231 Brook Lane

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 had been made following our previous rated inspection and our rating for this key question had improved to good. People’s needs were assessed, and care and support were delivered in line with current standards to achieve effective outcomes. Assessments recorded people’s likes, dislikes, choices, and preferred communication methods. Staff worked with professionals both internally and externally to the home which benefited the people they were supporting. People were supported to access health care services as they needed and had annual health checks. There were hospital passports and health action plans in place to assist external healthcare professionals to understand people’s needs. Positive behaviour support plans were in place to guide staff on how to respond should people display distressed behaviours. People’s rights for seeking their consent and respecting their choices were upheld.

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.

Relatives confirmed they were involved in reviews of their relatives’ support. Some relatives told us communication between the home and themselves had improved recently which led to more information and ideas being shared.

Staff confirmed assessments described people’s communication needs. One staff member told us, “Makaton, picture charts and story books are used. I have had training on Makaton.” Staff had read care plans and had the opportunity to comment on them. We were assured staff received updates relating to changes in people’s needs and their care plans. The manager gave us a comprehensive response detailing how assessments were carried out, this including using a multi-disciplinary team (MDT) approach. The manager told us care plans and risk assessments were devised with input from positive behavioural support specialist and community learning disability nurses.

We reviewed 2 people’s files. The files reflected people’s preferences and choices throughout. We reviewed evidence of people’s likes and dislikes. The manager told us, people’s choices and preferences were observed and documented daily to inform the care plans and ensured people have choice and control over their lives. We reviewed systems in place for updating care plans. The manager was in the process of updating the care plans. They told us and showed us, how they were involving staff and people’s relatives in this process. They were also working on a plan to ensure people were also involved in this process. The providers policy stated, ‘Support Plans must be regularly reviewed to ensure these are appropriate for the current needs of the person.’ We saw evidence of care plans being reviewed during the quality audit process. A keyworker system in place was working effectively . This meant a staff member was responsible for knowing when a specific person’s medical appointments were due, would help review their care plans, liaise with relatives and would attend meetings as staff member who knew the person well.

We were unable to gain evidence from people relating to whether they enjoyed the food and were involved in decisions about the menu. We did find evidence of this elsewhere and were assured people enjoyed the food and were involved in the menu planning process.

Training was in place to ensure staff were following best practice guidance this included training in learning disabilities, autism and Makaton which related to the people they were supporting, therefore we were assured staff were encouraged to learn about conditions affecting people and were following right support, right care and right culture guidance. Staff were completing the appropriate documents, including monitoring charts to support people with food and fluid intake, weight and bowel management. These were reviewed to ensure people maintained healthy lives. Leaders were keeping up to date with best practice and evidenced-based care. When asked, how do you ensure that you are keeping up to date with best practice and evidence-based care, the manager told us, “Following our policies, completing training, reading bulletins from local authorities and CQC. Evidenced based care is going to be me doing observations to ensure staff are following best practice. I also complete ad hoc out of hours spot checks. I complete these every 2 to 3 weeks. I have come in early, at night and at the weekends.”

People received care, treatment and support that was evidence-based and in line with good practice standards. The service had up-to-date policies and procedures to ensure care and treatment was delivered in line with national guidance and best practice. Policies we reviewed referenced national guidance this included the Health and Social Care Act 2008, Mental Health act 2007, Mental Capacity act 2005 and Department of Health and Social Care guidance. People’s nutrition and hydration needs were met in line with current guidance . We reviewed a Malnutrition Universal Screening Tool (MUST) which had been used to support a person who was at risk of malnutrition. Staff and leaders were encouraged to learn about new and innovative approaches to improve the way their service delivered care.

We did not receive any concerns in relation to people's experience of this quality statement.

Staff explained how they worked as a one team to support people’s health needs, for example when supporting a person to manage their diabetes. They told us they attended diabetes training, made sure the person ate a healthy diet and also documented what they had eaten. These documents and shift handover meetings were and an effective way to share information as one team. The manager understood the importance of effectively working across teams and services to support people. They gave examples of additional training which had been provided by external professionals to aid staff in supporting people who required additional medicines to manage their health conditions.

We sought feedback from professionals as part of the assessment process. We received feedback from 3 professionals. We asked, does the service work well with other health professionals, one professional told us, “Yes, I saw records of medical appointments and phone calls to GP’s etc.” However, another professional told us, information sharing could be better. We asked, does the service work well with other agencies in a responsive way to support people’s needs, one professional told us, “Staff have been working with Hampshire County Council (HCC) and the Integrated Care Board (ICB) to resolve the quality concerns. I have had no feedback from professionals that there have been any difficulties.” Although the feedback received was mixed, from assessing all the evidence we have reviewed, we were assured the service worked effectively to provide co-ordinated care and works well with other health care professionals to support people with complex health needs.

The provider had a collaborative approach to ensure staff teams and services worked together to provide the best outcomes for people. We reviewed the provider’s admission policy and spoke with the manager. We observed the admissions process was a collaborative approach with the person at the centre. We were assured staff would receive any additional training required to support a new person. Support plans contained a section on people’s goals and dreams. One person’s dream was to visit Disneyland Paris. During our on-site assessment the person was supported to communicate with us, that they were going to Disneyland Paris in 2 days’ time.

Relatives told us their relatives were supported to live healthier lives. They told us, they were involved in decisions about their relative’s health needs. One relative said, “My relative is healthy and staff get them out every day. They’re good at doing varied activities like hypnotherapy, bike rides and Play Zone.”

Staff were supporting people to live healthier lives. Staff members were able to give us examples of when they had worked with a range of different healthcare professionals to meet people’s needs. One staff member told us, “The chiropodist comes to the house. Opticians complete eye sight checks. GP & Nurses are seen when required and sometimes will do house visits. Community Learning Disability nurses and advocates also provide support.” Staff told us they felt suitably skilled to recognise and respond to changes in a person’s mood or mental well-being. They told us this comes from knowing the person and reading their care plans. If they had any concerns about a person, they would report this to the manager. The manager had systems in place to ensure people were supported to live healthier lives. They were able to confidently describe how they support people to live healthier lives which included, exercise, healthy eating, social interactions, and attending medical appointments to manage health conditions. The manager described to us how people had been involved in decisions about their health and well-being. Th staff team knew people well and would pick up any health deterioration and document and report it. They gave us examples including monitoring charts which were in place and additional training staff have received.

People were supported to live healthier lives by a staff team who knew them well. People benefited by having the support of MDT professionals who built positive relationships with people so they could support them with all relevant aspects of their care. We reviewed 2 people’s healthcare records. We noted people were supported to attend GP appointments, annual health reviews, dental appointments and to have their vision checked. Health action plans and hospital passports were reviewed and contained the relevant information. There were also bowel and weight recording charts in place for the people who required these. We were assured the staff team supported people to have the relevant health checks, and the manager had good oversight of this. The health documentation we reviewed was in date.

People’s relatives told us, since the new manager had been in post, improvements had been made in improving outcomes for people and communication. One relative told us, their relative going out more was a positive outcome and communication had improved.

When asked about monitoring people’s care outcomes, one staff member told us, “Food and drink intake is regulated very well.” Another staff member told us, “The community learning disability nurses come out and give advice. They support us to support some people when their mental health deteriorates.” The manager gave us a comprehensive list of how they monitor people’s care and support, which included, reviewing daily notes, spot checks, audits, ad hoc out of hours visits and incident analysis reviews. The manager gave us an example of how they improved an outcome for people, they told us, “Mealtimes are becoming less task orientated. People are better engaged at mealtimes. It’s a more sociable experience for people. Condiments, table mats and juice available which people can pour themselves. People are also going out more.”

The provider was monitoring and improving outcomes for people. We reviewed the provider’s quality audits. The actions included, updating support plans, completing mental capacity assessments, and holding best interest meetings where required. This evidenced family’s involvement in the support planning process. People were supported to complete survey’s, information was collated and analysed to create action plans and add to home development. One example was the introduction of a house meeting. During the first meeting the plan was to discuss easy read information around activity planning / wheel of engagement and menu planning had been implemented. The manager shared with us their action plan which included time frames to complete actions.

We were unable to gain this information from people themselves, however, from reviewing information and observations carried out by CQC we were assured staff gained people’s consent before providing care and treatment.

Staff understood and put in practice gaining consent to care and treatment from people. Staff were able to articulate how they sought consent, these included, giving people space, and trying different approaches with different people. Staff told us they had mental capacity act (MCA) training, and all staff could describe how this was relevant to their role. Improvements had been made following our previous rated inspection and the provider ensured staff were suitably trained and qualified to assess people's capacity to consent to care. The manager had a good understanding of MCA and was ensuring gaining consent to care and treatment was embedded in the staff team’s work ethos. They also understood the importance of holding best interest meetings if a person was assessed not to have the mental capacity to make a specific decision independently. The manager recognised people had not always been involved in care planning, they told us, “My longer term plan is to make support plans and planning more accessible for the people who live here.”

We reviewed people’s files which were a good reflection of the person and how they liked to be supported. The provider had a Mental Capacity, Consent and Decisions making policy in place. We reviewed MCA and Best Interest meetings for 2 people. We reviewed MCA relating to checks at night. The assessment detailed how the team had approached the topic with the people, which included communicating in their preferred method, using of easy read information, and asking simple questions to ascertain understanding and recall. When it was assessed, the person did not have capacity, a best interest meeting was held which included gaining people’s relatives and a community learning disability nurse (CLDN) opinions. The provider was following the correct procedures in relation to consent to care and treatment.