59 Bury Road

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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

During our assessment of this key question, we found systems in place did not always ensure people’s capacity and ability to consent had been adequately assessed and planned for. People’s needs were not always reviewed to ensure they were up to date and contained current information. You can find more details of our concerns in the evidence category findings below.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The area manager and the manager told us people’s needs had not been recently assessed. They told us they had identified this and had put an action plan in place to review and update all people’s support plans and risk assessments. The manager told us they hoped to have this completed by the end of March 2024. In the meantime, the manager told us there was a core number of staff who knew people well and were able to support people safely. We were not assured people’s needs had been assessed and that staff had up to date information about people’s needs.

People were not able to tell us if their needs were assessed and if they were involved in their assessments. We spoke with person who told us they were not involved in developing their care plan. They told us they had not agreed to their care plan. The person told us some staff understood their needs. They also told us, “We do have agency sometimes and they don’t know how I like to be supported. A relative told us, “The current staff team treat my relative with respect and demonstrate a person centred approach. The permanent staff appear to understand their needs, but understandably agency staff are unable to provide this same reassurance to them.”

Care plans and assessments were in place with information on how people should be supported. However care plans and risk assessments were out of date and had not been reviewed or updated. People who had medical conditions did not always have a care plan or risk assessment in place to guide staff how to support them with these conditions. For example, 1 person had glaucoma and arthritis, however, there was no detail of how to support this person with these conditions or of the signs to look out for if they were to become unwell. People’s care plans identified they were to have 6 weekly chiropody; however, we did not see any evidence that this took place. We were not assured people’s needs assessments were up to date.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We found shortfalls in the providers systems and practices in relation to supporting people to understand the care and treatment being offered or recommended to enable them to make informed decisions about their care and treatment. Most people had some mental capacity assessments and best interest decisions in place. However, none of the mental capacity assessments had been completed to describe what steps were taken to maximise the person’s ability to make the decision required, including support with any primary language barriers or communication needs. People’s care planning records did not evidence how people’s views and wishes had been taken into account or detail how people were to be supported to receive information in their preferred communication methods. We have reported on this in more detail in the quality statement Safeguarding.

We spoke to staff on how they gained consent from people. One staff member described knocking on people’s doors and ensuring they maintained people’s privacy and dignity. Another staff member talked about showing people picture symbols to try and establish consent. Staff understood their responsibilities around consent. The manager told us they ensured people could make decisions about their care by, communicating with them in their preferred method of communication. They said, “Some people cope better with just 2 choices. I use signs for some people.” The manager told us, “We will need to make sure they are involved and their families and record on a best interest meeting. Sometimes an independent advocate will be used. Local authority health professionals can also be included.” The manager was aware of our concerns with some MCA assessments and told us they understood their responsibility and planned to make improvements.

People told us staff always sought consent before providing care and support. One person told us staff took into account their wishes and preferences. However, 1 person told us an agency member of staff came into their room without knocking to gain consent. They told us they informed staff so it would not happen again.