Arrow Support Limited

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

People and their relatives where appropriate, were involved in the development of their care and support and their opinions were valued and their views respected. People's needs were assessed before they started using the service. Information from these assessments were used to develop individualised support plans and risk assessments. People were now supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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.

Most people were not able to tell us if they had taken part in an assessment of their needs prior to receiving support. However, one person said that he had the opportunity to visit his new house and meet the staff before moving in. Relatives confirmed that they had taken part in the assessment process and were fully involved in the care and support planning process. Comments included, “We took part in the initial assessment,” “They [meaning care managers] bring a care plan and show it to us and we go through it every week,” “Yes, I am involved 100%,” “I had an online meeting with them several months ago. They seem to be on the ball.” And “I was asked to comment on the care plan. I didn’t have anything to add.”

The registered and care managers told us that people's needs were assessed before they started using the service. Information from these assessments were used to develop individualised support plans and risk assessments. These were reviewed regularly and audited as part of the provider’s governance processes. Staff told us they had access to people’s support plans and confirmed that support plans were updated regularly and reflective of people’s current needs.

The provider had systems and processes in place to ensure all people’s needs were fully assessed prior to offering support. Records showed that information from these assessments were used to develop individualised care and support plans which covered all aspects of a person’s life and support. Care and support plans were regularly discussed and reviewed in conjunction with people, their relatives, healthcare professionals, and staff.

People and their relatives had confidence in the staff that supported them. One person said, “I’m happy with the support I receive, the staff are helpful.” Relatives’ comments included, “They are all very experienced. They all love the job they do. They look after him very well,” “I spend a lot of time with them to train them up, they all seem very knowledgeable,” “[Person’s name] had a carer that has been with him for 12 years. He makes sure everything is as it should be. I really trust him,” “They do all [Person’s name] meals. He is well fed. He gets a choice. He doesn’t eat anything he doesn’t like,” and “They are all nice people, that are knowledgeable about things. I am impressed with them.”

People received care and support in line with their assessed needs and best practice guidance. Staff told us they had received the training they needed to meet the needs of the people they supported. Support plans described the advice provided by healthcare professionals, such as dieticians and physiotherapists to ensure people’s healthcare needs were well understood by staff. Staff told us how the provider arranged additional training in respect of people’s identified care needs. For example, the provider had arranged for brain injury training for one person’s support team, while another person’s support team had received additional SALT [Speech and language therapy] training following a change in the person’s needs.

Systems were in place to ensure care was delivered in line with best practice guidance. For example, nationally recognised risk assessments were used to assess risks, such as the Malnutrition Universal Screening Tool (MUST) and Water Low Risk Assessment. We saw monitoring records were in place and care was delivered in line with best practice and people’s assessed needs. Appropriate training was in place to ensure staff were informed about and kept up to date with best practice guidance. For example, people’s care records highlighted where risks with eating and drinking had been identified. Where people needed a soft or bite-size diet, this was provided in line with their assessed needs and staff were knowledgeable about the extra support that some people might need to maintain nutrition and hydration.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People received support to manage their health and physical care needs and were encouraged to engage with a range of healthcare services. Relatives had confidence in the staff and told us their loved ones were supported and empowered to manage their care, support and health needs by staff who knew them well. Comments included, “They check his skin when changing him, if they notice marks and scrapes. They note it in the diary,” “They let me know if [ Person’s name] is not well or coughing,” and “They do routine things like making sure he is up to date with the dentist and appointments.”

Staff described how they supported people to manage their health and well-being to maximise their independence, choice and control, but recognised that there were times when people might need more support, through the use of prompting or encouragement to develop and maintain their independence and skills, such as with the making and attending appointments. Staff confirmed they had access to people’s support plans which contained up-to-date information and guidance on how to support people to live healthier lives. As identified within the involving people to manage risks section of this report, whilst it was clear staff knew people well and had a clear understanding of each person’s health needs. Some support plans lacked detail. We discussed what we found with the registered manager who told us they were in the process of updating all people’s support plans onto a new format and were confident that any gaps would be addressed.

Systems and processes were in place to effectively monitor people’s health and well-being. This included support plans and risk assessments. Records confirmed staff supported people to attend a range of appointments and described the advice provided by healthcare professionals such as GPs, care managers and dieticians to ensure people’s healthcare needs were understood by all members of their support team. Regular team meetings enabled the sharing of information about people’s health needs and records showed where people were either encouraged or supported to seek further advice from external healthcare professionals when needed.

People who wished to share their views with us spoke positively about the support they received; they told us staff and managers listened to them. One person said, “The staff are here to support me, I can do most things for myself but if I need help with something I can ask one of the staff,” Another said, “I can come and go as I choose, the staff are great” Relatives told us that people were encouraged and supported to lead active lifestyles, follow their interests, and take part in social activities. One relative said, “[Person’s name] chooses what she wants. If they can do it they do it, if not she tells them how to do it.” Another said, “They give [Person’s name] the freedom to do what he wants to do.”

Staff described how they monitored people’s health and care needs to ensure risks were mitigated and people received care according to their assessed needs. For example, staff described how they monitored people’s skin for red marks, applying prescribed creams and escalated concerns to the management team and/or external healthcare professionals as needed. People’s goals were central to the care and support provided, there was an understanding that staff were there to enable and support people to manage their own personal wellbeing and life skills. Staff had a good understanding about how people communicated and used this knowledge to support and empower people to make choices and share their views.

The provider had systems in place to ensure people’s care and support were continuously monitored and reviewed to promote good outcomes for people. Support plans were informative and provided staff with detailed information on people’s likes, dislikes, personal preferences, care needs and medical history. This enabled staff to support people in the way they wished to be supported to live full and active lives and to develop their independent living skills. Support plans and risk assessments were reviewed and updated when people’s needs changed. An electronic care planning system meant staff had access to up-to-date information. Regular meetings with people, their relatives were appropriate, staff and external professionals helped to ensure people were at the centre of their care and support.

People who were able to share their views with us told us they were able to make their own decisions, come and go as they chose and live the life they wanted. One person said, “I can come and go as I please. Staff are always around but they don’t tell me what to do. If I need support all I have to do is ask.” Another said, “There are no restrictions here, this is our house.” Relatives did not raise any concerns about the way in which their loved ones were supported. Comments included, “Staff respect our preferences, and this is important for us,” “They give [person’s name] the freedom to do what he wants to do,” and “[Person’s name] has a good quality of life.”

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 MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The registered manager described the action they had taken following the previous inspection in July 2023. This included assessing people’s capacity where necessary, updating mental capacity assessments, best interests decisions and reviewing the systems in place to ensure compliance with the Mental Capacity Act 2005 (MCA). Staff told us they had received training and had a good understanding of consent and described how they supported people to make decisions about their care and support. One staff member said, “When someone has capacity it’s important that we respect their choices and decisions.”

At our previous inspection in July 2023, we found the failure to accurately assess, and record people's capacity and best interest decisions risked compromising people's rights. At this assessment, we found improvement had been made and the provider was no longer in breach of regulation 11. The provider had a clear policy and developed systems and processes to help ensure people were supported to understand their rights. Staff had received training and had a good understanding of consent and supported people to make decisions about their care. Records showed where people were unable to consent to receive care and support, capacity assessments had been undertaken and best interest decisions made on people's behalf. Where restrictions had been placed on people's liberty to keep them safe, the registered manager was working with the local authority to ensure authorisation had been applied for. There were systems in place to ensure restrictive practices were kept under review and remained in a person’s best interests.