Alderwood L.L.A. Limited - Irchester

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Not all people received care and support based on their individual care and support needs and protected characteristics under the Equality Act. Not all Peoples social, cultural and religious needs had been assessed, However the registered manager was in the process of reviewing peoples care records. There was a lack of opportunities for people to pursue their individual interests or try new activities. Staff were unable to demonstrate how they actively encourage people to engage in positive risk taking and meaningful activities and assessed stimulation. People were supported to access independent advocacy services if required. The provider’s complaints procedure had been made available to people using the service and others. People had equal access to services and support. The provider had data protection procedures in place that reflected current legislation.

This service scored 36 (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 their loved ones received person centred care, and they felt their daily needs and preferences were understood by staff. However, we spoke to staff working directly with people. Staff lacked sufficient knowledge of people’s support needs in relation to communication methods and an understanding of effective responses to emotional distress. We observed people did not always have an informed choice of how they wished to spend their time or access to activities and daily living skills they found stimulating.

Staff could demonstrate an understanding of people’s personal preferences. Staff told us people are supported to make their own decisions of how they want to spend their time and what foods they want to eat. However, staff lacked knowledge of how to engage people in making choices regarding meaningful activities and stimulation.

Staff were observed to be led by people’s established routines. However, there was a lack of meaningful engagement and purposeful encouragement by staff to enable people to have informed choices of alternative activities or meaningful stimulation. We did not observe staff offering choices of meaningful in-house activities. This meant people were not being supported to achieve positive outcomes through lack of engagement and appropriate stimulation

Relatives told us there had been some recent changes in the service which impacted people, such as a lack of managerial oversight and significant impact on people’s planned activities.

Staff told us there was a lack of opportunities for people to go into the community due to the risks they present. One staff member told us “It would be nice to take people out more and go to different places. We don't really go anywhere much because it’s too risky and not safe”. The lack of positive risk-taking meant people lacked opportunities to develop and maintain skills and experiences and ensure person-centred activities were meaningful and purposeful.

External professionals raised concerns following a recent welfare check of a person at the service. Concerns were shared regarding the quality of care, effective staff approach, lack of meaningful activities and lack of oversight from the management team.

Staff training records confirmed staff had received the required induction and training in learning disability and autism. Additional staff training had been provided regarding meeting some specific care needs for a person and this had a positive impact on the person's physical health. However, the provider was in the process of changing their positive behaviour support approach and new training was being implemented to adapt their ways of working. Training records demonstrated not all staff had the same level of skill or training to support people with distressed behaviours. This meant we could not be assured people received continuity of care or a consistent approach to ensure people were supported safely. We took enforcement action with the provider and the management team took the appropriate action to have all staff teams trained within the same ways of working.

People had access to an easy read service user guide that informed them of the service they could expect to receive. They also had access to the provider's internal complaints and safeguarding procedures that had been provided in easy read. However, this information was not assessed as being effective for the people living at the service to ensure it was purposeful. Relatives raised no concerns about how information was provided, shared or stored.

Staff told us they had cue card menus in the kitchen to enable people to make an informed choice for their meal choices. However, these were not observed in practice over breakfast time or lunchtime. The manager told us they were reviewing their accessible information processes within the service at the time of the assessment.

The provider had a data protection policy and procedure and understood their responsibilities under the Accessible information standards. Information such as the provider’s complaint and safeguarding procedures was provided in easy read. Social stories were used to support a person with changes to their routine

Some relatives told us things had improved since the new manager was appointed. One relative told us, “The last few weeks have improved with the new manager. The communication has improved with them too.” However, some relatives told us they share requests and information with the manager, and this is not always communicated to staff teams working directly with people. This meant meaningful and important information is not always recorded or shared with staff teams working directly with people.

Some staff told us they were involved in key worker meetings with people and their families to review peoples care and support. The manager told us they were reviewing this process and looking at ways to improve them.

The provider had systems and processes that supported people to share their experience of the service including opportunities to identify activities they would like to do. This was via a monthly key worker meeting. However, we reviewed some examples of the key worker meeting minutes recorded by staff. This process lacked information and missed opportunities for staff to develop progression plans for people to ensure they were offered the opportunity to try new things, develop new skills or achieve positive outcomes.

Relatives confirmed there had been recent reviews of blanket restrictions within the service. They were positive about the access people had throughout the home. However, we observed blanket restrictive staff practice throughout the inspection which impacted people’s ability to access meaningful and purposeful daily living skills.

The manager told us they have improved people’s access to primary health care services for people. The service now has health professionals visit the home such as opticians, chiropody, dentistry services. This ensures people are more relaxed in their home environment to engage in health assessments.

External professionals raised concerns regarding the lack of assessed meaningful and purposeful engagement with stimulating activities. Concerns were also raised with the lack of management cover to support staff teams working directly with people.

People’s care plans recorded reasonable adjustments in relation to accessing health services. This included how staff would facilitate health appointments such as requesting a home visit appointment to enable the person to have sufficient time and not feel rushed. Equality and human rights, including people’s protected characteristics were known understood and planned for. There was a lack of management oversight across the service. Staff lacked knowledge of systems and processes to ensure they contact a relevant person in the event of an incident occurring. We took enforcement action, and the management team responded. An out of hours on call system was communicated with staff teams.

Relatives confirmed the service has improved on ensuring people receive access to health care services. One relative told us, “[Name] has got a new Chiropody service and we’ve been warned that this has to be paid for. They come to the house. They are more compliant and comfortable there” However, we identified a lack of proactive response by the provider to ensure appropriate referrals to relevant health professionals for investigative assessment had been undertaken.

The registered manager told us they worked with the parents of a person supported to ensure a change in their routine was managed safely. Social stories were developed to support the person to understand why and when these changes would happen.

The provider lacked systems and processes to monitor people’s progression and outcomes. Goals and aspirations were not recorded, planned for or reviewed. key worker review meetings were taking place with people, However, we reviewed notes from these meetings and where actions were identified for people, we could not be assured that these actions were completed. Dates of the actions had not been signed off as achieved and progression plans had not been put in place to review the progress made to meet the goals and outcomes identified.

Relatives confirmed there was some engagement with key worker meetings held at the service, however, they told us there was a lack of forward planning in relation to outcomes, aspirations and goals for people. One relative told us, “There is a lack of meaningful activities offered by staff”.

Staff lacked knowledge on how the service plan for people’s future and lacked understanding of people’s complexity of care needs they presented with. This meant peoples care was not always planned for effectively or communicated with staff teams to ensure peoples predicted health needs were assessed and managed. The registered manager told us parents of people living at the service had declined the opportunity to be involved in end of life care planning.

No person using the service was receiving end of life care. Care planning had not been completed to support staff to respond to people’s needs if there was a decline in health or hospital admission. People had recently had their care needs reviewed by commissioners to ensure care and support continued to be effective.