Hearts of Care Agency

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service. This key question has been rated inadequate.This meant services were not planned or delivered in ways that met people’s needs.

People were at risk of receiving inconsistent support as an effective care planning system was not in place. Not all care plans contained sufficient information to ensure staff knew how to deliver people’s care in a safe and person-centred way. For example, people with complex support needs did not all have sufficient guidance for staff about how to support them to ensure theirs and others safety.

People’s care and support did not always take into account current legislation and consider relevant nationally recognised evidence-based guidance. For example, plans to promote people’s independence and positive behavior support plans. This information is important so that people's individual wishes are considered and planned for.

The system in place to manage concerns and complaints was ineffective. Where people had raised concerns and formal complaints, these had not always been effectively recorded, managed, investigated, and/or responded to in accordance with the provider’s own policy. Following the policy meant the provider would have been able to make improvements from lessons learnt and make improvements as well as providing oversight.

The service was in breach of the legal regulation in relation to person-centred care.

This service scored 32 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Although relatives told us people received person-centred care and support, our assessment found that this was not always the case. People were not always involved in planning their care or creating their care plans. Care plans did not always highlight what people could do for themselves or prompt staff to encourage people's independence. The care plan for 1 person referred to them as ‘service user’ and did not always refer to them by their name. The care plan also referred to their challenging behavior but there was no risk assessment or positive supportive behavior plan to guide staff or reference to their severe learning disability and how this presented for them.

Staff told us they delivered person-centred care, however in records we reviewed this was not always demonstrated. Daily records of care and support were brief in detail. For example, records to evidence personal care and support had been provided did not have a clear description of what support had been provided and what was done to support independence, choice and wellbeing.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Care staff understood people’s cultural needs and background. A relative said, “They treat her and us with respect. They will say shall we take our shoes off when they come through the door.”

Whilst staff were aware of the diverse needs of people, it had not been recorded how people’s care and support should be delivered in a way that met their assessed needs, encouraged independence and was delivered in a manner that was coordinated and responsive. Daily notes were brief, task focused and not reflective of people's wellbeing and emotional needs.

Staff told us they knew people well and had access to all the information they needed to provide support to people. However, care records reviewed and the handover processes in place were ineffective in providing staff with the information they needed to meet peoples assessed and changing needs.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to meet people’s individual needs.

For people who would benefit from having their care plans in an accessible format such as ‘easy read’ so they could read and understand them this was not available. This is important so that everyone can access and understand information about them, regardless of their disabilities or limitations.This promotes inclusivity, equality, and gives people independent access to information and services and supports them to make informed choices.

The provider’s quality assurance surveys used for feedback about people’s experience of using the service were generic in content. For example, a person who was nil by mouth was sent a survey asking about the food provision. This could have been triggering for them and caused a negative reaction. The surveys were also not provided in accessible formats.

People’s individual needs to have information in an accessible way were not identified, recorded, highlighted and shared. These needs were not met and reviewed to support their care and treatment in line with the Accessible Information Standard.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

While the people and relatives we spoke with stated they were aware of the complaints process and shared their feedback, we found the provider’s handling of complaints did not meet the required standard.

Prior to the inspection we had received concerns regarding the service. When reviewing records at the service we found the complaint had not been recorded or investigated in line with the provider’s policy. This meant the complaint had not been dealt with in an open and transparent manner and lessons were not learnt.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Most people could access the care and support from health care professionals when they needed it. For most people supported by the service this was managed by members of their family. However, we were aware of an incident where the service was providing live in care where a person developed a wound and appropriate support was not requested by care staff. We were not assured that staff had the knowledge to ensure appropriate referrals and timely referrals were made.

Staff and leaders did not act on information about people who were most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

While the people and relatives we spoke with expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. The provider did not always effectively work with people and other partners involved in their care to ensure their care was well-coordinated and people were in control of their support.

The manager and director told us they ensured people’s care was tailored to their individual needs and preferences and that they protected and respected people’s equality and diversity. However, there were gaps in how the provider assessed and reviewed people’s needs around their learning disability and mental capacity to make specific decisions. This put people at risk of not receiving care that ensured equity in experiences and outcomes.

The provider did not always consider how to effectively support people with a learning disability when planning and reviewing their care, how these would affect their experiences, and what support was needed to ensure equity in outcomes. This was reflected in people’s care plans which lacked specific information on how to support people around their learning disability.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. This is important becauseit provides clarity on people’s wishes including choices about their care, treatment and support so that these can be respected.

People and relatives spoken with told us they were not supported to make informed choices about their care and plan their future care. A relative said, “I have not discussed the future, like residential care for him with them.” Another relative said, “No conversations regarding this.”