Assisted Care Solutions LImited

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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

Responsive – this means we looked for evidence that the provider met people’s needs.This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant people’s needs were not always met.The service was in breach of legal regulation in relation to managing and investigating complaints and concerns.

This service scored 46 (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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities. People and some relatives told us they have not met the registered manager before. We received mixed feedback from people regarding the culture of the service. One person told us, “I can’t actually see the company; it just seems to be a group of carers coming out”.The provider did not ensure staff had regular meetings or that minutes were taken of any staff communication to evidence engagement and strategic discussions. Staff told us meetings had not taken place “for a while”, and there was no formal process for supervisions. Some staff noted it was completed over the phone annually however there was no further evidence provided for it.This did not evidence the registered manager engaged effectively with staff to ensure the service was working strategically and in line with a shared vision. The registered manager did worked with the staff team so they could demonstrate a shared responsibility for promoting people's wellbeing, safety, and security. The registered manager did not maintain regular communication with the whole team to ensure they were able to share and discuss any matters or what was going on in the service. This did not always ensure there would be a positive and compassionate culture that supported people, their relatives and staff.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.We reviewed people’s care records and noted some people were also supported by external organisations such as district nurses and occupational therapists. Some people told us the adjustments made to their care needs were not always implemented by the service. For example, one person required 2 staff to attend the call to ensure safe manoeuvring. However, this was not always provided. The registered manager did not always ensure this was monitored so they provided a continuity of care to meet people’s individual care needs. The registered manager did not evidence further how they assured staff were appropriately supported to enable them to understand the needs of people before providing care.Relatives told us how involved they were with people’s care, and how they worked with the service to support people and their individual needs. Some relatives also told us they were main points of contact for the service and would communicate information to external organisations such as GPs on behalf of the service. However, this information was not always clearly reflected in people’s care plans to ensure all staff would recognise the support in place from relatives or unpaid carers.People were positive about the delivery of care from the same staff and told us, “[Staff] are kind and caring towards me and do know my routine and how I like things to be done” and “[The person] has dementia so staff have to be very sensitive to her communication needs which I think on the whole they are.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. We received mixed feedback from people and their relatives regarding access to care plans and records. For example, one person told us “I have only got my care plan, and I can see it’s in my folder on the shelf”, another person told us “No I have never seen my care plan and have never asked to see it. I didn't know it existed”. Therefore, the provider did not always ensure all people, and their relatives could access accurate, and up-to-date information about their individual needs. People’s care records did not contain detail if people required information in accessible formats. The provider had recently completed reviews with some people. However, it was unclear if the information shared during the review with people and their relatives was in an accessible format. We identified during one person’s review information about this person’s vision was discussed. The provider was informed during this review this person required use of a magnifying glass to support them. Despite this sharing of information that would affect this person’s accessibility, the information was not reflected in their care plan. Another person added, “Most of the staff do listen to me and respond in a way I can understand.” Staff used a group chat to share information and updates between each other about people and their relatives. We reviewed staff training and found they had not completed GDPR and data protection training to ensure they understood how to use, store and manage people’s information and data securely. The provider did not evidence there was an information governance policy in place. The registered manager told us staff used their personal phones to access the care records on a software to complete care calls. Although this was protected with a code, the provider did not ensure that there was an agreement for staff to terminate use and access to this software once they have left the service. We found some staff had accessed the system after they stopped supporting people. We raised this with the registered manager. This also meant any photographs taken during care calls were taken on personal mobile phones, the provider did not evidence there was any risk assessment completed to ensure the risk of harm to people’s privacy, personal information and security was mitigated. This did not ensure people’s data was always protected in line with GDPR.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.We received mixed feedback from people and relatives regarding the complaint procedure with this service; some people were not aware how to make a complaint and what the complaint process entailed. One person told us they had “previously raised complaints, I wouldn’t know what happens from a complaint necessarily or know the outcome. [Registered Manager] doesn’t normally feedback what’s happened”. Another person told us, “I don’t have any other numbers apart from [manager’s] so I would raise it with them”. Some people offered feedback to the provider during their reviews; however, we noted this feedback was not followed up in their care records. For example, one person “did not think the [registered manager’s] communication was very good”. It was unclear from this person’s record if any changes were made from this feedback, or if any learning had been identified and applied.Some complaints people and relatives told us about were not recorded on their care records or in the provider’s complaint log. The provider did not evidence there was a complaint policy in place. Providers must have an effective and accessible system for identifying, receiving, handling and responding to complaints from people using the service or people acting on their behalf. The registered manager was not able to provide evidence how these were investigated and addressed, including any lessons learned or improvements identified.

The provider did not provide evidence how they measured equity in access for people who use the service to ensure they could access the care, support and treatment people needed when they needed it. The service did not always respond promptly to changes in people's health or wellbeing needs, or make reasonable adjustments, which meant that people and their relatives were not consistently supported to access appropriate care and treatment. The registered manager could not demonstrate they worked with the staff team and different professionals to ensure the service was flexible and accommodating in meeting people’s needs. For example, one person was assessed as ‘high risk’ due to poor mobility and risk of falls. They had a pendant call alarm in place to support safety. However, there was an incident where the person “rolled over during the night and it set off his fall alarm, nobody called to check on him, management notified”. This person’s physical assistance risk assessment required an incident form to be created, however this was not completed. The provider did not consider the risks and needs of people to review such incidents and make reasonable adjustments. The registered manager did not provide further evidence how they worked together with staff to be alert to discrimination and inequality that could disadvantage different groups of people in accessing care, treatment and support.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.The provider had recently completed some reviews with people using the service, however some people told us they were not aware their families could be involved in this review. Some people told us they did not have a copy of their care plan despite requests made for this. However, people also told us they felt empowered and encouraged by the staff to give their views and share their concerns if they had any. People told us they had not experienced any discrimination or inequality.At the time of our visit, the provider did not evidence there was a formal survey or questionnaire in place for people and their relatives to provide feedback or suggestions, and a method by which this could be done anonymously. One person told us, “I have completed a few questionnaires over the past 4 years. There were no responses to any of the questionnaires completed and no changes either”. All other people and relatives we spoke to told us they had never had a questionnaire to complete. During our visit we discussed the importance of people’s feedback with the registered manager. The registered manager confirmed a survey would be produced and distributed to people to complete following our visit.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. People told us they felt supported to plan for important life changes, so they can have enough time to make informed decisions about the future, including any treatment that may be required. However, we found people did not always have plans in place for the future and how to manage their care if their needs and health changed. Some people’s care recorded noted they had resuscitation forms. However, this did not contain sufficient detail to ensure effective and timely treatment and support. This put people at risk of not receiving person centred care or experiencing positive outcomes if their health changed for worse. We reviewed staff training matrix and found staff had not completed end of life training. The registered manager told us, “It is a difficult topic to approach, so we don’t talk about it too much.” This did not demonstrate an understanding of this important area of people’s care and support.