Admiral 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.

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.

The service was in breach of legal regulation in relation to person-centred care, safe care and treatment and consent.

This service scored 38 (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 did not always have a care plan in place which accurately described their needs or have access to their care plan. There was no process for reviewing or evidencing review of care plans to ensure they were updated in line with people’s changing needs. Comments from people and their relatives, when asked about their care plan included, “I haven’t seen it, but I know they have one,” “I am not able to see it because it’s on the phone,” and “We talk about it, but I haven’t seen it.”

Assessments of people’s needs did not always include key aspects of their health and wellbeing, such as nutrition, skin integrity, health needs and involvement of other professionals. This meant care plans did not fully reflect people’s needs. The lack of robust care plans meant staff did not have access to essential guidance to deliver effective care to people who used the service.

Systems and processes in place for maintaining oversight of the quality of people’s care plans were not effective and had not identified that some care plans lacked important information and detail regarding risk management and people’s known medical conditions. We discussed this with the registered manager who told us they would review all people’s care plans

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. Staff and leaders were not aware of up to date or good practice guidance which would apply to the service, and were therefore not ensuring this was followed.

The provider failed to ensure people’s changing needs were consistently assessed and support plans fully reflected all the person’s needs, including health, risk management, emotional support and cultural, religious and spiritual needs.

Good practice guidance around supporting people with anxiety, frustration and agitation which may impact their behaviour towards staff was not considered or implemented.

Best practice guidance had not been followed in ensuring appropriate assessment and guidance was in place. Of the support plans we reviewed, 9 people were identified at risk of skin breakdown. None of these people had an effective skin management and monitoring plan in place

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.

Care plans and risk assessments were lacking, meaning people, staff and visiting professionals did not have relevant, necessary information to ensure continuity of care. There was no clear system for dissemination of important information to staff about people or the service to ensure staff new how to deliver effective, joined up care.

People did not have relevant information available, including risks and medicines information, should they require transport to hospital, or where shared care was in place between the service and other professionals.

The provider told us they worked with other professionals to support people including community nurses, social workers and occupational therapists. The registered manager was able to give detailed information when asked about professional’s involvement, however people’s care records did not include this level of detail which meant not all staff had access to this information. We discussed this with the registered manager who told us they would review people’s care plans and add detail where appropriate

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

People had goals, however these were generic around maintaining their health and wellbeing, without specific plans to achieve their goals and promote their health. Care plans and care records were not reviewed to ensure people were supported in a way which promoted independence and helped them maintain their health and wellbeing.

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 and the expectations of people themselves.

People’s care planning documentation was not always reflective of people’s needs, aspirations and medical conditions. Care plans did not consistently provide sufficient detail to ensure staff were able to recognise and respond to people’s changing health needs.

People who lived with diabetes, did not have an effective management plan in place for staff to follow. This meant people received care from staff who did not have access to adequate guidance. Of the support plans we reviewed, 2 people had a diagnosis of diabetes and did not have adequate information included in their support plans.

We identified a person who received a prescription weight loss medicine and they did not have a Malnutrition Universal Screening Tool (MUST) score which should be regularly reviewed. This meant staff did not have an accurate current score for the person, or the opportunity to regularly review and monitor this. Other professionals were involved in the person’s care, however the provider not having an effective monitoring system in place, meant their ability to escalate any concerns was limited

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

Systems and processes were not appropriate to gain people’s consent to their care. Though staff understood how to gain consent for personal care at the time, people’s agreements to their plan of care was not always signed by the person. No third party can consent on someone’s behalf.

People with cognitive impairment did not have appropriate assessments in place of their capacity to make decisions about their care in line with the Mental Capacity Act (MCA). Some care plans indicated the person lacked capacity, without a formal assessment, and staff should make decisions in the person’s “best interest” – however this does not follow the appropriate legal process for best interest decisions.

Records showed staff did not always obtain consent or ignored people’s wishes on several occasions, without any justification or lawful process followed. One capacity assessment was provided as an example; this example assessment did not demonstrate how the person was involved in the process to ensure they were supported to make or be involved in making the decision.

The provider and staff did not demonstrate an effective understanding of the MCA. This included a lack of understanding of their responsibilities and who should undertake assessments or make decisions in line with the Mental Capacity Act Code of Practice. There was a lack of oversight and no system in place to ensure consent and changes in capacity were reviewed regularly or when needed.