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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

At our last inspection this key question was rated requires improvement. At this assessment, the provider had improved, and this key question is now rated good. Processes were in place to ensure care and treatment was provided with the consent of the relevant person. People’s capacity to consent to care and treatment was considered and where appropriate, best interest decisions were made. The service worked well with in partnership with other agencies to ensure people’s healthcare needs were met and managed safely. Processes were in place to ensure people’s needs were assessed prior to admission to the service. People told us the outcomes they experienced in their care and support were much improved.

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 told us they were involved in assessing their needs and were able to contribute their views. Overall, people agreed that their needs were understood by care staff. One person told us, “They should understand that it’s a progressive condition, so the good days are the best it’s going to be, and I think they do get that.”

Leaders told us about how improvements had been made in relation to assessing people’s needs. An example of this was how, by involving other health care professionals in relation to meeting a person’s need, they were able to establish a course of action which resulted in a much-improved outcome for the person. Staff told us people’s needs were assessed and reviewed regularly with the person, to ensure they remained up to date. One staff member told us, “We go through people’s care plans with them, ask if there are any changes they’d like to make and discuss how we can do that.”

People’s needs were assessed and related care plans and risk assessments were developed. Assessments of people’s needs prior to being offered a place at the home were completed by the registered manager. Care plans and risk assessments were then kept under review, to reflect people’s changing needs. Clinical assessment tools for monitoring, such as skin integrity and weight loss, were also in place and generally kept up to date.

People received, and were involved in developing, the care and support they needed. People gave us examples of how the service worked with other involved health care professionals. For example, one person told us how their specialist nurse liaised with their consultant, and another person told us they were involved in regular medication reviews.

Leaders sought advice from health care professionals to make sure people received evidence-based care and treatment. For example, the service worked closely with Parkinsons nurses, Dieticians and the Learning Disability team. Staff told us they undertook mandatory e-learning training modules and completion of these was monitored by management. This included training in supporting people with a learning disability. The training was provided by a nationally recognised training provider. However, not all staff had completed training related to specific conditions that some people at the service lived with. The provider told us they had made arrangements for this training to be delivered to all staff.

Staff worked with health and social care professionals to make sure people received the care, treatment and support they needed. Where specialist health care professionals were involved in people’s care, their input and advice was included in people’s care plans.

People told us that staff knew them well and were able to support them with appropriate care, which met their needs. However, some people felt there was a noticeable difference when being supported by agency staff. Comments from some of the people we spoke to included, “The carers here are perfect. I’m not intimidated by them because I know them, I know how they work and they know how I like things. When you’ve got an agency it’s like having to do everything by baby steps, “ok, do this, then do this, then this, now this” and “There’s a noticeable difference when you’re supported by agency staff in terms of them knowing what they should do.” This was being addressed by the provider.

The service worked closely with people, their families and health and social care professionals to make sure people received continuity of care. Staff told us that information from other services was also fed into people’s care plans. One staff member told us, “If people are having district nurse or doctor input, we make sure that’s referenced in the care plan?”

The local authority had reduced the risk rating of the service due to the success of their joint working with partners.

Systems were in place to make sure people were supported effectively through any transition of care. Leaders and staff ensured information was shared appropriately, such as when clinical tasks were delegated or when people were referred between services.

People felt supported to live healthier lives. One person was supported to attend a local gym, they were dropped off and picked up by staff whenever they wanted to go. Another person had received extensive support to improve their mobility, which had achieved a good outcome.

Leaders were confident they had systems in place to make sure they gave people support to maintain or improve their health, wherever possible. Staff agreed with this and said they supported people in ways that didn’t take away their independence. One staff member said, “I think we’re quite good at not assuming someone needs something doing for them, so we always check what they need help with before doing anything.” Staff regularly discussed with people about their health and wellbeing and anything they felt they needed support with to make improvements. Where people were reluctant to make changes or were worried about something, staff spent time discussing this with them but recognised that when people had capacity, this was their decision to make.

Records showed that people were supported to maintain and improve their health. For example, people were supported to take part in regular health screening and received visits from a dentist and optician. Hospital passports were also in place for people who needed them, to help support with communication.

People told us the outcomes they experienced in their care and support were much improved. People thought this was due to a new management team, but also felt staff were very attentive to their needs.

Leaders were confident that outcomes for people using the service were improving and that the involvement of people in this process was effective.

Systems for gaining people’s views about the service had been improved. The frequency of quality assurance surveys had been increased from annually to quarterly. Outcomes of meetings and surveys were produced as a ‘You said we did’ document and was on display in the hallway. A monthly newsletter for people living at the home was also about to go into production.

Some people told us they were involved in their care planning and risk assessment process. Evidence was available to show how care planning was completed where the person was not able to be involved. For example, advocates were used where needed.

Systems were in place to make sure people understood their right to consent to their care and support. The registered manager told us people were involved in their care planning and in the writing of their daily records. We saw evidence of involvement in care planning and risk assessments. However, improvements were needed with record writing to evidence the involvement of the person. Staff understood people’s communication needs and described how people were able to give their consent to care and support, if they were unable to do this verbally. For example, one member of staff described how a person living at the service moves their head to indicate their responses.

Processes were in place to ensure care and treatment was provided with the consent of the relevant person. We saw assessments of people’s capacity had been carried out, where appropriate, and best interest decisions were in place where people lacked capacity to make a particular decision. Where people had capacity, consent forms had been completed.