QUALITY LIVING CARE 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 1 legal regulation in relation to gaining people’s consent to their care.

This service scored 42 (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 they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People or their relatives told us they had been involved in the assessment of needs, we found support was not always delivered in line with current standards. We found that people's care and support did not always achieve effective outcomes.

The provider failed to review people's support plans to ensure these reflected people's current needs. This meant the provider could not be assured the support staff were providing was as people required. For example, for 1 person who now had a hoist in their home this had not been reflected in their support plan or risk assessments.

This meant that support plans were not reflective of the people as individuals, to demonstrate a holistic, person-centered approach.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

The provider failed to ensure people’s changing needs were consistently assessed and support plans fully reflected all of the person’s needs, including health, personal care, social interests and activities and cultural, religious and spiritual needs.

The provider’s processes for ensuring people were consistently involved in their care planning and the information recorded in support plans was accurate, were not effective. Important information about people’s care and support needs had been omitted from some support plans. People’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs, such as home oxygen therapy and diabetes. However, people and their relatives told us they had been asked for feedback on their care.

For a person whose previous known risks indicated they required enhanced monitoring in relation to their skin integrity, there was a lack of evidence this had been consistently provided. Risk assessments were not reflective of the correct level of risk or did not include how such risks could be reduced.

People and relatives told us overall they were happy with the call times including the length of time staff were there. However, the provider failed to operate a robust system to monitor for short, late or missed calls. Although there was an electronic system in place, there was no auditing of such records. They told us that if a staff member had not attended, the person would call them. This did not reflect a robust or effective system to ensure staff attend the calls at the correct times and for the correct length of time. This placed people at risk.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The lack of robust systems and documentation meant that information available to share with other services and health professionals was not comprehensive. For example, we found for 1 person, who was at high risk of developing pressure sores and needed support with pressure relief, their support plan did not include reference to their skin condition or how this was to be monitored. We also found that where a person was on home oxygen therapy there was no information as to whether this was cylinders or an oxygen machine or what the correct setting for this equipment should be. Should the need arise to call for urgent medical assistance this lack of information could result significant harm to the person. In such an event, staff told us they would call the registered manager who would contact the family. This did not demonstrate a robust response to medical emergencies.

We were told by staff and the provider that team meetings took place. However, there was little documented evidence to support this. Staff told us they had supervision, but, again, these meetings were often not documented. This meant we could not be assured what had been discussed, or if these meetings were supportive and gave staff the opportunities to discuss important aspects of their well-being and performance. However, staff told us they felt supported by the registered manager.

There was positive feedback from people and relatives about the service. One relative told us, “They [care staff] are friendly and very caring.”

People and their relatives told us they knew who the manager was.

The provider’s systems did not always support them to manage people’s health and wellbeing. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The provider’s system and processes to ensure care records and risk assessments reflected the support needs of people were ineffective. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence.

Staff could tell us how they would contact the office staff to access additional support from healthcare professionals to help people manage their health, should this be required. However, records demonstrated that staff had not received training to support people with all their specific health or lifelong conditions known to the provider, such as home oxygen therapy.

People told us they were able to make choices and decisions.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations.

Support plans had not been developed for people with long term health conditions. This meant they could not evidence how people’s outcomes would be improved.

Compliments about the service were not robustly recorded. The provider told us they had received no complaints since providing support, but they had received compliments. There was no analysis of such compliments to identify themes and trends. This meant opportunities had been missed to use positive outcomes to help drive improvements across the service.

We saw staff supervisions had taken place; however, this was sporadic rather than planned. There was no system of tracking supervisions, and the provider was unable to demonstrate all staff had received supervisions. This meant they had not always been provided with an opportunity to discuss any concerns they may have about people’s care or how it could be improved. There was no evidence to demonstrate staff received annual appraisals and staff confirmed this.

The provider told us that no incidents had occurred since they had started supporting people.

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 provider was not compliant with the Mental Capacity Act (MCA) 2005. The provider had not consistently obtained evidence that those making decisions on people’s behalf had the necessary legal authority to do so. This meant the provider could not assure themselves people were being supported in the least restrictive way and decisions were being made on their behalf appropriately.

Whilst we were told people currently using the service had capacity to make decisions. However, we saw, and were told, that relatives were making decisions for people in relation to their care on a day-to-day basis without any related information or guidance on this having been recorded in people’s care plans. We were concerned in relation to the registered manager’s and staff members understanding and application of the MCA. They were not adhering to current requirements in relation to the MCA, deprivation of liberty and best interest decisions.

There was a lack of recorded evidence that people using the service consented to their care and the sharing of information on their behalf.

The provider’s training matrix indicated that 4 out of the 7 staff had received training in relation to consent, MCA and deprivation of liberty. Staff members we spoke with could not clearly tell us what applying this training meant for their care of people using the service.

All the people and relatives we spoke with told us that staff gained consent prior to supporting them.