Top4Care Services 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 good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 assessed and reviewed people’s health, care, wellbeing and communication needs with them to help ensure aspects of their care and treatment remained effective.

Risk assessments were in place and provided clear guidance for staff to mitigate these risks. These were regularly reviewed and updated when people’s circumstances changed. Care plans included specific preferences and routines, such as how people wished to be supported. People’s communication needs were identified and understood. Staff worked with people to identify and achieve their goals, such as attending college and developing independent living skills. Daily records reflected these plans, including promoting independence and offering choices around meals and activities.

People were involved in the assessment and review process. Staff and leaders confirmed people and relatives participated in decisions. One relative said, “When he had mental health problems I was spoken to about what he likes, doesn’t like. They asked for his history and his needs.”

The provider did not always ensure that care planning and delivery aligned to current evidence-based guidance and best practice.
Staff supported people to monitor aspects of their physical health, including blood glucose levels where required. We found staff were monitoring this for one person daily and they maintained records. However, care plans did not provide clear guidance of expected readings or actions staff should take if results fell outside of normal ranges. This meant staff did not have access to information to identify changes in the person’s health. This created a risk that care may not always be delivered consistently.
The same person’s care records also lacked clear guidance regarding the monitoring of their blood pressure. The recorded readings were generally consistent with those obtained during GP appointments; however, care records did not contain clear guidance regarding abnormal readings or actions staff should take if concerns were identified. Whilst there was no evidence that the person had come to harm, this increased the risk of inconsistent practice and reduced assurance that health outcomes would be effectively monitored and reviewed.
Since the assessment, the provider has reviewed and updated care plans to ensure they provide clear guidance for staff. This has included protocols for blood glucose and blood pressure monitoring.
Records showed that people had access to a range of health and social care professionals. Recommendations made by these professionals were generally reflected in people’s care and support arrangements. The provider assessed people’s nutrition and hydration needs. Staff were aware of people’s dietary requirements. Staff received training relevant to their roles and used this when supporting people. Staff were able to describe how they supported people and sought advice from healthcare professionals when required.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing about their assessed needs across teams and services.

Systems were in place for staff to communicate information about people’s needs. Staff completed daily records to ensure continuity of care and shared updates about changes in people’s health or behaviour, including using technology for people to access appointments online. Care plans reflected input from healthcare professionals, such as GPs and Community Mental Health Teams. The provider worked closely with other teams and services to ensure continuity of care and minimise disruption. Staff told us how they used a diary to record scheduled appointments.

The provider understood people’s mental health needs and the importance of working in partnership when people were distressed. Relatives spoke positively about the communication with the registered manager when concerns arose. One told us, “We have a partnership on who can get to him first. In the end [the registered manager] spoke to him on the phone and deescalated the situation. He was able to carry on to college.”

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 ensured people were provided with information and signposting to other resources and support networks when they were discharged from the service, to help them manage their health and wellbeing."

Staff promoted healthier lifestyles and supported people to make informed choices about their health and wellbeing. We found records showed people were encouraged to engage in physical activity through gym memberships and make healthy food choices. One relative also told us, “I have seen the menus. It’s all healthy eating. I was very happy with it.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure systems for monitoring care and treatment supported positive clinical outcomes.

The provider completed monitoring of people’s health needs; however, systems were not always effective in demonstrating how information was used to improve outcomes. For example, audits had not identified that one person’s diabetes care plan did not include clear escalation guidance for abnormal blood glucose readings. We found that care records did not clearly document the rationale for monitoring the person’s blood pressure and there was no information on what risks were being monitored or how recorded results informed care and support. This meant staff did not have clear guidance regarding the purpose of monitoring or how to respond to changes in the person’s conditions.

Similarly, processes had failed to identify that the same person’s blood pressure monitoring records lacked clear instructions for staff on when concerns should be escalated. Since the assessment, the provider has reviewed and updated care plans to ensure they provide clear guidance for staff. This has ensured staff have consistent information to monitor and improve outcomes.

Staff completed regular reviews of people’s needs and records demonstrated outcomes were regularly reviewed and people involved in discussions about their support where possible. Staff understood people’s goals and aspirations, such as developing independent living skills, maintain relationships and accessing their community to improve overall wellbeing.

The provider did not always demonstrate how people's rights around consent and privacy had been considered when delivering care and treatment.

The provider used CCTV within communal areas of the service. However, records did not clearly evidence how people’s consent had been obtained or how decisions had been made in accordance with the Mental Capacity Act 2005. The provider was unable to demonstrate the use of surveillance had been fully considered, proportionate or regularly reviewed in line with people’s rights and privacy.

The provider acknowledged the absence of a CCTV policy and since the assessment has developed and implemented one to strengthen oversight.

However, this concern did not have an impact on the provider’s overall approach to consent. Care plans included clear sections on consent and sharing information. We found care plans had been signed, demonstrating people’s involvement in decision-making and observed staff obtaining consent before providing support.