HF Trust Cheshire

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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

There was a lack of involvement with people and relatives around the care and support they received, what they wanted and their experiences. A person-centred care planning and goal setting training roll out plan had commenced during the assessment process. This was to be delivered to deputy managers, then to team leaders and the teams in services, following on from this training people were going to be involved in person centred care reviews and have involvement from their support staff and family members. Managers and staff acted on what they believed to be the best for people without any consultation or involvement with them which has resulted in people not being treated as individuals.

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.

People told us, ‘’Some staff are marvellous and engage very well with [Person] and are a good match for them. However, described other staff members as 'bone idle'. A family member shared, ''[Person] is often left disappointed when their scheduled one-to-one sessions and activity plans are cancelled due to staff shortages. This happens the majority of the time and have had to step in to support [Person] with activities.'' A family member told us [Person] can access their healthcare needs and the family member had no concerns around this. Another family member said, ‘’We are not kept informed about [Person’s] care and support needs despite constantly reaching out through various means of communication to try and have a discussion about concerns around [person's] care. We only receive information from [Person] when they call to let us know they are feeling disappointed that an activity or session has been cancelled or worried about which member of staff will be supporting as they often don't know them.

The turn around manager had indicated that there was training underway to have person centred care planning and goal setting rolled out to the deputy service managers. Then roll out into services which will have care planning sessions with people at the centre of their plans and people they want to be included in the planning sessions. This was going to take time to train leaders and staff, implement, undertake the sessions with people and those involved and embed in services through to reviewing process.'' Leaders told us, ‘’Care plans are updated when any change takes place to a person. A full 6 month and yearly review takes place. Family and friends are involved in the yearly review in most cases; however, we do have examples where people’s family are involved in care plans for any updates’’. At assessment we were unable to view recent reviews of care pans and who was involved and there was no evidence in plans these were completed 6 monthly and annually hence the training roll out for person centred care and goal setting as described in this report.

Feedback was mixed from family members where they told us they were involved and some family members reported that they were not involved to support and reported frustrations with liaising on their loved ones behalf such as, ‘’[Person] is often left unaware of this as despite trying to chase up communication aids, behavioural support plan, speech and language therapist and physio, I don’t know who is supposed to be actioning what.'' Another family member told us, ‘’Due to staff shortages there is no consistency of support.’’

Leaders told us if they identified a package of care was no longer suitable or if funding was to be reviewed, they said, ‘’We would contact the local authority with evidence as to why we can no longer meet the need, complete a case review to see if the service was the most appropriate package, and if not we would agree a transitional plan with an appropriate provider, we also refer to CHC and DST processes where more complex professionals need to be involved in a person we support and at all stages the person, family, advocate, and a professionals team are involved in key decision making.''

Partners we spoke with raised concerns regarding care provision, integration and continuity. A partner told us "I don't feel there is continuity in the services as staff are moved around at short notice to lone work in houses they have never worked in. They don't know the individuals they are supporting." Another partner commented, "Staff are unaware of the need for consistency and do not follow the support offered by people's family and health colleagues."

The provider had contingency plans in place to enable people's care to continue safely in light of unforeseen events. However, people did not always receive their commissioned support hours due to staff shortages and sickness. As a result, people's ability to access community services, health appointments and activities of their choosing were hindered.

We observed individualised person centred plans and one-page profiles, we observed in care files easy read booklets and pertinent to matters that were important to people such as managing their money, medications, accessing health care services and activities.

Leaders told us ‘’One key aspect of accessible information is the provision of health action plans. We use an understandable actionable health-related plan that is in pictorial form and also have a yes or no or comment boxes to accommodate different skill levels. They include diagrams that are valuable in conveying complex concepts in a clear and concise manner. Activity planners for the week are in place, that show photos of places they have planned to go to and the transport they are taking, this also includes any appointments, now and next cards / photos. They are personalised by staff, and for any places they go to, a photo will be taken so the next time they go, its not just a generic picture, but one that’s meaningful, as we have had a situation where a person we support had a fear of anyone in a white coat, as she associated this with a traumatic event so a photo taken of the actual venue reduced her anxiety. Additionally, we support people to manage their finances. To cater for various literacy levels our financial information is in pictorial format with minimal text. This enables people to navigate the complexity of banking and money management whilst promoting independence. The 'my medication' documents are also tailored to an individual’s level of understanding. To plan meals, we use accessible meal planners which have a choice of pictures. Our person - centred planning documents, are tailored to an individual’s communication needs and preferences including easy read policies and forms and access to the photo symbols on the website. We are developing a document called Fusion evaluation form, this is used to ensure people are agreeing to their consent and treatment on a regular basis. Tenant’s meetings are also in an accessible format.''

Staff were knowledgeable on how to communicate with people and followed people's communication plans effectively. However, there was limited input from people into reviewing and contributing towards their care plans and positive behaviour support plans.

Family feedback was mixed, some family members told us that they were involved in providing feedback to the provider and some were not involved. One family member told us there was a survey sent out via email once a year. They had attended meetings the family had initiated to provide feedback and suggestions, but these had never been acted upon. Another family member had provided feedback over the years, and they had always felt listened to. Action to make changes had taken place sometimes following this and sometimes not. One person told us they had been recently sent an email with a survey asking for feedback. However, they had proactively tried numerous times to work with the service regarding their feedback but this hasn't been acknowledged or responded to. Another family member told us they had only been invited to provide feedback once and this was via a recent email survey sent out.

Staff feedback was mixed from positive experiences they had sharing their concerns and observations, however we received feedback from staff due to the management changes that have mainly happened this year have meant staff raising issues had not been listed to. Some staff members dis not recall being involved in surveys and some staff members report that they had been involved in surveys. Staff also report that there had been times when they had not had a line manager in post. Leaders told us, ‘’ We send out regular feedback surveys to staff, family and visitors. From these we collate the comment trends and highlight key phrases and we send out a ‘You said, We did’ feedback’'. Team meetings are held monthly and 1 to 1 supervision are a safe place for people to raise concerns. The manager has a duty of care to listen and act upon these. Where this has not happened, disciplinary action has taken place. We have a whistle-blowing policy in place. We have had poor cultures that felt that they couldn’t raise concerns and, in these circumstances, we hold deep dive sessions to understand why that is.''

We were not provided specific 'you said we did' documentation with outcomes recorded from the leadership team. Team meetings were not always happening regularly for all staff teams, staff were not in receipt of regular supervisions with their line managers. House meetings with people were not always taking place in some of the services. There were many inconsistencies across different teams.

Family members we spoke with did not share any concerns with their loved one accessing services. Family feedback was mixed in relation to being involved in supporting their family members to appointments, some family members state they were fully involved and attended appointments where some family members were not involved and were not always aware of appointments that were attended or the outcomes at times.

Staff feedback the people they supported received annual health care appointments and they were supported to attend regular GP appointments and health related appointments such as opticians, dentists and chiropodists.

Partners gave mixed feedback on the subject of equity in access. A partner told us, "Everyone has access to healthcare and there are no issues with visits." However, another partner commented, "Being able to identify a key person to contact has been a barrier in trying to arrange visits for people."

We received mixed feedback on the subject of equity in access for people. People had health monitoring forms in place which evidenced visits to health professionals with outcomes recorded. However, staff support was inconsistent due to shortages and people did not always receive one-to-one support to enable them to access the local community.

We received mixed feedback, some families were involved in planning and care plan production and some families were not.

Leaders told us, ‘’We have a person that does not like to have their nails cut. We have worked with family and other services to desensitise the person. This was advocated by the support team as they were concerned for the health of the person as this impacted not just the issue of have overgrown nails but was displayed in behaviours which impacted their well-being. We review this as part of support planning. Call MDT’s and support families to raise concerns. Hospital discharge planning process is relevant here too, we also work with the safeguarding lead at HFT to raise concerns at a higher level and ensure peoples rights are respected.''

The provider had an equality and diversity policy in place to guide staff in how to support people to experience equity in experiences and outcomes. However, people's care plans were often incomplete and lacked input from people and their families. Where people did not have capacity to make a particular decision, the provider did not always follow the principles of the mental capacity act. As a result, we were not assured people had equity in access and outcomes given their individual needs.

We received mixed feedback that some family members were involved, and some were not involved in their relatives future plans. We observed there were DNACPR (do not attempt resuscitation orders) in place if people were to become unwell, for some people, these had not been incorporated into a care plan and no planning for the future had been considered in those instances.

Staff had fed back this was an area that needed some focus. Leaders told us, ‘’We work with professionals and staff teams attend training to ensure they have the right resources and skills. We support the staff teams more intensely during this time as this often has an impact on their well-being also.''

There was an and of life planning and support policy in place to guide staff on best to support people with end-of-life care. However, elements of this were not incorporated in people’s end of life care plans, meaning people’s care was not tailored to their wants, needs and wishes.