Anytime Care 2020(Leicester)

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 newly registered service. This key question has been rated 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 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. However, the provider’s monitoring, systems and processes had not identified where care plans had not been consistently updated following review meetings with the person and or their relative.

For example, a person’s care review recorded how they no longer used a catheter, however the person’s care plan record had not been updated. We found other examples where review records captured changes to people's needs and circumstances, but the corresponding care plans had not been amended accordingly. This meant staff could not always rely on care plans to provide accurate and up-to-date information about people's current needs. This could lead to inconsistent care and treatment.

The provider had developed a care package review procedure. People confirmed they were involved in both formal and informal discussions about the care package. These reviews provided opportunities for people to express their views, discuss their experiences of care, and ensure support continued to reflect their current needs and preferences. This demonstrated how people were encouraged to participate in decisions about their care and treatment and that the provider sought to involve them in reviewing and planning their support.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, this was not always in line with legislation and current evidence-based good practice and standards.

We identified examples where best practice guidance was not consistently followed in relation to medicines management and the assessment, management, and mitigation of risks associated with some people's healthcare needs. This included omissions in care planning and risk management documentation. This meant staff did not always have access to sufficiently detailed guidance to support people effectively. These issues increased the risk of inconsistent care and demonstrated that care and treatment were not always delivered in line with recognised best practice.

Some people required assistance with eating and drinking. Where people had been assessed by external Speech and Language Therapy services, recommendations relating to their eating and drinking needs were reflected within their care plans. Records demonstrated that staff were aware of these recommendations and provided support in line with professional guidance. This helped to ensure people's nutritional needs were met safely and reduced the risk of complications associated with eating and drinking difficulties.

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 had systems and processes in place to share important information with others to support consistency and continuity of care. This included effective internal communication procedures to share information with staff. Care records also confirmed referrals were made in a timely manner to external health and social care professionals. This demonstrated a collaborative approach to care delivery and helped promote positive outcomes for people.

Whilst staff were generally positive about communication arrangements and confirmed that information was shared effectively, some staff felt communication between the management team and staff could be improved.

Staff meetings were held monthly, or more frequently when required. We reviewed staff meeting records from the previous 3 months and found they covered a range of relevant topics, including updates to people's care needs, lessons learned from incidents, policy changes, training, and service developments. These meetings provided an opportunity for staff to discuss concerns, share information, and receive updates to support the delivery of effective and consistent care. Overall, records demonstrated that the provider had established systems to promote information sharing and support effective communication across the service.

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. However, there was a lack of guidance and information available to staff to support their understanding of people's known health conditions, the impact these conditions had on individuals, and how they should be supported to meet their specific care needs.

This lack of information, combined with gaps in staff training, increased the risk of staff not fully understanding people's healthcare needs, recognising signs of deterioration, or responding appropriately to changes in people's health and wellbeing. The provider had not ensured that care records, training arrangements, and staff guidance provided a comprehensive framework to support the safe management of people's health needs.

People told us that having regular care staff helped provide consistency and continuity of care. They said staff understood their routines and preferences and were responsive to their needs. However, we were aware of staff changes, enhancing the importance of record keeping to support staff unfamiliar with people to understand and monitor their health needs safely and effectively.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Care plans were outcome-focused and reflected the aims and preferences people wished to achieve and maintain. People were involved in the assessment, planning, and review of their care and support, enabling them to express what was important to them and how they wanted their needs to be met. Reviews were used to discuss progress towards agreed outcomes and identify whether any changes to care and support arrangements were required.

Staff understood the importance of delivering person-centred care and supporting people to achieve outcomes that mattered to 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 Mental Capacity Act (MCA) is a law in England and Wales that protects and empowers people aged 16+ who may lack the ability to make certain decisions for themselves. It sets out clear principles for assessing capacity, making decisions in someone’s best interests, and supporting people to be as involved as possible.

The registered manager was not fully meeting their responsibilities under the MCA or following the provider’s MCA policy.

The management team informed us they had not completed any MCA assessments or best interest decisions. We found examples where people's mental capacity had not been fully considered or assessed in relation to their care and treatment needs.

For example, 1 person's care plan stated they could experience fluctuating mental capacity. However, there was no guidance available for staff on how to support decision-making. Including how to determine whether the person had capacity at the time a specific decision needed to be made, or when a best interest decision-making process should be followed.

Another person was completely dependent on staff for all aspects of their care. However, the section of their care plan relating to mental capacity had been left blank. As a result, we were not sufficiently assured that the person's capacity to consent to specific aspects of their care and treatment had been assessed or appropriately considered. This meant the provider could not demonstrate that care and treatment were being delivered with the person's lawful consent or, where they lacked capacity to make particular decisions, that decisions had been made in their best interests in accordance with the Mental Capacity Act 2005.

Care plan guidance included information about the importance of staff gaining consent before care was provided. Staff demonstrated an understanding of their responsibilities in relation to seeking consent, and daily care records confirmed that consent was consistently obtained before care and support were delivered. This demonstrated the provider had promoted a culture where people were encouraged to retain choice and control over their day-to-day lives, helping to ensure care was delivered in a respectful and person-centred manner.