Radis Community Care (Oak Tree House)

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 58 (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 needs was effectively captured in their care plans and risk assessments.

People’s needs were not always reviewed in a timely or meaningful way to ensure information remained accurate and up to date. This meant staff did not always have clear guidance to support people effectively. We identified several discrepancies and missing information within people’s care plans, including inconsistencies relating to medicines information, people’s ability to maintain their home, mental capacity, falls risks, medical conditions and refusal of care. One person’s personal handling risk assessment and plan had not been updated in 18 months.

Care plans evidenced people were involved in their care, and many had been signed to evidence agreement. However, where people lacked capacity to make decisions about aspects of their care, it was not always clear what assurances had been considered or how consent had been appropriately obtained. This meant capacity and best‑interest decision making processes were not always clearly evidenced.

Relatives told us, they were not always confident their loved ones received care from staff who fully understood their individual needs.

Although the provider had governance systems in place, such as reviews of daily records and medication charts, these processes had not identified or prevented the errors we found. Assessments and care plans did not consistently reflect people’s current needs, which reduced assurance that care was being planned and delivered effectively.

The provider generally planned and delivered people’s care and treatment in partnership with them, taking account of what was important to them. However, we identified areas for improvement in the quality and completeness of people’s care planning and associated risk assessments.

Care plans were not always in place for people with specific health conditions. For example, one person living with diabetes did not have a care plan to guide staff on how to recognise risks, monitor their condition or respond to signs of concern. This placed them at risk of receiving ineffective or unsafe support.

Where care plans identified concerns relating to people’s fluid intake, these were not always supported by appropriate risk assessments. In one case, a person’s care plan identified poor fluid intake, yet the person was recorded as not being at risk of dehydration. This inconsistency meant staff lacked clear guidance on how to support the person safely.

One person’s care plan identified a need for support with continence care, however, it did not specify what continence aids were used or how support should be provided. This limited staff guidance and consistency of care.

Where people were supported with meal preparation, relatives told us, they had concerns their loved ones were not always encouraged to eat enough. Some relatives felt staff did not always provide adequate support and raised concerns about staff knowledge and skills in food preparation and the time they had available to support their relative.

The provider worked well across teams and services to support people. The manager liaised with health and social care professionals when required.

The service maintained clear communication channels and liaised with external professionals to help ensure people and their relatives remained informed, however people’s documentation was not always updated to reflect the action taken.

People were involved in developing their individual care plans although we found there was inconsistency in how comprehensive they were such as providing staff with details of people’s individual daily routines.

The provider generally 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.

Where people were at risk of isolation, care plans identified support needs to ensure staff met people’s needs and were aware of the risks.

The service was looking to employ a wellbeing worker who would support with running activities which all people at the scheme could access, providing touch points, checking in with people to see how people were. The service also worked with other local charities to facilitate activities.

The provider did not effectively monitor people’s care and treatment to support continuous improvement.

Although audits were in place, these were not consistently effective in identifying areas requiring improvement which had the potential to negatively impact people’s outcomes.

Staff recognised changes in people’s needs and appropriately raised concerns or sought professional input to support people’s health needs. However, changes to people’s care and support and actions to monitor concerns around risk were not always reflected in people’s care plans to effectively improve people’s outcomes.

People and their relatives told us, they felt involved in regular reviews of care and were kept informed about changes in people’s needs.

The provider did not consistently assess people’s mental capacity when required in relation to decisions about their care and treatment.

Mental capacity assessments had been completed in relation to people managing and consenting to their medicines. These assessments were detailed and clearly documented how decisions had been reached. However, we identified inconsistencies within people’s documentation regarding their overall ability to consent to other aspects of their care.

Although capacity assessments were completed for medicines, there were no corresponding mental capacity assessments in place for other areas of care, such as personal care. In some cases, people who had been assessed as lacking capacity to manage their medicines had signed their care or support plans. It was not clear how these decisions had been made or what consideration had been given to concerns about the person’s decision making ability.

Where people were assessed as having capacity to make day to day decisions, some care plans directed staff to consult family members for more complex decisions. However, there was no evidence family members held Lasting Power of Attorney, and there were no supporting mental capacity assessments or best‑interest decisions to guide staff on which decisions required family involvement.

We also identified examples where people had signed their support plans, despite the documentation stating they were unable to make decisions about their personal care. In these cases, there were no mental capacity assessments recorded to support this decision‑making process, which raised concerns about how consent had been obtained.

Where people were recorded as being unable to manage their finances independently, care plans stated family members provided support. However, we did not see evidence of appropriate legal authority, such as Power of Attorney, or best interest decision records to ensure these arrangements were lawful and, in the person’s best interests.

Despite these concerns, care plans contained positive guidance for staff on how to seek people’s consent and support decision‑making. This included guidance on effective communication, offering choices, and allowing people sufficient time and information to make day to day decisions.