Archived: Qualified Care Ltd

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. This is the first assessment for this service. This key question has been rated 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 person centred care and safe care and treatment.

This service scored 25 (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 had failed to conduct comprehensive assessments to understand if they could support people prior to accepting new packages of care safely, or that they had continued to assess peoples need as they changed to ensure staff were supporting people appropriately. All the care plans we reviewed had very limited or no information about people’s health needs, or evidence the provider had any knowledge of these. For 1 person who the service had started supporting the manager told us, “They have dementia but I don’t know if they have any other health needs, we haven’t discussed this.” Staff told us one person’s needs had significantly increased in recent months, including a deterioration of their dementia, often becoming distressed. They said, “Now we have to support with medication, and sometimes assist them with personal care.” However, the manager had no knowledge that this was taking place, and their care plan had not been updated so did not reflect that the registered manager had considered how they could safely manage these needs.

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. There was very little information for staff explaining how they could support people’s health needs in line with clinical guidance or best practice. This included for conditions including falls, constipation, diabetes, mobility and dementia. Where people were distressed, there was antipsychotic medication in place which could be given to assist them when required. However there was no guidance on when this might be required, why medication was being given or if it was being given, if it was being effective. We could not be assured if staff were ensuring they were acting in the least restrictive manner possible and only using this medication where it was safe and necessary to do so.

The provider did not work well across teams and services to support people. Staff we spoke to explained they were exhausted, and sometimes struggled to respond in a timely way to people’s need due to the lengthy hours they were working. Though we received positive comments about individual staff, they did not receive the support they required from the registered manager to provide safe care or treatment. Staff had no clear guidance on how they should work with other agencies involved in people’s care as well as their families. The provider explained to us how for some people they also had family members who would support in their care, but this was not mentioned at all in their care plans meaning there was a lack of clarity on who would be responsible for which tasks. One person had another care agency visiting them, but there was no detail of who this care agency were and how and when the provider may need to engage or work collaboratively with them to support this person’s needs.

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. There was no guidance on how staff should support people with their health needs to stay healthy and well. For most health conditions there was no detail about these in people’s care plan. For example, one person had a significant heart condition but this was not referenced in their care plan at all, so staff did not have any information on how to avoid exacerbating this. Another person had a wound on their leg which the care plan stated was being supported by visits from district nurses. However, staff told us this had not taken place for several months and the care plan had not been updated. Staff explained how they would apply creams and the symptoms of concern they would look out for. But there was no guidance to allow us to confirm what care this person should be receiving, or how staff were supporting this person to maintain healthy skin. Staff had received no training in the majority of the health conditions of the people they supported.

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. The provider had no systems in place to monitor the care being delivered to ensure it was effective and supporting people to stay healthy and well. Multiple people were receiving “as and when” medicines which were to manage people’s constipation, anxiety and pain. Where they were being given, the provider failed to keep any records of why it had been given and if it had been effective. This meant they could not monitor if medicines were effectively managing people’s health needs, or if further medical advice may be needed to help people manage their condition. For people at risk of constipation staff explained, “We rely on the person telling us if they are in pain, then we can administer laxatives.” However this person had advanced dementia so we could not be assured they would be able to verbalise this, meaning they were at greater risk of harm as staff could not effectively monitor when they had gone to the toilet. Bowel charts were in place for this person but were not being filled in. There was often no written information on what care people should be receiving, and people’s care notes were often left blank or completed up to 5 days afterwards. Therefore, the provider had no ability to monitor if people were receiving the care they needed.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. None of the staff working at the service had completed training on the Mental Capacity Act 2005. Therefore, the provider could not be assured they were aware of their responsibilities to support people in line with consent, and ensuring people were able to have capacity to make decisions for themselves unless assessed otherwise. Though care records recorded staff asking for consent, because staff had not received any training the provider could not be assured how this was being done or that staff had a clear understanding of how to do this in line with the law. One person had a restriction placed on them where medicines had been locked away by care staff, however there was no evidence of why this decision had been made, who had been involved and how the provider had assessed this decision was in a person’s best interests. There were discussions with people around how staff would support them in line with their mental capacity once they started using the service, but there was no evidence people’s mental capacity had been proactively reviewed after this point.