Archived: Santos 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

Our rating for this question has remained inadequate. We identified a continued breach of the legal regulations. The registered manager and nominated individual continued to lack understanding of the Mental Capacity Act (MCA) and how this applied to people’s care. This placed people at risk of having decisions made on their behalf unlawfully, or not getting appropriate support if they needed assistance in making decisions. Some people care records did not accurately reflect their current needs. People reported that staff supported them to manage their health needs and worked together well.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People shared mixed views about whether the provider had assessed their needs prior to them receiving care. One person said, “At the beginning the hospital put a care plan in place and put it out to tender and Santos got the job. They didn’t see [person] or us they just sent out the carers. I think the agency have been – people from the office and senior carers and they have been doing a lot of paperwork.”

However, another relative shared more positive feedback commenting, “[Person] has a care plan and we are in the process of updating it with [name of nominated individual]."

Staff told us people’s needs were shared with them before they provided care to people. Staff told us they used an electronic recording system which guided the care they provided and recorded all completed care tasks.

Leaders told us they monitored the recording of people’s care frequently throughout each day, to ensure people receiving their planned care. They acknowledged that some people’s care plans needed to be updated to ensure they accurately reflected their current needs.

Assessment and care plans did not consistently reflect people’s current needs. Where people’s needs had changed guidance for staff was not always recorded to ensure they provided safe, consistent care and support. For example, some care plans contained conflicting information about people’s mobility support and medicines. This meant staff may not provide care that met people’s current needs which could place them at risk of receiving inconsistent or unsafe care. Effective systems were not in place to identify that care plans did not contain accurate and up to date information about people’s needs.

Most people we spoke with said they were happy with their care. One relative told us they felt staff were observant and shared any concerns about the person’s health. They told us, “Staff do comment if [person] is not passing urine for example, they seem to be quite observant."

Staff were not always able to describe the reasons behind the care they provided with some having a limited understanding of people’s care plans and guidance.

Leaders did not always follow guidance about how people’s medicines should be administered or conditions managed. For example, the registered manager did not recognise the importance of following clinical guidance relating to the use of rescue medicines.

Processes had not been established to ensure people always received evidence based care. Where people’s needs required input from specialist professionals this had not always been sought. For example, a person was receiving support with their mobility which had not been assessed or recommended by an appropriate health care professional. Guidance available to staff about how to administer a person’s emergency medicines was not consistent and therefore did not follow best practice guidance. This meant people were not always receiving care and support in line with evidence based good practice.

People and relatives told us staff and leaders communicated well with each other. They told us when they contacted the care coordinator with requests or changes this was then shared with staff who provided their support.

Staff told us they received information from the management team and were kept up to date with information about changes in people’s care.

Leaders told us they communicated via the electronic monitoring system as well as providing updates in staff meetings. The nominated individual told us they worked with other agencies, such as social workers and district nursing teams to ensure people’s needs were met.

Partner agencies raised no concerns about how the service worked together to meet people’s needs.

Processes for sharing information between the staff team were not always effective. For example, although changes were communicated verbally, detailed written guidance did not always reflect those changes. There was a risk that staff may follow out of date guidance when providing people’s care.

Feedback about the support people received to manage their health was positive. One person said, “I take my own medicines and 1 day there was a problem. My carers checked everything and they made sure I had their number and told me to call if there was a problem and they would come back.”

Staff were able to explain people’s health needs and told us they referred any concerns to the management team who took action accordingly. Staff shared examples with us about the support provided to a person with eating and drinking and how they had involved the person’s GP to ensure they were supporting the person effectively.

Leaders told us they included information about people’s health needs within their care plans.

Systems in place to monitor people’s health needs were not always effective. The registered manager failed to identify the risks that their lack of understanding and poor practice could have on people’s health. Records showed that where people’s health needs had changed staff had made referrals to healthcare professionals.

One person told us they had seen an improvement in their care which they felt benefited them. They said, “I am more independent with my new carers, I am pleased.”

Staff shared examples with us about how they had supported people to improve their independence. Leaders told us they carried out reviews to check on people’s progress and the outcomes of their care.

Process in place to monitoring outcomes for people were not effective. Despite some reviews taking place, care plans had not always been updated to reflect people’s current needs. For example, 1 person’s care plan did not reflect changes made to their care following a number of falls.

We received mixed feedback about whether people were asked for their consent before care was provided. One person told us, “Communication is a big problem. The carers are not good –they just don’t engage with [person]. There is no social aspect at all, no chat and no connection.” However, another person was more positive and said, “They always ask for consent ‘would you like?’ Or ‘can we do this for you?"

Leaders told us staff had received training in respecting people’s decisions and consent. They told us they monitored this through spot checks carried out for the purposes of quality assurance. However, they were unable to provide clear information about people’s capacity to make decisions. The registered manager consistently told us information about a person that conflicted with their care plan. This demonstrated a lack of understanding about the person and the Mental Capacity Act (2005).

However, care staff shared examples with us of how they asked people’s permission before providing care and support. One staff member told us they explained to people what they were about to do and involved them in decisions.

Information relating to people’s capacity to consent to their care was unclear. Assessments of people’s mental capacity had been carried out, but the records of some of these assessments gave conflicting information and did not always align with people’s care plans. This placed people at risk of having decisions made on their behalf unlawfully.