Trafalgar Community Care Limited

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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

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 good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 58 (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.

The provider did not always ensure people’s needs were fully assessed to support effective care and treatment.

Care plans showed a clear focus on people’s preferences, routines and what mattered to them, with detailed “about me” sections supporting person-centred care. However, we found risk assessments in general lacked depth and personalisation. For example, people with health conditions such as glaucoma and diabetes had general information recorded about the condition and not how it affected them personally day to day. It was evident when speaking to people that staff knew people well and understood their individual needs, but this was not always recorded clearly. The provider had identified this and was in process of transitioning to a new electronic system. One of the actions was to ensure assessments were more robust.

The provider generally ensured people received effective care and treatment that met their needs.

Staff demonstrated good clinical awareness and monitored people’s health, including checking blood pressure and oxygen levels and escalating concerns appropriately to external professionals. There was evidence of effective partnership working, with staff involving GPs, community matrons and paramedics when needed.

People and relatives provided consistently positive feedback about outcomes, describing staff as skilled and responsive to changing needs.

However, some care plans lacked clear links between people’s conditions and how care should be delivered in practice. For example, actions staff had taken, such as what food someone had been offered to help manage their diet, had not always been recorded. We fed this back to the provider at the time of our inspection and they have taken immediate steps to rectify this.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider worked effectively with partners and within teams to deliver coordinated care.

Staff worked well with a range of external professionals, including GPs, community matrons and paramedics, to support people’s health and wellbeing. There were examples of early identification of health concerns and timely referrals, such as recognising swelling or foot conditions and arranging treatment.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff actively monitored people’s health and responded appropriately to changes. There were examples of staff identifying early signs of health deterioration and arranging medical support, which helped prevent escalation.

Care plans promoted independence and reflected people’s preferences, supporting them to remain living at home. Families highlighted the positive impact of care, including enabling people to stay in their own homes, including at the end of life.

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.

For example, 1 person with diabetes had information in their care plan stating staff should monitor their diet. However, there was no clear evidence to show this was being recorded consistently. Some care plans stated staff should monitor or reassure people but did not explain how this should be done. Conversations with staff and people showed staff knew people well, but care records needed more detail. The provider had already identified this before our inspection and was in the process of making improvements.

The provider did not always clearly evidence that people were informed about their rights in relation to consent, or that these rights were consistently considered when care and treatment were delivered.

Care records usually showed consent had been sought and recorded, particularly for medicines. Many records stated people could make their own decisions, and some showed a Lasting Power of Attorney was in place.

However, capacity was not always formally assessed. For example, 1 person was unable to sign documentation, but there was no recorded mental capacity assessment to support decision-making. We fed this back to the provider who has since taken action to improve this process.

Overall, consent processes were in place, but capacity assessments were not always applied consistently and needed some improvement.