Cheshire Support Services

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 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 comprehensive assessment for this newly 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.

The provider was in breach of the legal regulations in relation to good governance.

This service scored 50 (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 was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. For example, people’s needs were not adequately assessed prior to them receiving care. There was limited evidence regular reviews were carried out with people to ensure care plans were developed to provide staff with a clear understanding of what these needs were and how to support them effectively. These shortfalls placed people at risk of ineffective and inappropriate care which did not meet their needs, wishes or preferences.

However, staff knew the people they were caring for and could describe how they met their needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Evidence based tools to enable a structured approach to the assessment and monitoring of risk were not used in respect of people’s individual health conditions and risks such as skin integrity, nutrition and hydration and other risks specific to the individual. For example, when people had current risks relating to their skin, recognised assessment tools had not been completed, despite these being highlighted on the electronic care planning system as needing to.

However, people and their relatives were generally happy with the support they received from staff in relation to food and drink. Comments included, “The carers know what he can and cannot eat and provide him with thickened drinks.”

The provider did not always work well across teams and services to support people. Care plans did not always include the contact details of other health professionals involved in people's care or explain how staff should work with them. External health professionals had shared details with the provider about people’s complex long term health conditions. The provider had not always used this information to effectively plan people’s care and support. Care plans lacked information on these conditions, how they impacted on people’s lives, the symptoms to spot in the event of ill-health and what action staff needed to take. However, people and their relatives felt assured staff would take action to contact health professionals if they were unwell.

Staff supported people to manage their health and wellbeing. Staff described the action they took when a person was unwell and required a review from external health professionals. Our review of incidents confirmed the required action was taken to support people with their health. People and relatives provided positive feedback about how attentive staff were to changes in their health. Comments included, “[Person] has lots of UTI’s (urinary tract infections), so they monitor [Person], make sure fluid intake is high, and check the colour of [Person’s] urine. If they have any concerns the let me know and I contact the district nurse or GP,” “If they notice any marks on [Person’s] skin, they report it to the boss and let me know” and “They notice if my urine is cloudy. They advise me to drink more or phone the GP."

The provider did not routinely monitor people’s care and treatment to continuously improve it. People’s risks were not properly assessed, and staff did not have sufficient information to monitor and mitigate risks. There was limited evidence people’s care was adequately monitored to ensure their support was safe and effective in promoting positive outcomes. For example, not all shortfalls with the quality of care plans and risk assessments had been identified by the provider’s monitoring systems. The registered manager was open and honest and told us audits of care plans had not been completed for several months.

When people’s needs changed, their care plans were not always reviewed to ensure they remained fit for purpose and reflective of people’s current needs. For example, staff had recently started supporting a person with their medicines following a change in their needs. No medication support plan or risk assessment had been put in place and leaders lacked assurance on essential information about how medicines were ordered and their role in administering.

People and their relatives provided mixed feedback about care reviews. Some people told us they had good communication with office staff and spoke with them regularly about changes to their care, whereas others told us they had not had reviews for a significant time or in some cases not at all. For example, a person who had been using the service for a number of years told us they had not had a review. Our review of care planning records confirmed reviews were infrequent as we identified many assessments had not been reviewed for a significant period of time.

We shared our findings with the registered manager and they took responsive action. They demonstrated they had booked several appointments with people to discuss their ongoing care needs, some of which had been completed during our assessment period. They committed to improving their systems to better monitor and improve people’s outcomes.

The provider did not always tell people about their rights around consent. Preadmission processes did not always taken place prior to care being delivered. As a result, records did not assure us people’s consent to care had been sought prior to staff delivering care. The registered manager had identified the shortfalls in consent processes and had developed templates for staff to use. Whilst we could see some work had been taken to improve, further improvement was needed to ensure this process was consistently embedded and records to evidence people’s consent were in place.

However, people told us staff always sought their consent before undertaking care. Our conversations with staff confirmed this and they described how they respected people’s right to refuse.