Head Office

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

We assessed all quality statement within responsive, and found areas of concern. The rating for responsive has improved to requires improvement.

We identified one continued breach in regulation in relation person centred care.

We found people’s care plans continued to not include sufficient, factual information to ensure staff could meet people’s individual and current needs. Records still did not evidence person centred activities were regularly supported.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Not all relatives felt their loved one received person centred care all of the time. People did not experience effective communication as staff did not have any information on how to interpret their body language and gestures. For example, one person’s records stated the person used gestures and body language to communicate. However, there was limited information on what gestures were used and what they meant and how staff should interpret body language cues. People’s records did not always evidence person centred care. We found some people’s care plans held incorrect information, and at times care note information was regarding a different person.

Staff told us they knew people well. The staff we spoke to were able to describe people's current needs, likes and dislikes. However, not all staff could tell inspectors people’s life history. Staff stated all information was contained in people's care plans and risk assessments. However, we identified multiple concerns with the information recorded in people s care plans and risk assessments. Therefore, we could not be assured that staff had the information required to provide good quality person centred care.

Inspectors observed staff practices that were not person centred. For example, inspectors observed staff giving people medicines at a communal table, and entering people's bedrooms without knocking, without consideration to people’s privacy. Inspectors saw when people became anxious and were requesting to go out, staff did not always engage with them appropriately or respond to their requests, to reduce anxiety or distress. We observed at some supported living settings staff were on their tablets (electronic recording system) a lot of the time (during our assessment) and were not interacting with people during this time.

People did not always experience continuity in relation to meeting their needs. This was particularly evident with activities. Although it was clearly recorded in people’s care plans what they like to do socially, care notes showed a lack of routine occurrence or continuity. For example one person was noted as liking bowling and yet staff had only supported them on one occasion in a 60-day period to go bowling.

People may not quickly be integrated into their local community due to insufficient planning. A relative told us, “At the moment [person] has only just started going to the local shops or a walk around the block as they don’t know the area they’re in. Due to needing a driver they don’t go much.” Another relative told us there were insufficient staff in place when their family member moved in which meant their transition into a new area did not go as planned.

The registered manager’s told us, “There is a lot going on in local communities and we support people to get involved. We check that people are getting the opportunities they want to.” Despite this feedback, we did not always find people were supported to integrate into their local community as people’s preferences in their activities were not always met.

Professionals expressed concern about the lack of continuity with the recording by staff which could result in a person not receiving appropriate care. A professional told us, “When I looked at the [person’s] chart there was 11 days in June where the chart was blank. I spoke to the staff member and they advised that often this is because people press the wrong icon (on the care planning system). I looked up one day which was blank and could see that staff had recorded a bowel entry under mobility."

We also received concerns from partner agencies that the registered manager had given incorrect information regarding a person's ability on specific tasks. This meant the person could of been unnecessarily restricted.

The provider's processes to ensure people's ability to be integrated into their local community needed improvement. We received feedback people's activities were not always promptly organised, for example one person's ability to go out was affected by the lack of a driver. We were not assured these concerns had been identified by the provider's own systems to ensure their effectiveness.

Relatives felt communication and the sharing of information could improve. They told us, “Staff communicate, but its head office that’s the issue. I find head office very defensive when you call and not helpful”, “I think you get the easy stuff. But they struggle (with communication)” and, “As an overall company, communication was minimal, follow up was minimal.”

Staff told us some people used particular aids to assist with their communication. A staff member said, “[person] can choose the pictorials. We communicate with that.” However, due to the issues we identified regarding the lack of information recorded on how a person communicated we could not be assured information was provided to people in a format that suited them.

Important information was not always available in people’s care plans as processes were not sufficiently robust to ensure care plans were contemporaneous, up to date and accurate. Staff told us, you could not mention one person’s [relative] to them and yet, this was not written in the person’s care plan as a potential trigger for this person becoming anxious or upset.

Information in relation to the way people communicated was quite basic for some people. Records for one person stated they had limited verbal ability but could use some verbal communication. It also stated they used some natural gestures along with language and knew the names of permanent staff. However, there was no indication of what the most significant ones were. This meant this person may not always be listened to in the way they wished by staff.

Relatives told us they did not feel listened to if they raised a concern or complaint. Relatives said, “No they never have (responded to a complaint)” and, “We still don’t have a response from 2 weeks ago (when we raised a query).” A further relative said they, “Struggled” to get responses including receipts for her family member’s expenditure.

The registered manager’s told us, “We have monthly service user meetings and some service users are involved in putting together the newsletters. From the feedback in one survey [senior management name] was involved and went out to meet with the person to discuss their concerns.”

However, this did not always happen in practice. We read notes from the monthly meetings and these did not record anyone’s individual views. They were written as logs of what was going on at the setting. For example, staff had completed information about people’s monies being counted each day by staff, maintenance of people’s vehicles being checked and menu’s being updated, ‘with the help of service users’.

Processes were not robust in ensuring people were listened to and involved. Although there was more evidence of pictorial information being used with people, staff had still not developed a robust way of supporting people to express their views and ideas. Meetings and notes were written in a way that could not be accessible to people.

Some people were supported to access the community in a way that meant something to them. For example, one person was supported to go home each weekend to mix with people they knew. They told us, “I go home every weekend and most of my friends are there.” However, we found people did not consistently receive the support around Right Support, Right Care, Right Culture, as we found not all people had good access to local communities that most people take for granted.

Although the registered manager told us, “Some of the residents from 4 different homes we support meet up every Friday evening and do different things such as pub, bowling, meals out, parties etc”, we did not always find everyone had the same opportunity.

Processes were not always effective in ensuring each person had the same equity in access. Although some people were supported to access external professional support, this was not consistent and as such meant that not everyone was being given equal opportunities.

People did not always have the opportunity to experience things that meant something to them. One person was recorded as being catholic and was used to visiting a catholic church on a Sunday. Their care plan noted that when they had settled into the supported living service they should be given the opportunity to attend a local catholic church. Despite this, there was no record of this person ever being supported to attend church, or even being offered the experience of attending one.

The registered managers told us, “There are various opportunities for people and we ensure these are made to everyone. We have people in work placements, volunteering and one person has just applied to work in a nursing home which is something they wanted to do.”

The team leaders and individual supported living setting manager’s worked with people to identify goals and as such supported people to help them reach these.

Despite information being recorded in people’s care plan about the things they liked to do or experience, staff did not always make an effort to enable people to participate in their preferred activity.

However, some people did have good outcomes. We read one person attended outdoor activities of their liking and another was provided with equipment and support to fulfil their wishes. One person wanted to make their own dinner and staff gave them a notepad and pen and sat with them to make a list of the ingredients they would need to buy to make the dinner.

We read in people’s care plans, where relevant, that staff had approached relatives in some instances in relation to a person’s wishes for the future.

The registered manager’s said, “This is something we have been doing with service users and their families. End of life conversations are difficult though as predominantly we support younger people. But we are continuing to work on it.”

There was a system in place to help review people’s future was planned or recorded. Each person had a care plan entitled ‘death and dying’. Although most of these were blank, we read that staff had started to ask the person or their relatives for their feedback and input in this respect.