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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

People were 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. Staff understood when the principles of the Mental Capacity Act should be applied, however systems of gaining consent were not robustly implemented, this was a recording concern and we saw people being offered day to day choices and consent being sought from people. Care records were individualised, however there was not always detailed guidance for staff in people’s care plans or guidance was conflicting. People received care that was based on their assessed individual needs. People's outcomes were consistently good, and people's feedback confirmed this. Staff used a range of communication methods to engage with people effectively.

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.

While people and their relatives we spoke with expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards and there was not always detailed guidance for staff in people’s care plans or guidance was conflicting. People and their relatives did not share any concerns in relation to how their needs had been assessed. One relative told us, “They done a full detailed assessment, asking all about [relatives] likes, dislikes, eating, drinking and social activities. It was very comprehensive.”

The concerns we identified regarding guidance in place for staff were discussed with the management team who started to address the issues during the assessment. Staff were aware of people’s needs and were able to describe how they supported people. Staff liaised with appropriate professionals to request a reassessment of need.

There were processes in place to assess people’s needs. However, there was not always detailed guidance for staff in people’s care plans or guidance was conflicting. For example, one person’s assessment stated they had an eating and drinking plan (SALT plan) written by a health professional. The care plan did not give the details of the specific plan. Prior to the assessment the manager had contacted the health professional to request another assessment, which had been arranged. During the assessment the provider clarified with the professional that the person was not currently on a SALT plan.

While people and their relatives we spoke with expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards and staff did not always receive training and competency assessments in line with best practice guidance. People and their relatives did not express any concerns in relation to the care they received. They confirmed they were involved in planning and reviewing their care.

We did not see evidence of how the service ensured that staff were up to date with national legislation, evidence- based good practice and required standards as they were not always provided with person specific training and competency assessments had not always been completed. For example, management told us staff had not received up to date training in physical intervention and staff were supporting 2 people with 2 separate delegated clinical tasks without having their competency assessed by a health professional. The concerns were discussed with the management team who started to address the issues during the assessment and provided feedback on the changes they would make to improve the service. This included ensuring staff received appropriate training and competency checks. Staff were knowledgeable of people’s risks related to their care and support and their needs; however, care plans were not always supporting them with information that was evidence- based and in line with good practice standards.

There were processes in place to ensure staff received person specific training in line with good practice, however this had not always been delivered. Best practice guidance was not always being followed in relation to people being supported with a clinical task, and competency assessments had not always been completed.

People benefitted from a consistent staff team who worked well together. One relative told us “If anything happens with [relative] they will pick this up early as they have got to know him so well.”

Staff told us they worked well together as a team. One staff member told us, “We work well as a team.”

One professional provided the following feedback to the service, “[Person] has received really high quality care and service, [Person] is offered very flexible and person centred care, they have taken the time to understand [persons] lived experience and adapted support based on this. [Person] has built close reciprocal relationships with staff. [Person] feels safe and supported in their home. [Person] has felt really accepted and validated in their home, which is important to them and has made the world of difference.”

There were processes in place to support teamwork. This included regular meetings, supervision and the communication systems that were in place.

People were supported and encouraged to live healthy lives.

Staff supported and encouraged people to lead healthy lives. Staff told us how they supported people with their specific needs such as eating and drinking, and where required, monitored food and fluid intake.

The service worked in partnership with people and their families to help them to maintain a healthy lifestyle and access appropriate health care services as needed, such as district nurses, GPs, the mental health team and occupational therapists. People’s care plans informed staff whether people needed support with oral health needs.

People experienced positive outcomes whilst being supported by the service. We were given examples of how people’s lives had been improved. This had included reducing incidents and improving community access.

Staff were dedicated to supporting people to receive positive outcomes. They told us how they ensured that people’s support was “Led by people” and the outcomes they wanted to achieve. Staff provided us with examples of how they monitored people’s care to ensure better outcomes and how they engaged with healthcare professionals when needed.

There were processes in place to monitor and improve people’s outcomes. Care plans included people’s chosen outcomes, what they could do and what they wanted to achieve. Other areas of people’s support were monitored where required such as fluid intake and bowel movements. Staff worked in collaboration with people, their families and professionals to ensure good and consistent outcomes for people.

While people and their relatives we spoke to expressed that they were generally happy with their care, our assessment found elements of care did not meet the expected standards and consent was not always sought in line with legislation as decision specific mental capacity assessments were not always in place. People and their relatives did not share any concerns in relation to staff asking for consent and involving people in making day to day choices. One relative told us, “Everything is client led.” People were asked their consent before support was provided. People confirmed they were supported to make day to day choices. Relatives were consulted when best interest decisions were needed. One relative told us they were involved in a best interest meeting regarding a medical procedure their loved one required.

The concerns we identified regarding Mental Capacity Assessments were discussed with the management team who started to address the issues during the assessment. Staff were aware of the principles of the Mental Capacity Act (2005) (MCA). One staff member told us, “It is about protecting and impowering people who may not be able to make their own decisions. We support people to make as many decisions on their own as possible, we always assume people have the ability to make their own decision unless we can prove they are not able to.” The registered manager told us they assume people have capacity until proven otherwise, capacity is subject based; one person might lack capacity in one area but not in another, and they always follow the least restrictive approach.

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. Processes were not always in place to ensure decision specific mental capacity assessments had been completed. The management team told us their plans to address this.