of their care and support who were enabled to communicate their wants, likes and wishes by a staff team learning communication methods, including Makaton and British Sign Language which was being further developed at the time of our assessment. The provider engaged with people in various formats such as providing easy read documents where preferred to support people to understand information, for example feedback surveys and their outcomes. Staff had supported people to have interpreters present during health appointments enabling people to directly give and receive information empowering them to have control.

The provider did not always make it easy for people to share feedback or raise complaints about their care, treatment and support.

During our assessment a person told us they had been asked by a staff member not to raise a concern with CQC, however they felt confident enough to share their experience with us. The senior manager supporting the assessment ensured this did not happen again as soon as they were aware of it. The staff member no longer works at the service, the person explained they were treated this way by one senior member of the team, and this was not their usual experience of other staff who were supporting them, following the action senior management took they were satisfied with the outcome. Others being supported said they had not experienced this treatment. People were able to make their voices heard and felt confident telling staff if something was not right, one person told us, “I would say if something was wrong and know how to make a complaint.” People had their choices respected and told us they felt listened to. To strengthen people's channels to give feedback and share their views, regular daily meetings were held with individuals to ensure their views were heard, recorded, and responded to appropriately. In response to concerns people had raised in these daily meetings around their safety, relating to a new person who had recently moved into the service, the provider held Risk Enablement Panel meetings with input from external partners and senior management in which they discussed people's safety concerns, the support needs of a person who recently moved to the service and measures to lower the impact on others wellbeing living at the service.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Staff supported people to access health professionals routinely for ongoing treatment and responded to people's health needs promptly, which included working with the district nurses and specialist clinics in a collaborative approach to expand the staff knowledge around the conditions of people they were supporting. People were involved directly in booking their own appointments and had independence, choice and control as well as support where needed. Staff had supported a person to have an interpreter present to facilitate communication in their preferred method during health appointments.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Managers had not fully considered the information they had available regarding a person's care and support needs, as part of assessment and care planning. This resulted in significant impact on a person's wellbeing, who subsequently spent time with the emergency services including interactions with the police. During our assessment the provider reviewed and changed a persons support plan to include guidance for staff to follow, and accessed internal positive behavioural support training. Other people told us they were generally pleased with how staff supported them to gain positive outcomes for example, support to access wheelchair services.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People had been offered discussions about their future including any wishes they had for end of life, and where comments were made, they were recorded.