Rosekeys

On this page

• 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 assessed all 6 quality statements in the effective key question and found areas of good practice and concern. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question has changed to requires improvement. Peoples care and treatment was not always optimised as their health, care, well-being, and communication needs were not assessed with them. Peoples care plans were not kept up to date and relatives were not always kept up to date with changes in their relative’s health and wellbeing which was especially important for people unable to advocate for themselves. Staff spoken with during the assessment had good knowledge of capacity and consent and respected people’s choices.

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 receiving care and support had not told us if they were involved in planning their care. People’s relatives told us communication had previously been poor which had meant they had not had any engagement regarding assessing their relative’s needs.

The manager demonstrated a good understanding of the importance of carrying out an assessment of needs for people. They said, “The assessment process is crucial and this information is factored into care plan. What they like, their specific routine. We are all very different.”

The effectiveness of people’s care and treatment was not maximised as the provider had failed to use a robust assessment and review tool. This meant care plans and risk assessments did not always reflect people’s current needs and wishes. We observed a new staff member who was on induction being given time to review care plans.

People’s relatives communicated previous concerns regarding their loved one’s care not being in line with what was important for and what mattered to the person. However, at the time of the assessment people did not highlight any current concerns.

The management team spoke about how they planned to achieve the delivery of care and support that met people’s needs, wishes and aspirations. One of the management team told us, “I take into consideration people’s health, communication, mobility, how they want to be treated, looked after and cared for”.

The quality of care planning documents was mixed with some of them containing very little information on what was important for the person and what mattered to them. We saw some people had identified goals but they hadn’t been revisited to support the person to achieve the outcome that was important to them. There was information available to staff in the kitchen regarding people’s fluid and nutrition needs to ensure people with modified diets received their drinks and food prepared in a way that was suitable for them.

People did not highlight any concerns regarding how staff and services worked together. However, people’s relatives told us that the staff team did not always work effectively with them or communicate information to the relevant professionals in a timely manner but that this had improved recently. One person told us, “There was an incident when [relative] was taken to hospital, which I was not told about straight away”.

The manager told us how they work effectively across teams and services to support people. “We collaborate with support workers, staff, GP, advocate, chiropody, district nurses. If individual can’t express their needs our support workers enable this”.

Professionals working with the service did not feel they worked collaboratively and shared information appropriately and shared examples of barriers they had experienced when requesting information to support a person to make an informed choice.

We saw some evidence of documents which would support teams to work effectively together, including hospital passports, but these documents were not all current. The manager was able to provide evidence of communication between the service and other health professionals including the Community Learning Disabilities nurse.

People communicated some historical concerns regarding care and support but, at the time of the assessment, no concerns were shared with the inspection team.

We spoke with the management team about actions they take to support people to live healthier lives. “Certain individuals may need speech and language team referral because problems swallowing, an OT assessment, GPs etc. We are implementing healthy eating, people have got a choice, unless specifics for certain reason from GP or something”.

We saw that people had been referred for equipment to support to avoid pressure injuries and people had seen the dentist and GP but documentation did not consistently evidence how people were supported to live healthy lives.

People did not communicate any current concerns. We spoke with people who told us about recent holidays and outings and planned activities that they wished to do.

We spoke with the manager about how they monitored and improved outcomes for people. They told us, “We do this by collating data from care plan reviews, feedback, surveys and putting committees into place to empower teams, residents and resident's families”. The feedback provided was reflective of the new processes being implemented by the management team at the time of our assessment.

Documents reviewed during the assessment did not evidence that people were supported to experience improved outcomes. We saw examples of outcomes recorded that had not been reviewed or progressed. However, the manager was implementing new processes to support improvement of outcomes including opportunities for people and relatives to make suggestions and give feedback, and the review of care plan documents.

People and relatives did not communicate any concerns regarding consent. However, it was not always evidenced or demonstrated how people’s consent was sought.

Staff told us they understood the importance of seeking people’s consent when providing care and support including people who are assessed as lacking capacity to make certain decisions. One staff member told us, “Address the situation with sensitivity and respect for the individual's rights and preferences to ensure that the person's rights and well-being are protected”.

Documentation regarding consent and people’s capacity to consent to care and treatment was poor. We reviewed care plans with conflicting information regarding whether a DoLs was in place or not. Mental capacity assessments were completed poorly. For example one stated the person had capacity but “had been in care a long time.” Best interest decision stated for one person it was best to “do it for them”. There was no evidence of family or professional involvement