Gemcare South West - Extra Care Scheme

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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 33 (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.

People told us their care needs were reviewed but not as often as they would like. We observed staff supporting one person to eat at lunchtime. The care plan had not been updated to reflect this need.

Staff said, “A lot of care plans not up to date and haven't been for a long time” and “Care plans are not up to date as the previous manager didn’t bother.”

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Care plans did not contain person centred information about people’s nutrition and hydration needs or related health conditions or consider evidence-based good practice. Where a person had lost weight, the service had not monitored their food and fluid intake as requested by a health professional.

We observed staff were supporting one person with their meal at lunchtime. They left the person before they had finished their meal. Later, when another staff member went to support, they no longer wanted their meal.

Another person had a diagnosis of type 1 diabetes. Their care plan contained no guidance for staff to safely support them in line with NICE (National Institute for Health and Care Excellence) guidelines.

The provider did not work well across teams and services to support people.

The provider had not given some staff access to systems to make records of the care they delivered in people’s daily care logs, so other staff did not know what had happened at each visit. This meant concerns may not be identified and escalated as needed.

Care plans were not detailed and did not always reflect people’s up to date care needs. This made it difficult for staff to have an accurate understanding of people’s needs. This meant staff may not provide safe or consistent care.

The provider did not 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.

Care plans did not contain detailed information about people’s individual health conditions including signs of deterioration and what action staff should take in response to these signs.

Care plans did not always reflect how the person was impacted day to day in relation to their conditions. For example,there was no information on how a person’s dementia affected them and how staff could best support them. A relative told us, “I really don't think that they have any understanding of dementia. They will say to [my relative] “Well you've got dementia, and you don't know what you're doing.”

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

The service did not always communicate with people regarding their needs and wishes. Staff had not always carried out reviews of people’s care and people told us some staff did not support them to achieve positive outcomes. One person told us they had not been out of their home in 12 months other than to attend hospital appointments. They said they would like help with this and had mentioned it to the service, but nothing had happened.

People told us the provider was not always effective in addressing their concerns such as visit timings and quality of care so they could achieve good outcomes.

The provider did not always respect people’s rights when delivering care and treatment

Some people told us they did not feel their views and wishes were considered when their care was planned and delivered.

We identified one person living with dementia who may have lacked capacity to make specific decisions. Their care plan noted they did not need a Mental Capacity Act (MCA) assessment. This meant the person’s views and wishes may not have been considered and decisions may not be made in accordance with the principles of the MCA.