Hearts of Care Agency

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 service. This key question has been rated Inadequate.This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The provider did not always follow the Mental Capacity Act 2005 Code of Practice. They did not ensure people’s mental capacity was adequately assessed in relation to specific decisions and that they supported people to fully engage in mental capacity assessment processes. People were at risk of their rights not always being upheld and their unwise decisions not being respected due the provider not considering the possible least restrictive nature of some support strategies in place.

The provider’s systems and processes did not fully consider national best practice guidance on supporting people with a learning disability and autistic people, for example around assessing their needs, wishes and experiences of living with a learning disability and how these were to be addressed in their care to promote their independence and rights.

The service was in breach legal regulations in relation to person-centred care and staffing.

This service scored 29 (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 consistently check and discuss people’s health, care, wellbeing and communication needs with them.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. Leaders were not assured that people’s needs had been appropriately assessed and understood by staff. People had not been involved in a meaningful review of their support.

The manager and a director told us they assessed people’s needs and gathered information from people, people’s representatives, social services and other professionals as needed before starting to support people. However, people’s care plans did not always accurately reflect all their needs. For example, staff did not have all the right information to support people effectively.

The provider’s systems and processes did not consider national best practice guidance on supporting people with learning disability and autistic people. For example, assessing needs, wishes and experiences of living with a learning disability and how these were to be addressed in their care to promote their independence and rights. For example, there was a lack of robust assessments of how people’s learning disability affected their communication and what support staff could provide when people became distressed.

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.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. People did not receive care that was in line with evidence based good practice and standards. For example, staff and the provider did not have awareness of best practice guidance in relation to supporting people with a learning disability and autistic people living in the community. The provider had not ensured people’s care plans provided guidance to staff on how to support them to be as well as possible, physically, mentally or emotionally.

The provider and manager lacked awareness and understanding of specific guidance and best practice standards in relation to supporting people with a learning disability and autistic people. For example, they were not aware of and how to apply guidance such as ‘Right support, right care and right culture’’. Staff supporting people did not have full understanding of learning disability. A director told us that staff had been enrolled on a relevant online training course in line with the national guidance, but this had not been completed by all staff. This put people at risk of not receiving care meeting their specific needs.

The provider’s registration specifically excluded providing personal care to people with a learning disability or autism, but they were providing personal care to people with this diagnosis. The provider told us they had not seen this condition on their registration certificate.

The provider did not work well across teams and services to support people. People and their families told us the service communicated well with them. However, the service did not communicate effectively with other professionals. From care plans we viewed we found that other care providers were providing support to some people. There were no details in the care plan regarding how the service shared information with the other services and what aspects of care each organisation was responsible for.

The manager told us that information regarding any updates and changes to people’s care were recorded in the care plan. We found that daily notes were brief and lacked sufficient detail. For example, a care plan note recorded ‘Today is bank holiday [person] not going to school.’ There were no details of any care provided. Staff told us there was no care provided as this was a bank holiday, however this was not clear from the records.

All staff employed had been recruited from overseas via the Government sponsorship scheme. Staff received an induction into the service. However, documentation we saw did not demonstrate the full induction process was followed. There was no evidence of planning and regular oversight to ensure staff were provided with training in effective communication and with meeting the needs of people with complex physical and mental health care needs. The wording in some care plans was poor and did not demonstrate appropriate communication. For example, a care plan recorded, “She also has medications for her normal bowel routine that would cause her not to have her bowels for days when missed.”

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

People’s health and wellbeing was not managed as set out in standards such as Right Support Right Care Right Culture. Staff told us they knew what to do if they had concerns about a person's health or if there was a medical emergency. However, care and risk management plans were inconsistent in the quality of guidance provided for staff in meeting people’s health and wellbeing needs.

Entries in people’s care plans regarding food and fluid monitoring were inconsistent. Care plans were not clear as to if people needed their food and fluid monitored. Where fluid intake was recorded this was inconsistent and the overall intake was not monitored to ensure the person had consumed sufficient fluid. This placed people at risk of harm as they may not be receiving adequate nutrition and fluids.

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 and relatives told us that their care was reviewed. A person said, “Yes, review and they asked about his care. They asked if things need to change to let them know and not wait for the next review.”

We found the provider did not have an effective system to ensure detailed audits were carried out to capture the experiences of people and implement planning with actions to improve the quality of care delivered and the outcomes for people.

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

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. For example, the provider did not work in line with the Mental Capacity Act 2005 and associated Code of practice. People’s capacity to make specific decisions in relation to their care and treatment was not always effectively assessed. People could not be assured their rights were upheld. The provider and management team lacked understanding about people's rights.

The manager could not explain how they adhered to Mental Capacity Act 2005 Code of practice when assessing people’s capacity. They were not able to explain how they ensured people were supported when making unwise decisions or how they would recognise possibly restrictive practices when planning and reviewing people’s support. Staff told us they had training around mental capacity, and they asked people for their choices when supporting them. Staff told us, “We are supposed to give choices, explain choices to help understand, encourage and find way to come around,” and “If someone lacks mental capacity, you have to seek consent before doing anything.”

The provider failed to ensure people’s mental capacity was adequately assessed in relation to specific decisions and that they supported people to fully engage in the mental capacity assessment process. For example, mental capacity assessments lacked detail on how the person’s capacity was assessed, and care plans did not correlate with these assessments. People were at risk of their rights not always being upheld and their decisions not being respected.