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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 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 consent to care and treatment.
 

This service scored 29 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.
The provider did not consistently assess people’s needs before or after admission, and care plans were not kept up to date. A person had been living at the service for over a month, and they did not have a full care plan in place. People had not been assessed to use the equipment in place, such as mobility equipment.
Relatives informed us they had been involved in the care planning process on admission but had not been invited to a care review.

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 and treatment were not always based on current best practice or clinical guidance. There was no systematic approach to monitoring people's weights. A weight monitoring audit had not been completed until it was requested as part of the inspection process. The weight monitoring audit that had been completed did not include all people living at the service and there were insufficient weights recorded for some people to effectively monitor weight loss. Due to this, tools like the Malnutrition Universal Screening Tool (MUST) and Waterlow score being used to assess malnutrition or pressure damage risk were not up to date or in place. Care plans and risk assessments contained contradictory information, for example around diet and swallowing needs, placing people at risk.

The provider did not always work well across teams and services to support people.
We found that while some referrals had been made to the community district nursing team to support wound care, information surrounding this had not been recorded on people’s care plans, with records on daily notes recording limited information. Furthermore, due to monitoring records being inconsistently reviewed and a lack of managerial oversight, the need for referrals to healthcare professionals had not been identified in a timely manner.
 

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.
Changes to people’s needs were not always recorded in people’s care plans and appropriate actions were not always identified or taken by the provider. This meant important changes to people’s health and emerging risks remained unresolved and the level of care was not representative of their needs.
We were told by relatives that people were not supported by staff to go out into the community, with a relative telling us, “[Family member] only goes out if we take [them] out.”
 

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. We found the need for monitoring had not always been identified, where it had been identified and implemented this had not been clearly recorded in people’s care plans. Furthermore, there were no systems to review or analyse information recorded by staff on people’s daily care records. For example, we reviewed fluid intake monitoring records for a person, it showed they had limited fluid intake which had not been identified by the service and medical advice had not been sought regarding their risk of dehydration. The expected daily fluid intake of the person had not been included in their care plan, and no guidance was included for staff to follow if there were concerns around their fluid intake.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.
The service did not consistently act in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and associated code of practice, or the provider’s own MCA policy. Mental capacity assessments were not always completed for the relevant decisions that needed consent and a robust best interest decision making process had not always been followed. The service had not completed mental capacity assessments for several people, during the inspection process 14 mental capacity assessments were completed and 8 DoLS applications were applied for. This had not been identified by the service until the DoLS log had been requested. We found where mental capacity assessments had been completed, they were not decision specific and recorded multiple decisions on the same form.
The consent sections on people’s care plans had not been signed and there was no evidence seen that consent had legally sought for any decisions.
The service had surveillance equipment in place, CCTV cameras, in communal areas and along some corridors, however, the provider could not evidence mental capacity assessments or best interest decisions had been completed; or consent had been sought for the use of the CCTV.