South Manchester Care Limited

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.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 33 (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 make sure people’s care, and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 7 care plans and/or risk assessments in detail and found records lacked sufficient detail and did not provide staff with clear guidance about people's assessed needs and risks. We also reviewed a further 3 records and identified additional areas for improvement. Information within records was often incomplete, inconsistent, or out of date.

For one person, the overall risk summary was undated and unsigned. The document instructed staff to follow a specific care plan, stated only trained and competent staff should provide a particular element of support, and directed staff to follow medicine administration records. However, when we sought clarification, the provider told us the person's relative routinely delivered this aspect of care rather than care staff. This created confusion about the support care staff were expected to provide and made it unclear what care the person actually received.

Some care records included person-centred information, such as preferred activities, important relationships, and communication preferences. However, most records focused primarily on tasks rather than the person's individual needs. They lacked sufficient detail to reflect the complexity of many people using the service and did not provide staff with clear guidance on how to meet those needs safely and effectively.

One staff member told us the care documentation was “not up scratch, paper work isn’t always in place, actually next to nothing in place. I have to try to work out what is needed from the daily notes which are not up to scratch. Care plans don’t inform carers what they should be doing, what equipment is needed, etc.”

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.

Care and treatment were not always delivered in line with recognised standards and guidance. The provider did not demonstrate a clear understanding of the requirements surrounding delegated healthcare tasks.

Support plans relating to distressed behaviour lacked detail and did not accurately reflect the level and frequency of incidents experienced by some people. For one child, records evidenced repeated assaults on staff, family members, and members of the public.

Although staff completed incident forms, records were inconsistent and lacked adequate managerial oversight. For example, one incident record described injuries but did not identify who had sustained them. None of the incident forms we reviewed contained evidence of management review or oversight.

Information recorded in daily care notes did not always correspond with information recorded on incident forms. In one example, an incident form documented injuries to staff following an assault, while the corresponding daily records did not mention injuries and described the person's “presentation appeared positive”. These inconsistencies did not provide an accurate account of events and increased the risk people, staff, and members of the public could be placed at risk due to incomplete or inaccurate information.

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.

We saw evidence of the provider communicating with local authorities regarding some people's behaviours. We were also informed the provider representatives regularly attended multidisciplinary team meetings and often responded promptly to correspondence. During the assessment process, the provider was responsive and provided information quickly when requested. However, two external agencies raised concerns about delays in the sharing of important information. Some families also expressed concerns about communication and partnership working. One parent told us, “I just spoke to the manager to ask where one of the carers was and they said sorry and explained with a long context.” The relative also said they had not seen any care plans or any minutes of meetings.

Staff also identified concerns regarding information sharing. One staff member told us, “The care plans, I’ve never seen anything like it. Care plans are not always on the system, not detailed, I am having to ask the family to tell me what is needed for their child’s care.”

Although some staff and family members gave positive feedback about care planning and information sharing, the inconsistencies we identified meant we could not be assured relevant information was consistently available to all staff and stakeholders when required.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence,choiceand control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Records showed people, particularly children, were supported to take part in activities they enjoyed within their local communities. Staff also encouraged alternative activities tomaintainengagement and reduce boredom. Many of these activities involved physical exercise, which supported people's physical health, emotional wellbeing, and sense of belonging within their communities.

For one young person, records demonstrated improvements in their sleep routine following engagement in these activities. However, we identified missed opportunities to promote healthier eating habits and greater independence for the same individual.

Records showed the person ate a limited range of foods and, on some days, consumed chips as part of two main meals. Records did notdemonstratewhether staff had offered healthier alternatives or documented the person's response to those options. As a result, we could notdeterminewhether staff consistently promoted healthier choices or took opportunities to improve the person's independence in relation to food and meal preparation.

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

One person's care records identified goals to promote independence. Staff were instructed to support the person with activities such as “encourage to help prepare simple meals to develop independence whilst remaining supervised.” However, care records did not demonstrate staff had followed the care plan or supported the person to achieve this outcome.

The provider had not monitored progress against identified outcomes, and audits had failed to identify these shortcomings. As a result, the provider could not evidence whether outcomes were achievable, whether progress had been made, or whether staff had taken opportunities to promote independence.

Records suggested staff routinely completed tasks on behalf of the person rather than supporting the person to develop and maintain relevant life skills.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

We found no evidence consent forms had been completed for people using the service. We would expect to see clear evidence people, or those legally authorised to act on their behalf, had consented to specific aspects of care, such as the use of photographs.

Care records did not contain sufficient information to guide staff on how to seek and establish consent. For one non-verbal child, the communication plan was brief and stated they “can communicate by smiling and waving (their) arms. (They) will also communicate when (they) are unhappy or in pain by crying”. This person had complex needs, and this level of information was insufficient to support staff to understand the person's wishes, feelings, and preferences or to seek meaningful consent wherever possible.

Records showed staff documented consent from relatives when entering the person's home and providing support. However, this did not demonstrate staff had sought or considered the person's own current presentation or means of consent.

In another person's records, covering approximately six weeks, we found evidence of consent being recorded on only four occasions. Daily records included statements such as “I made their dinner...we took him”. This language presented the person as a passive recipient of care and did not demonstrate how staff involved them in decisions or promoted choice, control, skills development, and independence.

When we requested evidence relating to consent, the provider supplied records showing attendance at best-interest meetings. These meetings help ensure decisions are made in a person's best interests and in the least restrictive way possible. However, attendance at best-interest meetings alone did not demonstrate staff consistently sought , respected, and documented consent in day-to-day practice.