Alderwood L.L.A. Limited - Irchester 2

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

Improvements were required in how people’s individual needs were assessed, reviewed and monitored. Information recorded in care plans that provided guidance for staff about how to meet people’s needs were not consistently detailed. It was not clear what evidence based practice underpinned the behavioural strategies used. A person’s positive behaviour support guidelines was not sufficiently detailed, the registered manager and management team had failed to identify a more in-depth assessment was required. We were aware the provider was in the process of transitioning to a different positive behaviour support methodology. The registered manager told us how this may result in people’s individual needs being re-assessed and care records updated to reflect any changes to care and support needs. Mental capacity assessments and best interest decisions in relation to the staffing levels people received, and how behaviours of concern were managed, were not in place.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they were confident their family member’s individual needs had been assessed and planned for. They told us how they were involved in discussions and decisions about how care and support needs were met. However, from reviewing people’s care records we identified shortfalls in how people’s individual needs were assessed and planned for, this put people at greater risk of their needs not being safely met.

Staff told us they found overall people’s care plans provided sufficient guidance about how to meet people’s care and support needs. Staff told us the registered manager was always available and supportive, if additional information or guidance was required. Staff confirmed important information was shared via handover, staff meetings, care records and a communication book. However, guidance provided to staff of how to meet people’s individual needs was found to not be consistently detailed or up to date.

From reviewing people’s care records we found inconsistencies or missing information. It is important for care plan guidance for staff to be current and sufficiently detailed, to enable staff to provide effective and personalised care and support. For example, 1 person had limited verbal communication, their communication care plan did not record how they expressed their physical and emotional needs and preferences. Another person’s specific diagnosis was recorded in their positive behaviour support guidance but not their personal support plan guidance. This person’s care plan in relation to safety and behaviours included a behavioural strategy that was no longer being used. Whilst staff spoken with were found to be knowledgeable about people’s individual needs, the provider was continuing to recruit new staff and used bank and agency staff when required. This meant there was a risk people would not receive consistent and effective care and support. We were not sufficiently assured of the provider's systems and processes that reviewed care records and guidance for staff. We discussed this with the registered manager who agreed to amend care records to accurately reflect people’s needs.

Relatives told us they had no concerns about their family members nutritional or hydration needs. A relative said, “There's a choice of menus. Staff also monitor [name] weight. Staff will give them smaller portions and support them with exercise.” People told us how they had access to the kitchen and how they were involved in menu planning and cooking. A relative told us of the actions of staff and external professionals to support their family member who was experiencing a decline in their health. They were positive all was being done to support their family member’s increased anxiety that was impacting on their health safety and welfare. Whilst relatives were consulted and participated in discussions and decisions about their family member's care and support, via a variety of review meetings and opportunities, we were not fully assured the provider could consistently evidence how people and relatives were involved in discussions and decision making in how distressed behaviours were safely and effectively managed.

Staff told us they were made aware of updated policies and procedures by the registered manager. They were required to sign and confirm they had read and understood. Changes to people's individual needs and information was shared via a communication book and discussed in face to face meetings with staff. Staff told us how they ensured people received sufficient to eat and drink and how people's preferences and any cultural dietary needs were met. A staff member said, “Menus are developed with people, individual snack boxes kept in the kitchen and people are supported to go shopping regularly to choose their own snacks. People can access the kitchen when they want.” However, we were not sufficiently assured the provider supported staff with sharing information about best practice guidance that informed their decision making in how people’s needs were effectively met.

We were not assured evidence based practice was used to underpin the behavioural strategies used. For example strategies included the use of a stress ball, stress gauge and visual communication tools. Staff and the registered manager told us these were overall successful and worked well with people at the early stages of supporting distressed behaviours. However, they were less effective as the level of distressed behaviour increased. Incident records confirmed these strategies were not fully effective during periods of crisis prevention and management. We were therefore not fully assured behavioural strategies effectively responded to people’s assessed needs. People’s nutrition and hydration needs, including dietary and cultural preferences had been assessed and planned for. Where the GP had advised people about weight management, care plans provided staff with guidance of the actions required to support the person such as monitoring weight and increasing physical exercise. Care records confirmed people were being supported as required.

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.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Relatives told us they were involved and consulted in decisions about their family member’s care and support. People also told us how they were involved in discussion and decisions about their care and support, this included a monthly meeting with their keyworker (a named staff member with additional responsibilities). However, we were not sufficiently assured people were fully protected by the Mental Capacity Act (MCA). People and their relatives had not been fully involved and consulted in all aspects of care and support decisions, where the person lacked capacity to consent to their care.

Staff confirmed they had completed training in the mental capacity act (MCA) and understood the principles of MCA. A staff member said, “There are 5 key principles to follow to assess and make a decision, a best interest decision must include least restrictive options.” Another staff member told us if a person refused to consent to care and support, they would try again later and if this continued, they would inform the shift lead or registered manager. The registered manager told us how MCA assessments were completed and for what decisions, and how others were involved in the process, including supporting the person to be as fully involved as possible. They told us how they supported staff’s knowledge and understanding by having discussions in staff and supervision meetings and confirmed staff were required to complete relevant training. However, the management team had failed to ensure all appropriate decision making processes had been completed as required.

Examples of MCA assessments and best interest decisions documentation was reviewed. These were found to be overall detailed, and included action taken to support the person as fully as possible, to be involved in the assessment process. Others such as relatives and external professionals had been involved and consulted. However, whilst MCA and best interest decisions had been completed for a range of care and support interventions, they had not been completed for the level of staff support people received and the behavioural strategies used to support people. This was a concern and demonstrated the MCA assessment and best interest decision process had not been fully adhered to. We discussed this with the registered manager who acknowledged there were missing assessments and best interest decisions and agreed to take action.