Caring with Dignity 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.

This is the first assessment for this registered 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.

This service scored 58 (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. The assessment process was not reliable or robust in practice. Concerns were identified regarding the accuracy and quality of care plan information. For example, staff reviewing care plans entered incorrect mobility information for 2 different people, which did not reflect their current needs. Evidence indicated information had been copied from archived documents rather than based on a fresh assessment. Further inconsistencies were identified, including discrepancies in medicine information within care plans. Although there were systems for oversight, such as monthly reviews of daily notes, these had not identified or prevented the errors found. Overall, assessments did not consistently reflect people’s current needs, and governance systems were not effective in ensuring care planning information was accurate and up to date.

Despite these issues, the provider had systems intended to support people to be involved in their assessments. The registered manager described consulting directly with individuals, including those without family involvement, to ensure their preferences were reflected in support plans. People and relatives also had access to the ‘care app’, which provided visibility of visits and planned tasks, helping them stay informed and involved in their care.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Although the service generally monitored changes in people’s conditions and maintained contact with health professionals, documentation provided limited evidence of the consistent application of national clinical tools, such as the Malnutrition Universal Screening Tool (MUST) and the Waterlow pressure ulcer screening tool, highlighting an area where practice could be further strengthened. The implementation of best practice screening tools highlights areas of risk to people. Failure to ensure these were consistently implemented meant there was a chance these risk areas would be missed, which increased the risk of avoidable harm.

Despite these gaps, the service demonstrated good practice in several areas. Staff reported having sufficient time to support people with meals and relatives confirmed that carers actively encourage food and fluid intake, including supporting individuals to maintain or gain weight where required. As one family member commented, “They’re helping [person] put on weight and live a life, not just exist.” People’s routines were adjusted to promote safe eating and drinking, for example by adapting visit times to reflect dementia-related sundowning, helping to maintain wellbeing and nutritional stability. Sundowning is when a person, often someone with dementia, becomes more confused or unsettled in the late afternoon or evening. It can happen because they are tired or their body clock is disrupted, and it usually improves again by the next morning. One relative stated, “They changed [person] times because of [person] dementia and sundowning.” There were examples of personalised communication approaches, such as written communication and support with hearing aids. These measures helped ensure people could understand and engage with their care in line with best practice for accessible communication.

The provider did not always work well across teams and services to support people. Areas for improvement were identified, reflecting some inconsistencies in people’s experience. One relative shared, “I don’t feel particularly listened to,” and reported they were unaware of being invited to provide feedback. Concerns were also raised regarding continuity of care, with one comment noting, “We don’t usually get the same carers and there is no continuity,” highlighting the impact of staffing consistency on coordinated care delivery.

Despite these issues, the provider demonstrated generally effective partnership working across teams and services to support people’s care. Assessments of need were shared appropriately when people moved between services, reducing the need for individuals and families to repeatedly recount their circumstances. The service maintained clear communication channels and liaised with external professionals to help ensure people and their relatives remained informed. Hospital passports were kept in people’s homes and sent with them when required to support continuity of care. Internally, information was cascaded through established messaging systems and team meetings were held with minutes shared among staff to promote consistent communication. Feedback from some families reflected positive collaboration, with comments such as, “They call to check I’m ok too” and “They’re my ears and eyes since I am based far away.” During and following the assessment process, steps were taken to address concerns, including reviewing and updating care records, refreshing document packs in people’s homes, and strengthening consistency within care teams

The provider generally supported people to manage their health and wellbeing to maintain independence, choice, and control. Staff encouraged people to do what they could for themselves and sought to check directly with individuals about their needs and preferences, including how support should be delivered. Evidence showed people were supported to maintain independence, manage aspects of their own health, and make healthier daily choices.

Some families reported positive examples of proactive support, stating, “They push the drinks and know what to do,” when early signs of medical needs appeared, reflecting meaningful support around nutrition and wellbeing. People also felt reassured when staff monitored health changes and facilitated timely access to healthcare professionals, such as arranging prescriptions, spotting infections, or adapting routines. For example, adjusting visit times for people using the service affected by dementia.

Staff and leaders demonstrated an appropriate understanding of people’s underlying health needs and worked with external professionals to prevent deterioration. Overall, the service promoted healthier living through monitoring, responsive adjustments, and collaboration with external health partners.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. Outcomes were not consistently achieved, and gaps were evident in formal monitoring processes. For example, one family member reported, “When [person] needs changed after coming out of hospital, some carers didn’t adapt very well and [person] confusion increased rather than improved,” reflecting inconsistent continuity of care and its impact on wellbeing. Gaps were identified in the medicine recording, increasing the risk of errors and reducing the reliability of records for safe care. Daily care notes also contained inaccuracies, such as information about a person being entered in another person’s notes, which could affect staff understanding of individuals’ current needs and changes in health or behaviour.

Despite these concerns, people experienced some positive outcomes, and staff made efforts to support improvements in health and quality of life. Relatives described examples where staff actions contributed to better wellbeing, and staff monitored general health changes, escalating concerns to external professionals when needed. Leaders maintained oversight of people’s clinical outcomes through hospital contact, discharge letter reviews, and communication with healthcare professionals, helping to ensure care remained responsive to changes in need.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. People and relatives generally felt their views were considered, and staff sought consent appropriately. People were asked directly about their needs and preferences during care planning, and families were consulted when clinical changes occurred, ensuring decisions reflected what mattered to the person. Staff consistently described asking for consent before personal care, medicine or food preparation, with 1 staff member stating, “I ask for consent during personal care, medication, preparing a certain type of food.” Relatives also highlighted carers remained respectful and maintained privacy, with staff giving examples of calming distressed individuals and seeking consent before each intervention.

Staff demonstrated an understanding of who had capacity to consent and how to proceed when people could not make certain decisions. They were able to explain consent principles and how they involved families or representatives where required for decision-making processes. Staff reported receiving safeguarding and Mental Capacity Act related training as part of induction and ongoing development.