Almag Healthcare 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 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.

This service scored 54 (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.

There was a lack of consistent engagement with people who used the service and their next of kin or representative at the start of people’s care packages. People told us this lack of initial contact and assessment was a concern. People also told us they did not have a copy of their care plan and had not been asked to review their care plans for accuracy.

We saw examples where information from hospital referral assessments had been copied directly into the provider’s care plans. Some of this information was not relevant to the person’s current needs in the community setting and had the potential to confuse staff or lead to inappropriate care. We discussed this with the registered manager, who agreed to review and amend care plans and risk assessments where necessary.

Overall, people told us they were satisfied with the care provided. One person raised concerns about having to repeat and direct the staff and of a language barrier causing some difficulties. We shared this with the registered manager who agreed to follow up.

The registered manager told us they contacted people a short time after the care package had commenced to ask how it was going and if any changes were required. However, this was not recorded. This meant there was no evidence these checks had taken place, reducing oversight of people’s early experiences of the service and limiting the provider’s ability to identify and respond to concerns or required changes in a timely way.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always follow legislation and current evidence-based good practice and standards.

We identified where the provider’s policy and best practice guidance had not been followed, as reported in the Key Question of Safe; Medicines Optimisation.

Additionally, there was a lack of recognised assessment tools used to support the registered manager to effectively assess people’s care needs, mitigate risks and monitor any changes.

People’s nutrition and hydration needs were not effectively monitored. Where people required staff support to ensure they had eaten and drank enough or had health needs requiring their fluid input and output to be recorded, this was not consistently or sufficiently documented by staff. This meant important information about people’s nutritional and hydration status was not being monitored or acted upon, increasing the risk of unmet needs, deterioration, or avoidable harm.

The provider’s systems and processes that supported how well they worked across teams and services to support people needed strengthening to ensure consistency was delivered.

There lacked a procedure to support people to only have to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us they found the registered manager to be supportive, responsive and how they had regular contact with them. Whilst the registered manager confirmed this, we were unable to confirm due to the registered manager not maintaining records. This meant there was no formal evidence of what was discussed, agreed or actioned, limiting oversight and the ability to track improvements or address issues consistently and hold staff to account.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff gave examples of how they supported people with their health needs, including a deterioration. This included reporting issues to a person’s relative, escalating concerns to external health professionals such as GPs and community nurses.

Staff confirmed that the consistency of care provided to people had improved. This meant staff were regularly supporting the same individuals, enabling them to build positive, trusting relationships and gain a deeper understanding of each person’s needs, preferences, and routines. As a result, staff were well‑placed to recognise even subtle changes in a person’s health or wellbeing. This familiarity allowed them to identify concerns quickly and take prompt, appropriate action, helping to ensure people received timely support and reducing the risk of avoidable deterioration.

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

As described in the Key Question Safe; Involving people to manage risks and medicines optimisation, people’s clinical needs and expectations were not consistently met.

People’s care plans were not consistently outcome focussed. Initial care reviews were informal, and the registered manager was in the process of developing review systems and processes going forward. This meant important information that could improve people’s outcomes and experience of care was not consistently captured or acted upon.

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 Mental Capacity Act (MCA) is a law in England and Wales that protects and empowers people aged 16+ who may lack the ability to make certain decisions for themselves. It sets out clear principles for assessing capacity, making decisions in someone’s best interests, and supporting people to be as involved as possible.

We identified the registered manger was not meeting the MCA requirements. For example, the registered manager told us and records confirmed, 2 people lacked mental capacity to consent to their care. However, an MCA assessment and best interest decision had not been completed as required. We suggested to the registered manager they would benefit from refresher training to update their knowledge. The registered manager agreed to do this.

Staff were aware of the importance of seeking consent before care was provided and the principles of the MCA. A staff member said, “We provide person centred care, we do exactly what the person wishes to do. If they lack capacity this must be assessed and discussed with the person and others and a best interest decision may be needed. I never rush people, it's really important to always ask the person what they wish how they want to be supported.”

Relatives were positive how staff engaged with their relation. A relative said, “I find the staff to be very supportive and good with [relation], they explain what they're doing an ask and gain consent to provide the care, Overall, yes the care is very good.”