Carters Green Healthcare Services 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

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 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 need for consent.
 

This service scored 50 (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’s care and treatment were effective because, while they discussed people’s needs with relatives, this did not always result in people’s care plans, risk assessments and daily care records containing clear and adequate information.

Care plans and risk assessments did not always contain relevant information about people’s health, care, wellbeing or communication needs to enable them to receive care or treatment which provided good outcomes. For example, where people had identified health conditions, they did not always have a care plan or assessment which detailed how these conditions presented and impacted them, nor guidance for staff on how they could support people to meet needs associated with these conditions. This meant people were at risk of their needs not being clearly known and delivered by staff.

Leaders explained the care planning process during the transition of people moving to the service. This included people and relatives being involved in assessments and information obtained used to ensure people’s assessments and care plans contained accurate information about their needs and how these should be met.

Relatives told us they were involved in the review of their relative’s care plans and were involved in the care planning process before their relative moved to the service.

The provider did not always plan and deliver people’s care and treatment with them, including what was important.

Leaders were unaware of the ‘Right support, right care and right culture’ guidance. People’s care plans and risk assessments made little reference to the principles of the guidance, such as supporting people to exercise real choice, control and independence in their lives. When we spoke with the registered manager about the guidance, they acknowledged they were not familiar with it. This meant autistic people and those with a learning disability were at risk of their needs not being appropriately understood and met by staff.

However, relatives did tell us staff supported their relatives to access a range of amenities within their communities on a regular basis.

Care records were not always in-line with evidence-based good practice guidance. The information within people’s care plans and risk assessments made little reference to being based on the direction and guidance from external healthcare professionals, the registered manager telling us the service had little contact with healthcare professionals. This meant people were at risk of their care and treatment not being delivered to them in ways which reflected their identified needs.

The provider did not always work well across teams to support people.

While the service worked in consultation with people’s social workers, there was little other evidence to demonstrate multidisciplinary working, with the registered manager confirming this. As detailed in other sections of this report, the service also failed to notify the local authority and CQC when events occurred which warranted this contact. This meant people’s care was not always informed by a commitment by the service to work collaboratively with external professionals.

However, staff told us the registered manager communicated well with them and relatives also described an open and communicative registered manager and staff, with 1 relative saying, “Communication is good. They always communicate when there are changes or for updates.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

People’s care records did not always contain relevant information needed to ensure people could be supported to positively manage their health and wellbeing. We found relevant guidance relating to people’s health conditions and needs was sometimes not in place or, when it was in place, did not contain the guidance staff needed so they could support people to live healthy lives. This meant people were at risk of their health needs not always being met.

However, staff had received training relevant to people’s health needs, and the staff we spoke to showed an awareness of people’s health needs, which was supported by most of the feedback we received from people’s relatives.

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.

People’s care and treatment was routinely monitored by people’s care plans and risk assessments being regularly reviewed by staff; however, this monitoring was not always effective. These reviews, and a lack of care plan audits, failed to identify many of the concerns we found regarding the lack of relevant information in people’s care records, and so was not always able to ensure people’s outcomes were positive and consistent. This meant there was a risk the care and treatment people received from staff may not always meet their needs.

However, people’s care was monitored by senior staff undertaking regular visits of people’s homes to assess staff practice, equipment and to seek relative feedback. Leaders also sought the views of relatives about their relatives care via satisfaction surveys.

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 service did not always consider the Mental Capacity Act 2005 (MCA) when supporting people. The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When people lack mental capacity to make particular decisions, any decisions made on their behalf must be in their best interests and as least restrictive as possible.

Although people’s care plans and the registered manager confirmed people lacked mental capacity regarding much of their care arrangements, where this was applicable, there were no mental capacity assessments and, where required, best interest decisions in place for all these people. This meant people were at risk of their human rights not being respected.

Staff training records showed staff received MCA training; and staff and relative feedback demonstrated staff had a basic awareness of the principles of the MCA.