Alderwood L.L.A. Limited - Irchester

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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

We found the service had failed to ensure reasonably practicable ways to make sure that people who use the service receive person-centred care and treatment that is appropriate, meets people’s needs and reflects their personal preferences this resulted in a breach of Regulation 9, (1), (2), (3), Person-centred care, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were required in how people’s individual needs were assessed, reviewed and monitored. Information recorded in care records that provided guidance for staff about how to meet people’s needs were not consistently detailed or completed by sufficiently skilled or trained staff. It was not clear what evidence-based practice underpinned the behavioural strategies used. People assessed as needing support with distress or managing their emotions did not have positive behaviour support guidelines sufficiently detailed, or crisis intervention plans appropriately assessed. We were aware the provider was in the process of transitioning to a different positive behaviour support methodology. However, this way of working was not embedded in the service at the time of this assessment. Mental capacity assessments and best interest decisions in relation to the staffing levels people received, how behaviours of concern were managed, and crisis intervention prevention strategies were not in place.

This service scored 54 (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 told if there was a significant change in the needs of their loved ones, however, they were not involved in the care planning process. Some relatives said they were involved in key worker meetings but were unsure how information shared was being used in care records. One relative had significant concerns as they were not involved in an assessment or decision process to manage significant crisis intervention risks.

Staff told us it was the management team responsibility to ensure care records were completed. Staff told us they didn’t contribute towards to development of the care records, however, they do get told when they need to read changes in peoples care needs within the records held in the office. The registered manager told us they were reviewing all care records for people and implementing a new care planning document. Throughout this process the registered manager told us they had identified a lack of referrals to health professionals, such as speech and language teams to support people with choking and referrals to the internal PBS lead for support with managing people’s distressed behaviours. These referrals had now been made and people were awaiting a relevant assessment.

People’s care records lacked information on how to keep people safe when presenting with distressed behaviours and lacked guidance for staff to follow to support people with crisis interventions. Risk mitigation was not sufficiently detailed and lacked effective responses which was proportionate and in line with managing risks to people. We took enforcement action, The management team ensured appropriate assessments were completed, records were updated and staff were re trained.

Relatives told us the service regularly have meetings with health and social care professionals. One relative told us “[Name] has a DOLs (Deprivation of Liberty Safeguarding) in place, it was recently done with the Local Authority” However, we were not assured relevant reviews were undertaken with appropriate health care professionals and commissioners following significant safeguarding incidents, which impacted peoples care and treatment.

The Registered Manager told us they had implemented tools and assessments to ensure people’s care records were up to date and reflective of peoples care needs. The manager was working within some current guidelines and standards expected. However, the manager had identified that not all ways of working were evidenced based and had made referrals to health professionals where support was required.

There was a lack of evidenced based care and support provided within the service. For example, a person was restricted throughout their mealtime experience. Staff approach meant they controlled the pace and amount of food a person ate throughout their mealtimes. However, they had not had their needs assessed by an appropriate health professional to ensure the right approach was adopted by staff to manage the risks to people and the support had not been written within care records as a recognised approach with guidance for staff to follow. This meant the person had unauthorised restrictions placed upon them and staff approach was not person-centred or evidenced-based to ensure risks to them were individually managed. People had behaviour guidelines in place to support them with distressed behaviours and crisis intervention prevention. However, the guidance had not been completed inline with a PBS methodology and a functional assessment had not been completed by a trained and skilled person to ensure they were effective and responsive to peoples individual needs.

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.

Relatives did not raise concerns regarding consent and support. However, we observed people in the service communicating with staff through behaviours of concern. We found peoples preferred communication methods were not used by staff teams working with people to ensure people could make informed decisions or express their emotions

Staff had received training and understood the principles of mental capacity and consent to care and treatment. The registered manager told us “We have recently reviewed the restrictions within the service, including completing relevant mental capacity assessments. We have addressed those changes made within staff meetings, supervisions and there is a folder in the kitchen with easy read information for staff to understand what restrictions are in place for people and what that means to people”

Examples of Mental Capacity Act (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.