Adrian O'Brien Rachel Amiee O'Brien - 122 Scorer Street

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

At this assessment we did not assess all quality statements within this key question. We assessed 2 quality statements in the effective key question and found areas of good practice and areas of concern. Although people felt they received good support, care plans were not up to date and did not reflect people’s assessed needs. People told us they could make decisions, however there was a concern people did not always have the mental capacity to understand decisions they were making. Furthermore, decisions were being made in people’s best interests without consent.

This service scored 67 (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 decisions and received good support from staff. We saw a person had been involved with their care plan reviews as they had signed to agree with the content. However, it was not clear if people understood whether they were receiving appropriate care and support. For example, incidents were not always well managed and often required police assistance and personal care was not always carried out in line with people’s needs which had resulted in skin injuries.

Staff told us care plans were discussed at staff meetings. They explained that any changes to care plans were shared at those meetings, so staff were made aware. However, staff conceded that not all relevant information was included in people’s care plans and there hadn’t been a meeting recently with staff.

There were no systems or processes in place to assess, monitor or review safety effectively when people had moved into the service. Care plans and other records had not been reviewed and did not contain essential information to ensure people received the support they needed. Although the service was working with minimal staff, there was limited evidence that when more staff were employed that a robust system was in place to appropriately communicate any changes to people’s needs.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

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 Supporting people to live healthier lives 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.

People told us they were involved in decisions. Despite what people told us we found discussions were being held without a person’s consent or knowledge about their ongoing placement at the service. Although this was seen to be in the person’s best interest, the provider had not followed the principles of the Mental Capacity Act 2005 (MCA). The 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.

Staff understood the importance of ensuring they gave people all the information needed to help make decisions and had completed training on the MCA. Staff told us examples of how they had supported people to understand information which had enabled them to make informed decisions. However, where a person potentially lacked capacity to understand all the relevant information, staff had not followed the correct process to protect or empower people to make their own decisions.

The provider had a Mental Capacity policy which provided guidance for staff to follow. Despite this we could not be assured the provider was following the principles of the MCA when discussions were being held about a person’s ongoing care and treatment without consent. This meant people were not always empowered to have control over their lives and furthermore were excluded from discussions that impacted on their future.