Sherwood

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 under this provider. This key question has been rated Outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (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 always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Assessments of people's needs were individualised, holistic and comprehensive. The key aim for the majority of people living at the service was to ensure people were empowered to progress towards independence at their own pace. Staff followed best practice guidance to ensure there were clear structures in place to enable each person to progress towards their own recovery and rehabilitation. The service placed a strong emphasis on promoting independence, health and wellbeing. People were supported to maintain balanced diets, monitor their own health and access healthcare services when needed. Staff worked effectively with healthcare professionals to ensure coordinated and timely care. People were fully engaged in developing their care plans, which were highly personalised and reflective of their identified needs. One person said, “I have a copy of my care plan, and I am happy with everything.” Another person said, “My relatives visit me every 2 weeks, they are very happy with the care I receive.”

People were encouraged to progress towards independence and all of their achievements were recognised. Staff consistently focused on what people could achieve, celebrating progress and supporting people to develop skills, confidence and greater control over their lives. People we spoke with told us they had plans and goals in their care plans, which had been set by them and agreed with the staff team. One person said, “The staff encourage me to cook for myself, they support me with my cleaning but will only provide support when asked.” The service used a clinical risk register, which identified any risks and staff learning which would enable better outcomes for each person. This training was individualised and tailored, for example, where people had a diagnosis of blood borne viruses, staff had completed training to enable them to understand the risks and impacts of these.

External partners we obtained feedback from were positive about the robust approach of the service. One partner told us, “The provider is proactive in sharing updates regarding individuals' care and support needs and is effective in raising concerns when they arise. The service regularly requests reviews where necessary to ensure that care arrangements remain appropriate and responsive to the person's changing needs.”

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.

The service worked with the person and those external teams involved with them, to ensure a safe transition which met their identified needs. Assessments of people's needs were holistic and comprehensive. The staff team used current guidance from The National Institute for Health and Care Excellence (NICE). NICE provides national guidance and advice to improve health and social care. This ensured the service was using evidence-based techniques to support the delivery of high-quality care and support. People’s care plans were developed and regularly reviewed for each identified need and staff had clear guidance on how to meet those needs.

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.

People's health care needs were met by the positive partnerships established with health and social care professionals. One person said, “I have been at the home for around 2 years, it was an easy transition for me, they were flexible for my needs and preferences.” If people experienced a change in their mental health or needed emergency healthcare, staff acted quickly to arrange this. This meant people received joined up care that fully involved them where possible and ensured a high level of continuity.

We received positive feedback from all external partners who we contacted for their opinions of Sherwood. One external professional told us, “Communication with the service has always been prompt and effective, helping to ensure continuity of care and the safety and wellbeing of the individuals supported.”

The provider always supported people to manage their health and wellbeing to fully 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 were able to lead healthier lives and enhance their wellbeing because the management and staff team were dedicated and proactive in supporting them to do this. The deputy manager embraced the view that people should be provided with accessible information to support their own wellbeing, and for staff to support this where people were unable to make complex decisions.

Information on health and wellbeing was provided for people through discussion or easy read information boards displayed throughout the home. For example, support and information on drugs, alcohol, recovery groups, smoking cessation and healthy eating. Where people had a history of substance misuse, we saw staff supported people to understand the short term risks of this, and the potential longer term impacts on their health. Staff worked alongside people in a non-judgemental and supportive way, helping them to understand risks, make informed choices and work towards their personal recovery goals. We found staff to have a clear understanding of each person living at the service, in relation to their specific health needs.

People were encouraged to maintain a healthy diet and fluid intake. The service ensured they regularly monitored people’s intake, weights and skin, to ensure their wellbeing was supported. The management team recognised that some people may have a history of eating disorders, or a difficult relationship with eating regular meals. The staff team had developed a ‘breakfast club’, which people were encouraged to attend, to give routine to their meals, and an opportunity for conversation and social interaction. The staff team carried out a feedback session after each meal served during the day, to allow people to give their views in real time. This information was shared and discussed with the kitchen team, to ensure prompt amendments to menus could be made.

People living in the service had signed a 'community agreement' which we saw copies of in their care plans. This was a code of conduct setting out how people were encouraged to behave in and around the service towards each other; and in relation to not using illicit substances or alcohol on site. We spoke with people about this arrangement, and they spoke of feeling like part of a supportive community. Where people had experienced a mental health crisis, or had lapsed in their substance misuse, we saw the service had an understanding and supportive response. One person said, “I feel safe living at the home, having the staff around. If I am not feeling well, the staff will support me through these periods.”

The deputy manager explained, “Some people when they move in with us, are not quite ready for the transition from long term dependency, and often a related chaotic lifestyle. This can take some time for people to adjust to being in a place of safety. We provide intensive support in these early stages, and reassess regularly, to ensure we can continue to meet people’s needs.”

This flexible and highly individualised approach recognised that people’s needs fluctuated and support was adjusted in response to this, ensuring they were given every opportunity to develop confidence, stability and greater control over their lives.

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.

People received effective care and support which helped them achieve positive outcomes. The nursing team held weekly, ‘well person’ clinics. These were meeting where staff reviewed people’s health and wellbeing and could raise any concerns they had. The deputy manager explained how this had been used positively, to identify early weight loss for a person, and a change in another person’s blood pressure.

People's needs were comprehensively assessed and care was delivered in line with current legislation, guidance and best practice. People's care plans were person focussed and fully reflected their voice and views on the care they received. These preferences were mirrored in people's activity planners which included each element of a person's day. Staff listened to people's needs and supported them to make decisions in ways that suited them. For example, one person was encouraged with checking their blood glucose levels, with the use of an arm worn monitor. We observed staff supporting the person with understanding this, to enable them to have ownership of their own health needs.

The provider always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

People's rights under the Mental Capacity Act 2005 were fully respected, and decisions were made in people's best interests where required. The provider always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

The provider showed embedded, positive practices were in place, which supported people to be fully involved in decisions about their care and treatment. Where people were subject to restrictions, for example by having 1 staff member supporting them at all times, we saw this had been discussed with people and their advocates. People had care plans detailing this enhanced support need, and their feelings were fully considered. The deputy manager explained the service’ approach to ensuring they took the least restrictive approach to supporting people. They told us, “We always take the least restrictive approach, if a person is against the decisions in place, this is explored with them to support their understanding of these. Or for example, if the person has a planned moved to another service, we review these decisions, to ensure all documents are accurate, reflective and up to date.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When people lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and the least restrictive as possible. Mental capacity assessments were carried out where needed, to establish if people making decisions affecting their lives had the capacity to do so. Decisions made for people identified as lacking capacity to make specific decisions, followed the best interest process. We saw that people had been supported to make choices with involvement from independent advocates, and appropriate health and social care teams. Where restrictions were in place, there were easy read plans for people in their care records, so people could understand these. The registered manager had ensured that applications to the local authority for Deprivation of Liberty Safeguards (DoLS) were applied for in a timely manner.

We observed staff during our visit, allowing people to fully express themselves. If people required redirection, due to them becoming distressed, this was done in an understanding, empathetic way by staff. For example, we saw staff members giving people space and time to reflect after any event. Once the person had calmed, the staff member talked with them, to understand how they were feeling now, and asking if they required any further support.