19 Stone Lane

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

At our last inspection, this key question was rated requires improvement, improvements have been made and this key question is now rated good, the service was no longer in breach of regulations. People’s rights were now being respected, people were able to safely access all parts of the service, including the kitchen where they were empowered to make meals and drinks as they pleased. Staff worked in line with the principles of the Mental Capacity Act 2005 (MCA). People were asked consent for all support interactions. People and/or their legal representatives were asked to read and sign consent forms to enable staff to offer support. Staff respected people’s wishes and right to decline care. People’s needs were assessed prior to them living at the service and reviewed when their needs changed. Staff used nationally recognised tools to identify risks and planned care and support to address and mitigate the risks. People experienced good outcomes of care by receiving joined up care from staff and health and social care professionals. Staff followed professionals’ advice, monitored the effectiveness of treatment plans, and provided feedback to professionals about how people were responding.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People had been involved as much as possible when developing their care and support plans. People’s daily care records showed their individual needs and preferences were met. Most the people living at the service had been there for many years, assessments were reviewed to ensure up to date information was available about people to staff. A relative told us how their loved one had moved into the service and praised the staff for the smooth admission under difficult circumstances. They said, “From day one it has worked very well.”

The registered manager told us about their flexible approach to assessing people’s needs prior to them moving in. This would include people having the opportunity to meet other people living at the service and to spend some time at the service during the transitional period. The registered manager said, “All the guys have been here for years, there might not be a time when we have new admissions. I would like them to see the home and be more involved in the process with a flexible approach and to be person-centred.”

Where possible assessments would be conducted in a place and at a time to suit the individual. Only one person had moved into the service since our last assessment, due to circumstances outside of the person’s or the service’s control the admission process was completed quickly. The registered manager gathered essential information from the person’s previous placement and from their relatives. Despite the person’s admission being rushed, their pre-admission assessment paperwork was comprehensive and provided enough information for staff to support the person appropriately.

People were supported by staff who utilised evidence based tools to ensure they received good outcomes. For example, when people showed distress, staff used a form designed to reflect on what happened and what could be done differently to minimise future distress. Where needed, staff engaged with professionals for advice on how to support people. A relative told us, “[Person] is getting additional anxieties, we have been meeting with the psychologist. Medication has slightly altered and they had added medications at lunch now.”

Staff told us how they understood people’s care and support needs and where to find information if people’s needs changed. Staff knew people well and spoke about particular preferences people had and what strategies they used to prevent upset or anxiety for people. A staff member gave an example and said, “Every individual is individual here. We assess and know them so know how to prevent a behaviour, for example, [person] likes to have their calendar and needs to see what's on it, to them it's important. If it wasn't around [person] may get upset, we prevent this by making sure it's always here.”

Staff followed people’s care and support plan which provided guidance on how to best support them. Positive behaviour support (PBS) plans were written for individuals and detailed how staff could understand specific behaviours, how to prevent them and what to do after an incident.

People received joined up care and support as staff worked well with professionals. People’s health and care needs were understood and information was communicated effectively between services to ensure their needs continued to be met. Staff and management made sure health professionals were aware of people’s needs. A relative told us, “[Registered manager] and I went to see the consultant at the hospital to make a note of all [person’s] other problems.”

Staff told us they always had up to date information from professionals about any changes to people’s needs. The registered manager described a good working relationship with partners in care, they gave an example of a person who lived with chronic constipation which caused behaviours of distress and a fear of eating. After working closely with the person’s GP, there was a change of medicines and a routine for the person to follow. Staff worked with the person and as a result they had started to regularly eat and they were much calmer. The registered manager said, “[Person] had gained the weight they lost, they are now off [food supplement] and are now opening bowels 2-3 times a week. We got [person] off 4 medicines which weren’t working. We now see a massive reduction in behaviour.”

Visiting health and social care professionals provided positive feedback about the staff and service. One social care professional told us, “All of my enquiries were answered really promptly, professionally and in a transparent manner and I feel management afforded me a substantial amount of time to facilitate my review of one of the residents.” Another commented, “The advice I have provided has always been well received by the manager of the service, who presents as keen to understand them and implement them within the service. Care plan guidance I have provided has been followed and shared with all care staff by the manager.”

People had care passports in place which were available should they need to attend appointments. The care passports helped partners in care understand people’s communication preferences, their health and care needs and who and what was important to them. People’s care and support plans were updated with professional advice. Where needed, the registered manager engaged with health and social care professionals who supported staff to create additional guidance, for example, a communication passport.

People were able to make decisions about what they wished to eat and drink, staff encouraged healthier options too. People made choices about what they wanted to do and had a 4 week planner to include specific outings and activities they enjoyed. The activities promoted movement and exercises, for example, bowling, bike rides and swimming.

Staff told us how they understood people’s care and support needs and encouraged people to live healthier lives. Staff followed guidance provided by professionals to promote good nutrition, a staff member told us, “We have risk assessments and plans to monitor what people eat and drink.” Another staff member said, “To encourage healthy drinks and healthy meals, we have to look after their well-being.”

Care plans and associated records showed consideration and reflection of current legislation and best practice guidance. For example, specific care plans for oral care were in place and followed by staff. People’s care and support plans reflected dietary requirements as well as their preferences.

People were supported by staff who continually monitored the effectiveness of the support provided. People’s care and support was flexible to meet their needs and when people had their own strict routines, these were adhered to. People were involved as much as possible with their care and support plans, in the event they were unable to contribute, staff would watch out for signs that they were not happy.

The registered manager and staff monitored people’s outcomes and knew how to seek advice and support from health and social care professionals when required. Staff provided feedback to professionals following their input. A staff member told us, “We work well as a team. Communication is key. We communicate well when other people (professionals) come into the service so we as staff know what is going on but also letting the person know. Not knowing sometimes raises anxieties and other behaviours could follow which means they are sad.”

People had person-centred care and support plans which included best practice guidance and were updated to reflect changes to their needs. Daily care records showed people were receiving the support they required as identified in their care plans. The registered manager had a good oversight of incidents within the service, they easily identified where a person was not responding well to the support provided and initiated reviews.

Consent from people was now always sought in line with laws and guidance. Restrictions around the service had been lifted and appropriate risk assessments were in place so people were able to use all areas of the service safely. People were routinely asked for consent before they were supported. We saw staff requesting permission to assist people and offered choices. People were now involved in decisions as much as possible, where needed, mental capacity assessments were conducted and best interest decisions were made with people, their representatives and relevant professionals. A relative told us of their involvement and said, “I am [person’s] DoLS representative and can make decisions, if its more complicated we speak as a family.”

Staff were following people's wishes. People's right to decline care was understood and respected. Staff had training in the Mental Capacity Act 2005 (MCA) and clearly described how they followed the act in practice. When speaking about a person, a staff member said, “We need to give information, for example, [person] doesn’t always understand so we show them picture on the phone and give simple explanations. If it’s too difficult for [person] we would do an assessment and have a best interest meeting.”

The registered manager ensured people were asked for consent and permission prior to support being offered, they monitored this by being present within the service. Where people lacked capacity to consent to particular decisions, the registered manager conducted decision specific capacity assessments and involved relevant parties in best interest meetings. Where appropriate, people’s legal representatives provided consent to certain decisions.