Greenways

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 were not always involved in assessments around their care, meaning their contributions could be missed. People’s rights were not always protected due to staff not understanding the principles of The Mental Capacity Act (2005). Records around mental capacity and best interest decisions were also lacking important information to ensure the least restrictive practices were used to deliver care. People received varied experiences in accessing specialist care to meet their health needs. During our assessment of this key question, we found concerns around people not receiving person centred, evidence-based care, specific to their needs which resulted in a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found concerns around the principles of the Mental Capacity Act not being met which resulted in a breach of Regulation 11. You can find more details of our concerns in the evidence category findings below.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A person’s transition plan to moving to another service was poorly managed. The service had not involved the local funding authority in the person’s proposed move to one of their supported living services in April 2024, to ensure it met their needs. We asked for evidence of the separate accommodation and care contract; however, the registered manager told us they were not in place.

People’s wellbeing was not always being considered when reviews of care were undertaken by staff. Relatives told us they were not always involved in the review of their loved one’s care. One relative said, “We don’t hear anything about that, we would like to be involved in everything.”

The deputy manager told us they reviewed people’s care needs however they said they would update relatives after rather than during the assessment.

The registered manager and staff had a lack of understanding of the guidance around Right Care, Right Support, Right Culture. They were unable to tell us how people's diagnosis and health conditions may impact on how they presented their anxiety.

People did not always receive support that was in line with good practice standards to ensure compassionate and therapeutic care and support. The provider’s policy and procedure for positive behaviour support referred to out of date approaches and terms to describe people’s distress. It encouraged staff to ‘reward’ ‘good’ behaviour, and show ‘disapproval’ of ‘poor’ and ‘challenging’ behaviour and referred to ‘consequences’ to ‘modify behaviour’. It also said it was important people recognised the consequences of their behaviour to prevent them from doing it again. Furthermore, that people should be supported to behave positively to achieve ‘positive feelings’ from others. The document showed a fundamental misinterpretation of positive behaviour support and ‘consequences’ as punishment, rather than a way to understand the function of behaviour to prevent people’s distress. It failed to consider that some people would not have the capability or mental capacity to understand cause and effect. The policy adopted a coercive approach, which failed to value people or uphold their rights. An example of this is, 1 person was routinely told when they behaved in a positive way, they were able to participate in an activity.

People were not always supported appropriately in relation to their needs. One person told us that life would be better for them if their behaviour was better. They had not considered that their health condition related to how they might cope with anxiety.

People had lived at the service for a number of years, for some this was the only care establishment they had lived in since leaving their family’s home. No concerns were raised with us with this transition. Whilst people did not raise concerns with us directly, other evidence showed the service had not implemented their transition policy for a person's planned move. This meant it was not effectively managed and did not account for the person's emotional wellbeing during the process or when the move did not go ahead.

There were health and social care professionals who fed back positively about the service. One told us, “I have worked with Adelaide Care for a number of years and have found that they support a group of very complex individuals with skill, dedication and compassion.” Whilst healthcare professionals did not raise concerns with us directly, other evidence showed the service had not taken sufficient action to involve external professionals in support of people’s high levels of anxieties

Staff told us they worked well together. However the registered manager and deputy manager confirmed they had not requested additional support from health care professionals in relation people's high levels of anxiety.

Whilst there was positive feedback from some health care professionals. We found the registered manager and staff were not always providing the professionals with accurate feedback on people’s care. We found they were not requesting guidance and advice around people’s Positive Behaviour Support Plans.

Whilst health and social care professionals fed back positively, 1 told us they had not been consulted or asked for advice around people’s behaviour care plans. We saw people had attended other health appointments including dentist, opticians and GP.

The deputy manager told us they ensured people attended their health appointments. They also told us they had been unable to involve the Learning Disability team at the local authority in people’s reviews of care. They said, “They are going through a re structure. A lot of the learning disability team and care managers, a lot of their roles are changing.”

Relatives fed back their loved ones were able to access health care professionals when needed. One told us, “They do a yearly review on [person] where they cover everything.” Whilst people did not raise concerns with us directly, other evidence showed the service had not always involved appropriate support from external professionals

We looked at a sample of a person’s daily care notes and found on average they were spending 15 to 16hrs in their bedroom, and asleep for approximately 10 hours of this. Guidance stated the secondary door to their bedroom/bathroom area should be locked between 10pm and 7am, however there was no record of the door being locked or unlocked. The provider could not demonstrate how they monitored this regarding staff implementation and the least restrictive practice; we were not assured the person was able to leave their bedroom outside of these hours. There was no evidence of the person being offered activities in the evening, or whether this routine was the person’s preference or due to service convenience and staffing levels.

Relatives felt they were not always updated on their loved one’s care or any changes to their care. One told us, “Unless we want something, we don’t hear anything at all. It would be nice to be kept up to date with what [person] is doing.”

Staff told us they made care notes however we found these lacked detail and were often very task focused.

Staff were not always familiar with the principles of the Mental Capacity Act [MCA]. The deputy manager told us, “[MCA] is to assess if an individual to make an informed decision. I don’t do the assessments. We do have Drs that do the assessments.” However, we found the registered manager had undertaken capacity assessments for people and not external professionals.

The service did not consistently act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice, or their own MCA policy. For example, a person’s mental capacity assessment documented 13 different decisions at once rather than assessing each specific decision. There was no evidence about how the person was involved in the assessment, how information was provided or what adjustments were made, and what the person’s views were. The information recorded under the subheading ‘Is the person able to understand information related to the decision?’ listed the restrictions in place, rather than describing why the person was unable to demonstrate their understanding for each specific decision. The same document failed to demonstrate what less restrictive approaches had been considered, as required by the MCA 2005. It did not consider the suitability of the environment, compatibility with other people using the service, or whether the placement was appropriate to meet the person’s needs. It also failed to provide details about other named professionals and family members involved or what decisions were made in the person’s best interest. The registered manager had not followed the MCA or best interest process for a decision about a person moving to another one of their services.

People were not always being consulted in relation to their care. However, relatives told us they were consulted when decisions needed to be made. One told us, “I am involved heavily; I always have been.” Another said, “I go to all his appointments before any procedures, they have to get my written permission.”