CREATIVE CARE HOME 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 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. There was breach of the regulation safe care and treatment.

This service scored 46 (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 adequately assess or review people’s health, needs and care, with them on a regular basis.

People and their relatives told us they had been involved in discussions about their or their loved one’s needs and care when they first started receiving support. We saw that people’s needs, wishes and preferences were identified but had not always been adequately assessed to ensure staff had up to date information on what these needs were and guidance on how to support people effectively. For example, evidence-based tools to enable a structured approach to the assessment and monitoring of risk, were not used in respect of health conditions, falls, skin integrity, nutrition and hydration and other risks specific to the individual.

Some people had not had their care reviewed formally for a significant period to ensure information in relation their needs, care and wishes remained accurate and up to date.

These shortfalls placed people at risk of ineffective and inappropriate care which did not meet their needs, wishes or preferences.

The provider did not assess or manage people’s care and treatment in accordance with legislation and current evidence-based good practice and standards.

The provider did not have any adequate audit or quality assurance process in place to assess and monitor the delivery of care to ensure it adhered to recognised standards and relevant legislation.

Some people’s assessment and care plans did not reflect best practice guidance issued by The National Institute of Health and Social Care Excellence or the provider’s own policies for supporting people with specific health care needs, such as diabetes. NICE guidelines recommend home care providers ensure staff understand common conditions affecting people using home care services, for example, diabetes, neurological and health conditions, and physical disabilities and sensory impairments. Records showed some staff members including the registered manager had not completed training in specific health care needs such as diabetes and Parkinson’s disease before providing support to people with these needs.

People's experience of medicines did not follow good practice guidelines issued by the Royal Pharmaceutical Society, the National Institute of Heath and Care Excellence (NICE), or CQC.

The provider did not always have accurate records in place to share the right information about people’s needs and risks when people moved between different services in order to ensure staff and teams worked well together.

People’s needs and risks had not been adequately assessed to enable full and accurate information to be shared with other teams or other professionals should an emergency occur. Medicine records had not been properly maintained to enable professionals to be assured people had received the medicines they needed when they moved between different services.

We found however people were supported by consistent and familiar staff who knew them well which promoted opportunities for good verbal communication with the person’s GP or local district nurse teams who supported their health. There was evidence that referrals to specialist services were made when people needed additional support for example with regards to skin integrity or advocacy. A visiting professional told us the service worked with them well to support the health and wellbeing of a person using the service.

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

People’s visit records showed people received support from other health professionals when required. Records showed people who required support with their nutrition and hydration were supported appropriately, with snacks and drinks left for them in between visits. People living with insulin-controlled diabetes were provided with suitable snacks to help stabilise blood sugar levels if they became too low. Support with the administration of people’s insulin medicine was supported by the district nurse team who checked on people daily in addition to the provider.

People and their relatives told us staff supported them to be independent and helped them with the daily living tasks they needed help with. One person told us, the support from the service “Makes a difference” and helped them to remain independence in their own home.

The provider did not always monitor people’s care and treatment to continuously improve it or to ensure positive outcomes were achieved. People told us however their care expectations were met.

The systems in place to keep track of people’s needs and risks were not robust. People’s needs and risks were not properly assessed at the start of their support. Regular reviews of people’s risks were not completed in a structured or consistent way to enable changes to be identified

and monitored. Care plans were not always updated when people’s needs or the support they received had changed. Medicines were not always safely managed or monitored to ensure people received the medicines they needed to achieve positive health outcomes.

People told us the registered manager was involved in their day-to-day care, and we found the registered manager knowledgeable about the care people required. People told us they felt the support provided met their needs. A visiting professional also told us, “Myself and colleagues agree [Name of person’s] care is always to a very good standard.” At the time of the assessment the number of people being supported by the service was very small which enabled the registered manager and staff to be ‘hands on’.

The provider did not always ensure people’s consent were promoted in the delivery of their care where concerns about the person’s capacity to make decisions was in question.

The registered manager and staff understood the importance of gaining consent prior to supporting people with personal care. People told us consent to care was obtained.

There was a policy in place to guide staff on how to assess people’s capacity to make decisions in accordance with the Mental Capacity Act. This guidance however had not always been followed. Where there were concerns about a person’s capacity to consent, an assessment of their capacity was not always undertaken to ensure any decisions made were in the person’s best interests. This aspect of service delivery required improvement.