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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 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People had care plans in place which identified their care needs. These were not always reviewed in line with the providers stated timeframes. Relatives told us they were not always aware of any changes in care plans or had seen it. Comments included, “I didn’t know [person] had a care plan, I haven’t seen one” and “I didn’t know that [person] still needed to be moved every two hours.”
 

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.

The provider failed to ensure best practice guidance was followed. The provider did not follow manufacturer guidance on use of emollients and other medicated topical creams. Staff did not have clear, evidence-based guidance to follow and people were exposed to avoidable risk.

Records showed, people’s hydration needs were not routinely meet. People did not have fluids left by them for them to drink independently. This meant there was a reliance on asking staff for a drink when people wanted one.
 

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.

Systems were in place to ensure information was shared with external professionals and referrals were made to district nurses and local GP's.

Staff told us they worked well together comments induced, “Sometimes it can also get busy, but we work together and make sure the residents are looked after” and “I feel supported and valued by the team, and I appreciate the positive working environment, teamwork and guidance provided.”
 

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 found people were not always supported to ensure the risk of injury or deterioration in their skin health occurred. People were not always supported in line with their care plan.

There was a risk of people not getting enough to drink. Staff did not always record what support people had received throughout the day. We received mixed feedback from relatives about hydration. One relative told us they had concerns about their family member’s hydration. They told us, “I have noted that [person] rarely has a drink in front of [them]”. However, another relative told us, “[person] always has a drink beside [them] and they are always bringing [them] more water.”

We have asked the provider to ensure daily records reflect all the care and support provided.

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.

People’s care plans were not always reviewed when the provider had planned. Systems were not effective in identifying if care plans were reviewed. This meant there was a danger when peoples needs changed staff would not have up to date information on how to support them.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any decisions made on their behalf must be in their best interests and as least restrictive as possible.

Mental Capacity assessments had been written for people and had considered any restrictions such as CCTV. However, where the MCA concluded the person did not have capacity to decide about the use of the restriction, the provider had failed to ensure records relating to the best interest decisions had recorded who was involved and what they said and if the decision was the least restrictive option.