DCA Alderwood

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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 saw evidence best practice guidelines in supporting people was being followed. Teams worked well together, and advice was sought from external providers appropriately. People were supported to make healthy choices. However, suitability of the accommodation and compatibility of people using the service was not always given enough attention, which had led to breakdowns in care provision. There was limited evidence that best interest decisions had been completed following the Mental Capacity Ace Code of Practice guidelines.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people’s relatives about this quality statement. The majority of relatives felt that people’s needs were understood and supported. However, there was limited evidence of how much involvement relatives had in care planning and reviews. One relative felt that support needs were assessed appropriately but this support was not always put into practice.

Staff told us they have got to know the people they are supporting well and know the right approach to support their emotional regulation. They told us there were positive behaviour care plans in place but we saw that these lacked enough information on what caused people to become dysregulated. Staff told us that people’s support plans contained details of useful communication tools for the individuals.

Partners did not give any feedback in this area at the time of the assessment.

People’s needs had been assessed before they came to the service. People’s families had been involved, where appropriate, in the planning of people’s care and support. However, not enough attention had been given to the compatibility of people living in shared accommodation or the suitability of the property for that person. In one case this had led to a break down in a placement. The new manager assured us lessons had been learnt and as part of any future new placements the compatibility of people would form part of the assessment. It was not clear whether care plans were available in formats that were accessible to people.

Relative’s feedback on this quality statement was mixed. One relative told us people were supported to stay healthy and make healthy choices about their diet. Whereas another relative was unsure whether staff were enabling a healthy diet.

Staff told us they were implementing best practice guidelines to prevent autistic people and people with learning disabilities being over medicated. People did not receive sedation when they became distressed.

The provider had documentation to guide staff how to complete a Support Plan for each person. There was limited evidence of how much involvement the individual and/or their family had in completing this to ensure it was tailored to individual’s needs. Staff were given guidance on where to seek advice and support. The provider was in the process of reviewing elements of the documentation following the outcome of an inspection of another of their services. Some people’s care plans detailed interventions that were being implemented without external clinical guidance.

Relatives’ feedback on this quality statement was mixed. One relative felt they were always kept informed of how the person using the service was. However, another relative felt there was a lack of understanding of the person’s needs and communication barriers impacted effective information sharing.

Staff told us handovers between shifts were effective. They used both verbal handovers and a handover book and daily notes to make sure that incoming staff had all the information they needed to support the person effectively. One staff member told us staff handovers could be a particular trigger for the person they were supporting. They described how they minimise distress to the person at these times.

Partners did not provide any feedback in this area at the time of the assessment.

We saw from records and communication documents the staff sought advice and support from other services. For example, when concerns had been raised around how a person formed positive relationships with people a local community learning disability team was contacted.

People’s relatives told us the service was not always effective at supporting people’s access to healthcare. They told us they had had to seek out the appropriate support for people’s specific health needs. One relative told us the service did not always identify when someone’s health was deteriorating due to acute illness.

Staff told us how they support people to make healthy meal choices and create weekly meal plans. Staff told us they received training on people’s health conditions. One staff member felt that the team would benefit from better training around managing epilepsy.

Partners did not provide any feedback on this quality statement at the time of the assessment.

People were supported to live healthier lives. We saw people had access to other health professionals when needed, eg District nurse, Specialist Diabetes Nurse. A record was kept of any visits to the GP or dentist. People were supported with their diets and choosing healthier meal options.

People’s relatives told us that people’s goals and aspirations are not considered and planned for. Support was focused on managing day-to-day challenges.

Staff did not give any specific feedback covering this quality statement.

People’s care was reviewed and each person had a set of goals identified. However, there was an emphasis on goals related to people’s behaviour rather than their aspirations and interests. For example, staffing levels had been reduced for one person which meant the person was living a less restrictive life. Goals had not always been reviewed in a timely manner and more emphasis was needed on goals to enhance people’s lives. Work was underway to address this, which needed to be completed and embedded before we could fully assess the effectiveness.

People’s relatives were not always sure if restrictions on people had been agreed legally. One person’s relative told us “I feel I’m having to be very involved to ensure the support is right and I am not able to just be a parent.”

Staff told us how they gained consent from people and what they would do if people refused assistance. They told us people had varying abilities to make choices about their daily activities and they tailored their approach to suit the person they were supporting.

People’s consent to support and care had been sought. Where people had mental capacity to make decisions for themselves the provider had ensured they had access to communication aides to express their decisions if they could not do so verbally. For example, pictorial information. Where people lacked mental capacity to make decisions Mental Capacity Assessments had been undertaken and Best Interest Decisions documented. Some of the information in these documents was not as clear and detailed as they could be and was not reviewed in a timely way. There was limited evidence that the least restrictive options had been considered or that people’s views had been considered in best interest decisions. We shared this with the new manager who assured us this was being addressed.