Archived: Assisted Care Solutions LImited

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. We received mixed feedback from people regarding assessments of individual needs and care plan reviews. One person told us, “Yes when I first was introduced to this agency someone did an assessment of my care needs and what support I would need. But I am not sure if I have a care plan or even a review of it”. Another person told us, “Yes, I have had regular assessments of my care needs and support required. I have care plan reviews every 6 months”. The provider did not evidence there was a policy in place for staff to clearly identify and ensure reviews were completed regularly for all people, and to ensure there was equity in access. We reviewed people’s care records, and these did not always contain appropriate assessment tools to support review of people’s health and wellbeing, or to ensure care was provided according to individual needs identified in assessment and outlined in care plans. For example, staff supported one relative to have a break from their caring responsibilities. However, there was only nutrition and mobility care plans recorded. More details were necessary for staff to guide them how to support the person in their care, especially in emergencies. Some people’s care plans lacked detail or sufficient information relating to capacity assessments regarding specific decision making. For example, one person’s risk assessment for medicine stated, “[Person] is unable to tell you what medicine [they] take or when [they] are supposed to take it”. It was recorded in this person’s daily notes the medicine was ‘left out’ for this person to take with a timer on. The registered manager did not ensure there was a clear process to support the person with decision making and risk of missing medicine. Staff told us about the care needs assessment form that required completing and storing on people’s care records. Some staff told us they used a software programme to access people’s care records, and this would provide a list of care calls allocated for that day, with “tick boxes for doing tasks.” However, the provider did not evidence the assessment process and care records were audited to ensure people’s individual needs were captured and recorded with adequate information. The provider did not demonstrate they monitored the staff provided person centred care according to the tasks list.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We reviewed people’s care plans and risk assessments. These contained information related to peoples’ individual needs, fluid and dietary requirements. For example, one person’s care plan noted they were “prone to dehydration” and had “numerous times collapsed due to severe dehydration”. The care plan stated staff were to “record food and fluid intake at each visit”. Review of this person’s daily notes found carers were not recording fluid intake. This did not ensure people’s fluid intake and hydration was adequately monitored and reviewed to ensure people the risk of harm was mitigated. Not all staff had completed fluid and nutrition training to support their understanding and application of this area of care. The registered manager did not evidence there was shared discussion and learning of fluid and nutrition reviews, and if any discussion of relevant legislation, evidence-based good practice and standards were shared with staff.People and relatives told us how they worked with the service to establish meal plans for people to ensure their nutrition and hydration needs were met in line with their individual needs.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. We received mixed feedback from people and relatives regarding the provider working with other services to support people. We asked people if they felt this service and other professionals worked well together to look after them. Some people told us, “Yes, I think so especially with my GP.” However, other people told us, “I have been trying to get hold of a social worker via this service, but it hasn't occurred yet.” Another person told us, “I have no experience of them ever contacting the doctors or pharmacy. They will come to us and say we are concerned.” We identified from people’s daily notes staff were providing support with specific tasks that should be done by health professional such as support with dressings and catheter care. The registered manager did not demonstrate how they and staff worked together with those professionals to ensure people were not placed at risk of avoidable harm. The provider did not evidence staff were provided with current information to work together to support people, and that systems of information sharing were effectively monitored, reviewed and developed to support people. People and relatives were positive about the working relationship staff had within the service. Staff told us, “We communicate well all day and every day.” Another staff told us, “[If] anybody [has] any questions we can share and help each other”. Staff also told us they communicated with external services such as district nurses.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.We asked people and relatives if the service responded to health changes in a timely manner and sought support. People told us, “The carers say keep an eye on it and let [seniors] know if I am not feeling great.” Another person told us, “They don’t normally go straight to the GP...They are good at noticing if there is something off.” Relatives noted the communication was going well regarding people’s health and any changes. The registered manager told us the service “encourage people to support their health; most people now they are aware of the healthier life and how it could benefit them.” The registered manager told us, “If [people’s] health changes, depending on the situation, call GP, 111, 999 or [district nurse]. 100% sure staff would know how to respond to those issues.” However, we found these processes were not always followed or recorded. We reviewed people’s daily notes and found staff noted if people’s health or wellbeing was not usual for people’s baseline, staff also documented this would be escalated to management to monitor. However, the provider did not ensure action was always taken, or if this risk of deterioration was always effectively monitored. When people’s health deteriorated, it was not clear if any action was taken to seek guidance from a clinician to ensure people were not put at risk of harm. For example, during one person’s morning care call they were noted to have a fever, but it was not clear if any further support was sought. Another person was noted feeling ‘not themselves’ for a few days but it was not clear if any more support was sought. Although these observations were logged, however the registered manager did not demonstrate they had effective process to escalate it to health professionals to ensure timely response and support rather deterioration in health. The provider did not evidence there was a policy or process in place to safely guide staff when and how to seek medical attention for people’s individual needs.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.The provider did not have effective monitoring systems and process in place to ensure people using the service had opportunity to share feedback or suggestions. This did not ensure the provider monitored, reviewed and identified learning opportunities to continuously improve people’s care and treatment. Staff told us, “We are always asking people how they want care provided.” However, this did not ensure there was opportunity or space for people or relatives to provide suggestions or feedback anonymously.People told us, “I have never had a questionnaire asking my opinions”. During the time of our visit, we discussed this method of feedback with the registered manager. The registered manager confirmed they would be implementing a new survey to seek feedback from people and their relatives.We reviewed people’s care records and noted some were reviewed. We also noted the senior carer was completing reviews with some people and their relatives. The registered manager did not provide clear evidence how this information was monitored and audited to identify themes, trends and learning opportunities to improve people’s care, and how this was shared with staff to ensure continuity in care.

The registered manager was not able to fully explain and demonstrate to us that they had the skills or knowledge in the appropriate application of the Mental Capacity Act. The registered manager told us the service would not complete capacity assessments themselves and would seek further support. However, there was no policy provided to support this process and ensure people’s rights to making any decisions were considered. The staff respected people’s rights around consent and respected these when delivering person-centred care and treatment. Staff demonstrated they understood the importance of involving people in decision making about their care and support. People and relatives told us staff always asked their consent when completing personal care tasks. Relatives told us, “Yes they do ask [person’s] consent even though often she is not fully understanding the words they use.” People agreed staff sought consent from them. They said, “Yes, I think they do ask for my consent on a daily basis”, “Yes, because they know my regular routine so don’t really need to ask consent every day” and “Yes, they always ask if I am ready for a shower or wash.”