Marlow

On this page

• 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

Responsive – this means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement.

This meant people’s needs were not always met.

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.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Autistic people and people with a learning disability were not always recognised as an individual with their life ahead of them. Most people did not have plans for the future which included how they were motivated to express their wishes. There was a lack of understanding by staff and managers about how people who did not express themselves verbally interacted with the world around them. For example, a manager showed us a room they described as a sensory room, which consisted of fairy lights on the walls and little other equipment. When asked if people had had a sensory assessment to determine how they would use a sensory space or if staff had any training about how to develop and use a sensory room, they replied no. People’s responses to sensory stimulation are varied and need to be bespoke to avoid causing distress.

For some other people, their opinions and wishes were heard and respected. There was a lack of consistency across the planning and support for people.

There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

There had been a number of safeguarding alerts made to the local authority in relation to shortfalls in how staff understood and supported diverse health needs. One health professional said, “There is often a delay in acting quickly and accessing the most appropriate health advice across all staff. Weekends appear to be particularly dire in that the staff do not feel confident in escalating or know who to escalate to.”

There had been improvements in staff levels in recent weeks and staff told us they were feeling more confident.,

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. There was a lack of communication tools available for staff to use to support people. People had limited communication assessments to identify how they should best be supported to receive information in a meaningful way for each person. Records shared at the time of the assessment visit showed there had been no specific training around communication for staff. The provider told us this training was embeded into a blended training programe, which included the care certificate. Staff told us people did not have augmented communication tools, saying one person did have a book of images but did not wish to use it. Following the assessment visit the provider told us referals were made to the local authority community team and a speech and language therapist employed by the organisation in another area came to the service to provide additional training.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

The lack of effective communication assessment and subsequent lack of staff understanding of different communication methods meant some people had limited involvement in decisions about their care. Some people, often those who were able to talk about their wishes were supported to raise issues and actions were fed back to them. For example, a person said they wanted to move to a different part of the service, and this was being supported. The person was updated with progress towards this wish.

Relatives told us they had raised concerns, and some were responded to promptly, while others said they had to chase for a response. Managers had recently put in place more formally arranged meetings to aim to ensure relatives had the opportunities to discuss any concerns with a manager.

The provider did not always make sure that people could access the care, support, and treatment they needed when they needed it. The staff and managers had not always demonstrated the skills and knowledge to respond effectively to people’s complex needs.

There had been improvements made recently, and staff were more aware of how to ensure people had reasonable adjustments in place. For example, phoning ahead of a GP appointment to avoid long waits in a waiting room, which might cause distress for the person.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People and relative told us, whilst people did go out and about in the local area, opportunities were limited, and they felt this was an area where their lives could be enhanced.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.