Courage Healthcare Ltd

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care at the service.

This service scored 54 (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 always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Although care was delivered by staff in a person centred way, processes and documentation was not always in place to support this practice. Some people had limited information in place to inform how to reduce known risks and there was a reliance on other stakeholders providing this information. Daily notes were not detailed and did not provide a full account of how people were supported.

However, a healthcare professional told us that the support they observed people receive was person centred. They told us staff demonstrated good communication strategies with people they supported, and that staff amended their approach depending on the individual. When the professional made recommendations for activities they told us these were always supported and implemented by staff.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People’s care plans and risk assessments did not always clearly define responsibilities where more than one provider was involved. This created a risk of confusion for staff and reduced clarity around who held responsibility for different aspects of care.

People were supported by a small, consistent staff team who knew them well. Staff described effective working relationships with external professionals, including social workers, district nurses and occupational therapists. This helped promote continuity of care. A healthcare professional told us they worked well with staff and the provider.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider did not always make sure people and others acting on their behalf received information in a way that met their needs. Care plans were not available in easy-read or accessible formats, despite people having communication and comprehension needs. There was no information within people’s care plans to detail how they were meaningfully involved in creating and updating their care plans.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The provider did not always make sure people were fully involved in decisions about their care.
Documentation did not clearly show how people were involved in developing or reviewing their care plans. Although the provider was able to show how people communicated and their voice was heard, this was not documented to ensure a consistent response from staff. For example, some people used Picture exchange communication system (PECS) cards and Makaton for communication. There was no information on which cards were used, or which signs the person used. PECS are specialized, portable, picture-based visual aids designed to help non-verbal people, particularly those with autism, communicate by exchanging cards for desired items. Makaton is a language programme using signs, symbols, and speech to help people express themselves and understand others.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The provider made reasonable adjustments to ensure people could access care and support.
Staff described adapting care delivery to people’s communication styles, preferences and behaviours. People were supported to access services when they needed to, without barriers.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Although the provider and staff spoke positively about people and were passionate about improving people’s lives, they had not followed systems and processes to support this. For example, when people were not able to consent to information regarding their care and support, processes to support this decision making was not followed. When restrictions were in place, the provider told us these had been reviewed but there was no formal review or documented evidence of this. This meant that people were at risk of not achieving equitable outcomes, particularly during periods of increased risk or distress.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider did not always plan effectively for people’s future needs. People’s future goals, aspirations and longer-term planning were not clearly documented. Although the provider told us they had considered this, it had not been documented to ensure staff provided a consistent approach for people. Workforce planning, supervision and quality assurance systems were not robust, which limited the provider’s ability to demonstrate how they would sustain and improve care over time. People’s end of life wishes had not been discussed or considered with people and their loved ones.