Michdeede LTD

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• 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 inadequate. This meant services were not planned or delivered in ways that met people’s needs.

This service scored 32 (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 were at the centre of their care and support or work with them to ensure this was the case.

Staff told us they had not seen care plans or risk assessments for people they supported and relied on verbal instruction or shadowing to understand how to support people. Care plans were not always personalised. In one example, the person was not referred to by name, and people and their relatives did not have access to care plans or risk assessments.

Staff knowledge of person-centred care was inconsistent. One staff member was unable to explain what person-centred care meant, and others described a lack of training and guidance to support this approach. These issues meant people were at risk of receiving care that did not fully reflect their needs.

The provider did not always ensure care was coordinated, consistent or effectively planned to meet people’s needs. Care plans and risk assessments were not available for staff so they did not have clear guidance on how to ensure effective care provision was to be delivered, nor could they share information with health professionals or emergency services if required.

There was limited evidence of effective information sharing or joined-up working with others. Records did not consistently demonstrate how care was coordinated or updated to reflect people’s changing needs. However, some continuity was maintained. The provider aimed to offer consistent staff to support people, and relatives confirmed that staff were reliable and attended calls as expected. Overall, systems to ensure safe continuity and integration of care were not fully developed or consistently applied.

The provider did not ensure people and their relatives were given appropriate or accessible information about their care and support. We found important documents, such as service user charters and contracts, were not available in people’s homes, and relatives told us they were not aware of this information.

Information about people’s care was not always shared effectively. Care plans, risk assessments and pre-assessments were incomplete or missing, meaning staff and relatives did not have clear written guidance about how care needs were to be met and managed safely. Staff also told us they did not have access to policies and procedures, as these were held at the provider’s address. This lack of accessible and accurate information meant people and those supporting them were not fully informed or able to make decisions about care.

The provider did not consistently involve people or act on their views to improve care and support. Relatives told us they had not been involved in care reviews and had limited opportunity to contribute to decisions about care. Feedback systems were not embedded, and there was little evidence the provider sought or used feedback to improve the service.

Although a complaints process was described by the registered manager, there was limited evidence that people were aware of it or supported to use it. There were some positive examples of staff engaging with people during care delivery and communicating regularly with families. However, this was not supported by formal systems or recorded processes to ensure people’s voices were consistently heard. Overall, people were not consistently enabled to influence their care or the development of the service.

The provider did not ensure equitable access to care and support for all people.

Care planning and communication systems were not robust, which meant people’s individual communication needs were not always identified or supported.

There were limited aids to support communication particularly where people spoke a different language. Relatives were there to support communication between staff and people, however, the registered manager sent us examples of improvements to accessible communication that they wanted to implement. It was noted this was after guidance was provided during the assessment by the CQC. Access to information was also inconsistent. Key documents were not available in people’s homes, and staff did not have access to policies or procedures needed to deliver care safely. These issues meant people may not have been able to access care and information in a way that met their individual needs.

The provider did not have effective systems to ensure people experienced equitable care or positive outcomes. Care planning and risk management processes were inconsistent, which meant people did not always receive care that reflected their assessed needs. There was limited evidence of monitoring outcomes or addressing inequalities in people’s experiences. Records did not demonstrate how the provider reviewed or improved care based on people’s needs or feedback.

Relatives also reported a lack of transparency, including being told by the registered manager that staff were trained during initial assessments, when this was not the case. These concerns meant people’s experiences and outcomes were not consistently safe, equitable or well managed.

The provider did not ensure people’s future needs and preferences were consistently assessed or planned for. There was limited evidence of structured care planning to support people as their needs changed. Care plans and assessments were incomplete or not regularly reviewed.

End-of-life planning was not clearly established. The provider had not yet developed clear plans in partnership with people and their families.

Systems to review care, monitor changes and plan ahead were not effective, increasing the risk that people’s future needs would not be met. Overall, the provider did not demonstrate a proactive or consistent approach to planning for people’s future care.