Axis Care Group Ltd

On this page

• 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 requires improvement. This meant people’s needs were not always met.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People generally received care that was centred on their needs, and people and relatives told us staff knew them well. However, care records were not consistently person-centred and did not always provide sufficient detail to ensure safe, individualised care.

People’s care plans lacked personalised guidance. For example, one person’s continence care plan stated staff should support them to change into clean clothes and settle them but did not describe how the person preferred this support to be provided. This meant staff may not have been able to deliver care in a way that promoted the person’s dignity and comfort. In another care plan, the psychological and emotional support section stated staff should provide support “when required,” but did not identify triggers, signs of distress, or preferred reassurance techniques. This placed people at risk of inconsistent support and unmet emotional needs.

A further care plan recorded, “I have a few pressure sores,” but did not specify their location, category, required management, or escalation procedures should they deteriorate. This omission increased the risk of inappropriate care, delayed treatment, and further skin breakdown. Similarly, within the memory and cognition section of another care plan, it stated staff should “prompt and remind me constantly,” but did not clarify what the person required prompting for. Without clear guidance, staff may not have been able to provide structured and effective support, potentially impacting the person’s independence and wellbeing.

Risk assessments were not always personalised and lacked sufficient detail to guide staff practice. For example, a mobility risk assessment did not describe how staff should support a person to transfer from sitting to standing. In response to the question, “Are there any concerns identified regarding moving and handling?”, the recorded answer was simply, “Requires assistance.” This did not provide staff with clear instructions to ensure safe moving and handling, increasing the risk of injury to both the person and staff.

Following the inspection, the provider submitted revised care plans and risk assessments which were more detailed and person-centred, demonstrating that action had been taken in response to feedback.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The nominated individual and registered manager were knowledgeable about people’s health needs and organised appropriate referrals, to address any changes to their needs.

The provider evidenced that people were receiving care from a team of staff which ensured continuity of care. This continuity of care supports safer, more effective, and more compassionate healthcare by ensuring care is connected over time.

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

The service user guide, which is a key source of information for people who use the service did not provide sufficient detail and was not up to date. Some of the wording, such as “delivering skilled care to enable optimum health and wellbeing” was professional but not easy to understand by people who would access the service.

There was no information about how personal data was stored, who it was shared with and how someone can access their records. The fees section was brief and did not indicate how invoices were issued.

Communication needs were identified via the assessments completed, but as stated previously, these were not always accurate.

The provider did not always make it easy for people to share feedback and ideas. However, people were aware of how they could raise complaints about their care, treatment and support.

There was no evidence that feedback on the service was sought through questionnaires or surveys. These are important as it provides a way of listening to people’s experiences and improves quality. However, the provider did evidence some ‘new service user experience check in’s’ which they completed with the person or relative to see how people were settling into the service and if any concerns were raised, the provider took action to address them.

The concerns log which we received, started in June 2025 and ended in March 2026. There were 2 concerns listed on this log, which is not representative of what people, relatives and partners told us.

People and relatives told us they were not aware of a complaints policy or procedure. However, they did not feel this was required as they would be comfortable to raise any concerns with the registered manager.

The registered manager was consistently described as approachable and easy to talk to. People felt confident they could raise concerns if needed.

The provider made sure that people could access the care, support and treatment they needed when it was scheduled.

People’s care calls were mostly completed on time. The provider said that any documented delays in care calls was due to the network signal. They were in the process of considering how to problem solve this difficulty.

Staff supported people to ensure they were ready to access appointments with relevant healthcare professionals.

Peoples care was not always tailored for those who are likely to experience inequality in experience and outcomes.

Leaders had a good knowledge of the types of discrimination and inequality people who were accessing the service may face. However, the care plans did not always detail how people’s health needs presented for them or what adjustments staff needed to make to adapt the care they provided. We did not find evidence of impact, but this meant people could receive care with variable outcomes which could lead to inequalities.

People were 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. However, staff needed to support people to identify clear, realistic goals which could be monitored.

We reviewed a care plan for a person who was on an end-of-life care pathway. The care plan contained the appropriate details including the persons diagnosis, current symptoms, medication management, personal care preferences and how staff should ensure dignity and compassion during that period. It was clear for staff that the person had a DNACPR in place and which professionals were involved.

Staff had a good understanding of what constituted good end of life care. A staff member said, “It is about protecting their [people’s] dignity and ensuring their quality of life. It is about providing emotional support and welfare. It is about making sure they enjoy the rest of their life as much as they possibly can.”

People’s care needs and outcomes were often unrealistic and were not specific, measurable, achievable, realistic and time bound (SMART). For example, a goal for a person with ascites (the abnormal build-up of fluid in the abdomen), was to breathe normally without stress. Although there were improvements which could be made to this person’s breathing, it is unlikely it would lead to them breathing normally again in the future. Other goals lacked sufficient detail, including one for nutrition and hydration which stated, “I would like to eat properly.” Since the inspection, the provider has improved care plans and risk assessments and has reassessed goals with people and relatives.