Michdeede LTD

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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 newly registered service. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 29 (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 ensure people’s needs were effectively assessed and reviewed to support safe and person-centred care. Although relatives told us they were asked about people’s needs during referral, we found initial assessments were not consistently recorded or reflected within care plans.

Staff told us they often did not have access to care plans and relied on verbal handovers or shadowing to understand people’s needs. One member of staff said there was, “no folder with care plan in the home” which meant they did not have clear written guidance. This lack of robust assessment processes meant staff were not always aware of people’s current needs or risks, placing people at risk of harm and inconsistent care.

The provider did not ensure people’s care and treatment were delivered in line with evidence-based guidance or best practice. We found limited evidence that nationally recognised tools or guidance were used to inform care. For example, although care plans documented people’s health needs, there was no evidence of follow-up actions or enhanced monitoring such as fluid intake or skin integrity.

Staff lacked appropriate training to deliver care safely. Staff told us their induction involved being shown the person’s needs and starting work immediately, without structured training or access to policies.

Medicines were administered without appropriate training or competency checks, and there were no medicines risk assessments or accurate records. This meant care was not always delivered in line with best practice or current evidence, increasing the risk of poor outcomes for people.

The provider did not always ensure effective communication and collaboration to support joined-up care. Staff and the registered manager told us information was shared appropriately, including through informal methods such as messaging groups and verbal updates. However, we found limited evidence of this being recorded within care records. Some external partnership working was evident. For example, the provider described meeting with professionals such as social workers and health visitors to support people’s care.

However, systems to support effective teamwork were underdeveloped. Staff did not always have access to up-to-date care plans or clear written guidance, which reduced continuity of care and increased reliance on verbal communication. Overall, while some collaboration with external partners took place, systems to ensure consistent and effective communication within the service required improvement.

The provider did not ensure people were consistently supported to maintain and improve their health and wellbeing. Although care plans included some information about people’s health conditions and dietary needs, there was a lack of evidence to show how these were monitored or reviewed.

Staff knowledge and training in supporting health needs were limited. Staff told us they had not received relevant training in key areas such as diabetes or pressure care and requested additional learning to perform their roles effectively. Risks to people’s health were not always assessed or managed effectively.

This meant people were at risk of not receiving appropriate support to maintain good health and prevent deterioration.

The provider did not have effective systems to monitor care outcomes or drive improvement.

There was limited evidence of monitoring people’s outcomes or reviewing care effectiveness. Records did not demonstrate how the provider tracked people’s progress or identified when additional support was required.

For example, care plan records stated fluid intake was to be measured, recorded and monitored to ensure someone did not receive more that 1500ml within 24 hours. There was no fluid chart for staff to document this. Daily logs were vague in relation to this, as the amount of fluid given during each call was not recorded, for example, entries included, “a bottle of juice” or “water and a cup of tea.” People were at risk of poor health outcomes due to inadequate recording and lack of guidance due to the failure of the registered manager to implement enhanced monitoring records for staff to use.

Governance systems were not in place to support improvement. There were no records of quality monitoring or audits to assess the standard of care provided. Staff told us there were no consistent systems such as spot checks or supervision to oversee care delivery. The lack of oversight meant the provider could not be assured that people were achieving good outcomes or that concerns were identified and addressed promptly.

The provider did not ensure consent to care and treatment was consistently sought and recorded in line with legislation. Staff understood the importance of asking for consent before providing care and described how they sought permission from people before delivering support. For example, staff explained they would explain tasks and observe people’s responses before proceeding.

However, consent was not consistently documented. We found records did not demonstrate that consent had been obtained before people began receiving care. Staff knowledge of the Mental Capacity Act (MCA) was variable, and there was limited evidence of formal assessments or structured decision-making processes where required. This meant the provider could not demonstrate that care and treatment were always delivered in line with legal requirements.