Zeno Limited

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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

Staff sought people’s consent in ways which were accessible to the person. Decisions were made in people’s best interest and line with the Mental Capacity Act. Detailed assessments were completed prior to people moving to the service, to ensure their needs could be met and the environment was suitable. People were supported to consider aspirations and set goals, with staff keeping clear records of people’s progress and achievements. The provider worked closely and collaboratively with people, relatives and professionals, to ensure care was effective and to receive feedback on how they could improve. People were supported to remain in good health and attend any required medical appointments. People were encouraged and supported to eat a balanced diet, and where possible supported to be involved in meal planning and preparation.

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 had been involved in the assessment process, as well as ongoing care plan reviews. One relative told us the care plan had been emailed over to them for review a few weeks previously. They added, “They [Zeno] make sure we are happy with it and we make our own contribution to it and what’s needed, the social worker is also involved.”

The provider had a clear process in place for assessing people’s needs prior to admission. The provider’s development lead was responsible for reviewing all referrals and deciding whether the service was suitable. Once this had been determined, an initial visit was arranged to meet the person, their family and any professionals involved, before a transition plan was draw up and agreed. If the person would be sharing their accommodation with others, people already living at the property and their relatives were consulted prior to the move. Consideration was given about where people were placed to minimise the risk of disruption and have people with similar interests in the same property.

Relatives spoke positively about the service and the care and support provided, which they said consistently met the needs of people. One told us, “[Relative is glowing. They have lost half a stone since being there, they get home cooked food and are able to make choices about what to eat.” Another stated, “All the staff have got the best of intentions. We always feel they are trying their best to work out what to do next. They listen to [relative] and us and take us all seriously. This is the best service [relative] has been with and the staff seemed to be trained well in autism.” Food and fluid charts were used to record people’s intake. This included a section for documenting what specific fruit and vegetable they have eaten during the day, to help evidence a balanced diet. Individual programmes were used to support people’s nutritional needs. For example, one person required a varied diet to remain well but only liked a limited number of foods. To assist with this, a programme had been implemented to gradually introduce new foods. The person was offered a regular ‘buffet’ containing different food items, so they could identify new foods they liked, which could be added to their weekly menu.

The service had set up a learning hub. The learning hub provides classroom sessions and holistic home learning for people using the service. It also provides learning resources for individuals who are not yet quite ready for a classroom setting but would benefit from learning new independent skills. The learning hub is self-funded and free for all people using the service. The learning hub is based in a community setting in a building run by a charitable organisation. The learning hub is also registered with an education charity and awarding organization, who provide curriculum programs and qualifications to help young people develop knowledge and skills for learning, work and life. The hub is run by 2 learning coordinators who are highly experienced teachers with backgrounds in mainstream teaching, special educational needs, and working with people with a learning disability and autistic people. We noted 2 people using the service had been given additional responsibilities as assistant learning coordinators at the hub. In their role they could offer expert by experience support for the teachers and the people being taught. The learning Hub had recently launched an App which helped track people’s progress, communicate feedback / support outside of classroom sessions to staff teams to ensure there is a continuity of learning.

People, relatives and staff worked collaboratively to ensure the care and support provided was effective. The provider had introduced a number of different processes in which to gather feedback and seek views about the service. One of these was the family forum meetings. Relatives told us they found these a useful place to meet and chat about the service, both with the provider and other families of people using the service. One relative stated, “We attend the forum meetings and we say what we think which is heard, we get a good response from these meetings.” The provider produced a review document every 4 weeks, which was shared with relatives and professionals where required. These provided information about any medical issues, medicines management, nutrition and hydration, incidents, activities, how the person’s independence had been promoted, what goals had been achieved and future goals which have been set.

We saw a number of positive testimonials from professionals who worked with the service, which demonstrated how the staff team worked effectively for the benefit of people using the service. A learning disability nurse had stated ‘The assessment went very well due to the professionalism and caring attitude of the staff towards [person]. This was reflected in how they interacted in a calming manner with [person].’ A speech and language therapist had reported, ‘it gave a positive impression to come into an environment where the staff support team have such obvious, thorough knowledge and care in supporting the individuals in their home, where the standard of food offered was so high and where there was an evident impetus to make sure people were active and getting the best out of their days.’ A GP had submitted the following via email, ‘The carers who helped with my home visit to this patient yesterday were very professional and organised. They gave me good background information, ensured a safe area for examination and helped to encourage the patient by providing a cup of tea and biscuit for them, which also gave them something to focus on. This enabled me to examine their ear safely.’

Relatives spoke positively about the support provided to ensure people lived as healthy a life as possible. One relative told us, “Annual health check has been carried out. Chiropodist comes in every month, dentist is nearby. There is a very good dietician at the surgery as they had concerns over [relatives] weight. This was all down to previously being sectioned in a mental health hospital. When [relative] first came to Zeno about a year ago, they weighed 101.4 kilos, they are now 60 kilos.” Another relative stated, “Staff go to all [relatives] medical appointments, they are very sensitive to [relatives] medical needs.”

An anticipatory care calendar was used to record and monitor health appointments or reviews, these included annual learning disability reviews, medication reviews and dental appointments. Health appointment record sheets were kept documenting any feedback and actions following an appointment. Each person had a health action plan, which contained detailed information about their health needs and support required with these. To ensure people received safe and effective support should they require hospital admission, a traffic light document was in place. This provided key information about peoples needs, what was important to them, how they wished to be supported as well as a section for discharge planning.

The provider supported people to achieve goals and outcomes. Progress reports were kept and shared with relatives. Each person had an outcomes document within their care files, which listed goals and outcomes they were working on along with updates on progress. One person whose care file we reviewed wanted to increase their independence, learn to cook and learn to clean their home. We saw evidence this person was supported to take part in cleaning tasks each day, helped with grocery shopping and had learned how to scan and pay for their own items. We saw photographs of this person in the kitchen preparing meals, and saw they now prepared their own breakfast each day.

Alongside the outcomes document, the provider used a ‘pathway to better outcomes document’, which detailed all the processes in place which helped underpin the strategies and approach used with each person. It also covered what activities they completed each week, and the strategies in place to try and ensure positive experiences were achieved. The document also covered any incidents which had occurred, actions and support in place to manage these and improvements noted. We noted for one person, the use of supine restraint had been used frequently at their previous placement. Upon moving to Zeno, this practice had been stopped and had been replaced by the use of verbal de-escalation and non-contact methods using the least restrictive option. Over the last 2 years, the number of incidents had decreased from an average of 20 per month, to an average of 2 per month. This improvement had been achieved both as a result of changes in approach, and ensuring this person’s environment met their needs. Prior to moving to Zeno, this person had experienced several unsuccessful attempts at living within the community. They had now been living successfully in the community for 3 years.

Relatives told us staff sought people’s consent before and whilst providing care and support. Relatives also confirmed any restrictions in place had been discussed with them, and it was agreed these were the least restrictive and in the person’s best interest. One relative stated, “There are restrictions in place, but we’ve talked these through with staff. Some locks have come off doors which is much improved.” Each person had a Mental Capacity Act care plan, which covered any communication needs, information on capacity, best interest records and a list of restrictions or deprivations of liberty in place. Each of these was explored, explaining why needed, potential risk if it was not and when it would be reviewed. For example, restricted access to the laundry room due to this containing chemicals, or all external doors being locked, as people required support in the community to maintain their safety.

Staff understood the need to seek consent and explained how they did so. One told us, “I will seek the supported person’s consent before doing anything. For example, I will ask if I am okay to enter their bedroom, or support with personal care. All 4 supported people at my service are nonverbal so I ensure I have a good understanding of body language to know that consent is being given.” Care files contained clear documentation regarding whether people had capacity to consent. Each area / decision had been assessed separately, as per best practice. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. Were required, the service had followed due process and sought authorisation for any restrictions in place.