Abbeyfield Loughborough

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• 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

Peoples' needs were assessed and people had care plans to support them with their health and wellbeing. However, improvements were needed to provide people with opportunities to maximise their independence and maintain skills to reduce their support needs. Staff sought consent before providing care and support and people's capacity to make choices and decisions about their care was assessed. Further improvements were needed to ensure staff understanding of DoLS was fully embedded in working practices.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt staff knew people's needs and took action to ensure these were regularly reviewed and assessed. The registered manager had overseen the development of electronic care planning which had involved a full review of people's needs, wishes and preferences to support personalised care. People and relatives told us they had been involved in this process.

The registered manager told us they had implemented robust policies and procedures to assess and monitor the planned care for people to ensure they were meeting people’s needs and outcomes. This was supported by electronic care planning which improved their oversight of the care provided. Staff told us they were aware of people's needs and any changes in these through the care planning system.

The provider had policies and procedures based on best practice and current legislation. Recognised assessment tools were used to assess and monitor people's on going needs and recorded any changes in need that may impact on peoples care and treatment. Care plans were updated following appointments with health teams and primary health services.

People and relative felt staff were proactive in identifying and acting on issues or concerns to ensure care was provided in line with people's needs and wishes.

The registered manager told us they had completed comprehensive assessments and reviews on people’s planned care and care records while implementing their digital system. They planned and updated the care provided through the oversight of assessments and regular reviews with people and their relatives.

Peoples care and treatment was assessed and planned with them to ensure staff delivered person centered care and support. Positive behaviour support plans were implemented jointly with people and external agencies, to ensure positive outcomes for people and improve their quality of life.

People and relatives felt staff were proactive in identifying and acting on issues or concerns to ensure care was provided in line with people's needs and wishes.

Staff provided mixed feedback on team working but felt staff worked with external agencies to support people to achieve positive outcomes. These included GP, relatives and specialist agencies. Staff felt staff team work and communications required development and improvement as these were not fully effective and resulted in inconsistency in the care and service provided. A staff member told us, "Teams of staff do not always work well together to provide the best possible service. For example, communication isn't always good between care staff, housekeeping and kitchen staff, which results in frustrations and poor working practices." A second staff member described fractured team work between managers and staff which led to poor communication and relationships and improvements not embedded in working practices.

The provider had worked alongside stakeholders and organisations as part of an improvement plan. The provider had recently met their breach of contract with the local commissioning authority and had sanctions lifted as a result of recognised improvements in the care provided.

Staff worked well with external agencies to ensure people's care and treatment needs were known and understood. People were supported effectively with their health conditions, including accessing health appointments and screening. People's care plans provided guidance and information around specific needs and health conditions, based on best practice and guidance from external health professionals.

Relatives gave examples around how staff were responsive to changes in people's needs. For example, reviews of people's medicines to improve their health and well being or referrals for medical assessment through GP ward rounds.

Staff who co-ordinated activities lacked knowledge on improving outcomes for people and developing opportunities for people to maximise their independence. Staff could not tell us how they supported people with progression and goals and outcomes. The manager responded by ensuring activity staff had opportunities to develop through training.

People had care plans to support them with their health and wellbeing. However, there were limited opportunities for people to maximise their independence and maintain skills to reduce their support needs. Activity plans lacked opportunities for people to progress and develop independent skills and activity staff lacked knowledge regarding the importance of progression and outcome focused opportunities for people.

People provided mixed feedback around monitoring and outcomes of their needs. A person told us they felt staff had a good understanding of the outcome they wanted from their care and helped them to achieve this by respecting their choices and wishes. A second person told us they did not always feel supported to achieve good outcomes because staff were not always available to help them to do what they wanted to or help them in a timely manner. A relative felt staff were responsive but needed to be prompted at times to ensure their family achieved positive outcomes.

The registered manager told us the implementation of the digital system used within the service had improved the monitoring of care delivery and developed the improvement of outcomes for people. Planned care could be updated promptly by the registered manager through the oversight of the digital system.

People's care records were updated when a change in their needs occurred and regular reviews were completed to ensure the care and support for people was consistent and continually improved. However, daily care recordings by staff were not always factual or reflective of the care people received. For example, people’s food and fluid records were not completed effectively to ensure staff could monitor people’s daily intake and personal care records did not always evidence care was received in line with peoples planned care.

People told us staff sought consent before providing support and respected people's choices and decisions. One person told us, "Staff know I prefer to spend time in my room so they make sure I have everything I need and can call for help when I need it." A second person told us, "We are able to make some choices. For example, there are 2 options available for meals and staff will make an alternative if you ask for it." A third person felt staff did not always act on their choices and decisions as there wasn't always enough or consistency in staffing to respond to requests, such as sitting outside or going to their rooms.

Consent was not fully understood by all staff. A staff member gave an example where a person requested a change to their routine. When the staff member discussed this with senior staff, they were told 'It's not in their care plan'. This demonstrated some staff were not fully responsive to people's right to make choices and decisions on a daily basis. A second staff member discussed a care practice that had been implemented because it kept a person safe. They did not recognise that the practice was a potentially unlawful restriction. Staff referred to care plans to guide them around consent and decision making, but had a limited awareness of DoLS and conditions in place.

Staff had completed training and understood the principles of the Mental Capacity Act (MCA). People's care plans included mental capacity assessments. Best interest processes were followed were people lacked capacity to make choices and decisions were recorded and reviewed. DOLs were included in people's care plans and any conditions attached to authorisations were highlighted where relevant. However, staff did not demonstrate a full understanding of individual conditions attached to people's DoLS .