Archived: Independent Options Central Support Service

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.

This service scored 38 (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 were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs and the way they wished to be supported, were not always assessed by the provider prior to them accessing their service. For example, in one person’s file we saw their needs were assessed by the local authority but not the provider. People’s needs were not always periodically reviewed to ensure their current support plan was effectively meeting their needs, supporting choices and fulfilling their wishes. People and their loved ones were not always involved in conversations about their care and shared concerns. The feedback they provided was not always listened to. One relative told us, “We only have meetings if we request them, their annual review should have been last November, but it keeps being cancelled.” Another relative told us, “I would like to speak to the management more. We used to have meetings every 4 months which aren’t happening. I’m not sure about my loved one’s care plan as this has not been reviewed with me.” One stakeholder told us, “There were concerns communication is often delayed, incomplete, or absent, contributing to frustration and lack of trust.”

Following our assessment and feedback to the provider they took prompt action to address these areas of concerns.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People were not always involved in their care planning and staff did not know how to meet their needs. One relative told us, “Staff are quite young who have no caring backgrounds and don’t always know my loved one or understand them. My loved one’s care plan is not up to date. Staff do not know about my loved one’s condition, and they would talk very loudly or shout at them, clapping to get their attention because they don’t know how to treat.” Staff were not always aware of or, worked with best practice, and in line with current guidance. For example, in supporting people safely with their medicines. People’s dietary needs were overall met. However, some people did not always have access to healthy and varied foods. During our visits, we saw that some of the people did not have access to fruit or vegetables to choose from and were mainly served ready-made and processed food. Staff did not always understand how to prepare people’s foods. For example, one person was served plain wraps with no filling. There was no evidence in their care documentation, that this was their preference. Relativesexpressed their concerns regarding people’s diet. One relative told us,”My loved one had put a lot of weight on, and they have poor diet because staff don’t know how to cook the food they like. We asked for a smaller portion for them but when we visit during the meal times the plate will be piled high with sausages, fried chicken and chips. Staff also give them frozen vegetables which is good but it’s on top of bad stuff. We were told if we wanted good diet for our loved one, we would need to give them more money.” Staff did not always have a good understanding of how to support people with modified diet, and when people were at risk of choking. People’s individual hydration and dietary needs were not always clear in their care plan and the records about how to support people safely and effectively were not detailed.

The provider did not work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Staff did not always work well together to meet people’s needs and staff did not aways receive adequate support for example when there was an emergency. One staff member told us, “If we need support and ring the out of hours, we don’t always get response. For example, when there is a staffing issue and we need more staff.” Another staff member told us, “There is a culture of us and them.”

Staff did not always receive support in their roles and felt they could not always raise concerns. One staff member told us,” We don’t get much support from the registered manger, if something goes wrong, we get the blame. I don’t think I can speak up, things get brushed under the carpet.”

Staff feedback wasn’t gathered frequently, and staff did not have many opportunities to meaningfully engage in conversation with the provider. For example, staff did not have access to regular staff meetings.

Staff did not always work with stakeholders and partners to support positive outcomes for people, and we have received mixed feedback. One stakeholder gave positive feedback and told us, “Managers and support workers make appropriate referrals to my team, working closely with us as required in some complex situations.” However, another stakeholder told us, “It can be difficult to get responses to queries from managers.” Relatives also commented on poor communication with the provider and staff. One relative told us, “It takes my loved one to tell us if something happened. Communication can be difficult, and things can get missed.” Another relative told us, “We can’t say anything to staff without having it impact on our loved one. Staff will ignore us or treat us differently if they know we have spoken to the management about them.”

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

People did not always have access to or were supported to participate in activities which would enhance their physical and mental well-being. One relative told us, “They[staff] are doing very little with person. My loved one gets interaction at day services but at the house they are just chilling. They don’t do things as a household now but there is nothing to make them want to come out because staff aren’t doing anything with them.”

During our visit we saw staff did not always interact with people in a meaningful way and did not always meet their needs. For example, we observed one person who wished to watch a DVD. However, their player was broken, and they were getting distressed. A staff member was present at that time, but no action was taken to support the person. Only when prompted by us staff brought an alternative device for the person to enable them to watch a video which visibly calmed and reassured the person. When we visited one of the properties in the evening, we found people in their rooms on their own with no activities taking place. Some people were in a wheelchair and would a need staff member to support them to move. Some people could not communicate verbally, and they had no means of calling for help or assistance. People’s independence was not always promoted. One relative told us, “My loved one would be able to do things which I think staff are not giving them time to do.” Stakeholders and partners raised their concerns about people not always having adequate opportunities and support in meetingtheir needs. One partner told us,” Staff have not been following the person’s support plan in ensuring that this person engages in meaningful activities on a weekly basis.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

People and their relatives had very little opportunity to provide their feedback and engage in conversation with the provider about the way they wished to be supported. One relative told us, ”My loved one is less able to voice their needs to staff than some, so they are struggling.”

People were not always supported in a person-centred way considering their personal skills, strengths and goals. For example, we saw a care plan for one person who loved to watch football, and their goal was to attend a football match. There was no evidence staff supported this person in meeting their outcome which was important to them. This was very clear when we spoke to the person when visiting them.

Staff did not always know people and how to support them. One relative told us, “They [staff] try to meet my loved one’s needs and work around their wishes. There is a turnover of staff, and they have difficulty to understand staff because of cultural differences.” Another relative told us, “They[staff] treat my loved one like a child when they are in distress and not understanding, they have very complex needs.”

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

Staff did not always ask people for their consent when providing support. For example, we observed a staff member who was supporting person to access the bathroom. The staff member did not ask if the person wanted to go to the bathroom instead, they told them, ” We are going to the bathroom.” However, we also observed a staff member who was attentive to person they were supporting and asking their consent prior to assisting them with their diet.

Staff did not always understand and work within the Mental Capacity Act 2005(MCA). Best interest decisions which were completed regarding people’s care and support, were not always specific to the decision, that was made, and outcomes were not always clear. People’s consent to care was not always recorded. Representatives of people were not always included in the decision-making process. One relative told us, “There were changes made to my loved one’s routine and their medicines. When I raised concerns, I was told to not get involved.” Another relative told us, “My loved one’s preferences can be ignored in terms of food, but it is hard to feedback because staff seem to take things personally. Issues around choice can also take a long time to solve with staff as well because their managers aren’t helping staff from what I have seen.”