Courage Healthcare 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 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.

The service was in breach of legal regulation in relation to consent to care and treatment.

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.

People’s communication needs had been assessed and to maximise the effectiveness of their care and treatment. Where people did not communicate verbally, staff were able to explain how they used Makaton and PECS to support communication. Although this was not formally recorded within care plans, people were supported by a small staff team who knew them well. People’s needs were assessed regularly by the provider and staff. Staff knew people well and understood how to identify changes in the way people presented.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care and wellbeing needs. Care plans reflected people’s health conditions and were informed by relevant professional guidance. For example, care plans included detailed guidance on supporting people with autism, learning disabilities and mental health needs, including Positive Behaviour Support strategies and use of PRN medicines as a last resort. Staff demonstrated knowledge of nationally recognised guidance such as STOMP and Right Support, Right Care, Right Culture.

Staff were trained in mandatory subjects and described how they applied learning in practice, such as updating care plans and risk assessments following incidents to reduce the likelihood of re-occurrence.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Some people were supported by multiple providers. Where this was the case, there was not a joined-up approach to providing care. Although the provider had a good relationship with other providers supporting people, this did not translate into care plans, risk assessment and guidance for staff. Relatives told us they did not feel this system worked seamlessly between providers. While the provider stated that monthly meetings took place with other agencies, records did not consistently evidence effective coordination or shared decision making to manage risks and outcomes.

Other professionals told us they worked well with the provider. People were supported to access healthcare professionals in ways that met their needs. Staff had positive relationships with the GP, psychiatrists and occupational therapists to review people’s care and treatment.

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.

The provider supported people to live healthier lives by promoting independence, wellbeing and access to health services. Staff supported people to live healthier lives by supporting people by encouraging healthier eating habits and supporting people to reduce excessive intake of unhealthy food and drinks. One person was successfully supported to reduce their weight significantly due to the support of staff.

People were supported to access health services in ways that met their individual needs. For example, one person received regular home visits from their GP and specialist mental health professionals to reduce anxiety associated with attending appointments.

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.

The provider did not always have effective systems to monitor and improve outcomes for people. Although the provider knew people well, care plans and risk assessments were not sufficiently robust to monitor people’s outcomes. Although the provider was able to share information about how people had been supported to achieve positive outcomes, including reducing their weight and increasing activities to live a fuller life, systems to record this were not in place. This placed people at risk of not receiving consistent support from staff.

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

The provider did not ensure consent to care and treatment was always obtained and recorded in line with legislation and guidance. Care records did not consistently include mental capacity assessments or best‑interest decision‑making documentation where people lacked capacity to consent. For some people with complex needs, restrictions were in place, but records did not clearly evidence lawful authorisation or how decisions were made in line with the Mental Capacity Act 2005 (MCA). This included people consent to care, and when staff used physical interventions. Whilst physical intervention had been in place for some time for one person, and healthcare professionals were aware of its use, we saw no evidence that physical intervention was being used when not required. However, this restriction should have been reviewed by the provider to ensure that it remained necessary. This placed people at risk of receiving care without appropriate legal safeguards in place.

For day to day decisions, staff described obtaining consent through non‑verbal communication methods such as PECS and recognising familiar cues. However, for more complex decisions the MCA was not followed.