T Lives Healthcare Ltd

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 to rate this 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 was effective because assessments did not consistently provide accurate, practical guidance about their health, wellbeing and communication needs. Records identified health conditions, mobility, skin integrity, nutrition and hydration needs, but did not always explain what staff should monitor, how support should be provided or when concerns should be escalated. Some records were contradictory. For example, information about one person’s eyesight differed across records and from information provided by their relative. Daily records referred to dentures, but this need was absent from the care plan. People said regular staff knew them well. However, although some people had been involved in care planning remotely, they had not seen the completed care plans. This reduced assurance assessments consistently reflected people’s current needs and preferences.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care records included information about people’s health conditions, medicines and support needs. However, care plans and risk assessments did not consistently provide staff with clear, evidence-based instructions about how to manage identified conditions, monitor deterioration or respond to known risks. For example, records identified medical conditions, skin integrity concerns and nutritional needs, but there was limited guidance for staff on how these conditions should be monitored and managed in practice.

Staff said they followed the available care plans and guidance. However, those records did not always contain enough information to support consistently safe and evidence-based care. Staff described how they reported changes in people’s health and sought support from healthcare professionals when required.

People's records showed involvement from a range of health and social care professionals, including GPs, social workers, physiotherapists, district nurses and mental health teams where required. Staff told us they sought advice from relevant professionals when people's needs changed.

Staff worked effectively with relatives and healthcare professionals to help ensure people's needs were understood and met. One relative told us, "Staff have a bond with their [person]."

Staff shared information through electronic care records, handovers and communication with managers to support continuity of care.

Where concerns were identified, the provider worked with relatives and professionals to review support arrangements and make changes to support people's wellbeing and safety.

The provider supported people to manage their health and wellbeing and encouraged them to live healthier lives where this was relevant to their needs and preferences.

Staff supported people with their day-to-day health needs, including personal care, medicines, nutrition, mobility and monitoring for changes in health. Staff described how they encouraged hydration, monitored wellbeing and escalated concerns when necessary.

People told us staff supported them to maintain their independence and continue activities that were important to them. One person told us they were supported to attend activities and maintain friendships, while another described support with daily routines helped them remain independent and in control of their life.

Staff demonstrated awareness of the importance of choice, independence and promoting people’s wellbeing through person-centred support. They gave examples of encouraging people to make decisions and do as much as possible for themselves.

People and relatives were positive about the support they received from regular staff and said this helped them maintain their routines, wellbeing and quality of life.

The provider sometimes monitored the effectiveness of care and treatment, but systems were not consistently effective in identifying and addressing concerns or improving outcomes for people.

The service collected information about people’s care through electronic records, feedback from people and relatives, and reviews of care delivery. The manager described monitoring care through electronic systems and responding to concerns raised by people and staff.

However, governance and quality assurance systems had not identified or resolved significant inconsistencies in care planning, medicines management, consent documentation and risk assessments before the inspection. Records reviewed contained inaccuracies, omissions and contradictions that had not been recognised through existing monitoring arrangements.

Auditing processes for medicines and care planning were not sufficiently robust to identify concerns at an early stage. Following the inspection, the provider acknowledged these weaknesses and implemented action plans, new audit tools and additional review processes to provide greater oversight of care records and medicines management.

People and relatives generally told us they were satisfied with the support provided and felt regular staff understood their needs. However, the weaknesses in governance meant the provider could not consistently demonstrate systems were effective in monitoring people’s outcomes.

The provider did not always demonstrate that consent arrangements were lawful, clearly understood and accurately recorded. People told us staff asked for consent before providing support and respected their choices. One person said staff asked for consent verbally before supporting them with their care. Staff were able to explain how they sought consent, respected refusals and followed the principles of the Mental Capacity Act 2005 when people made decisions about their care.

Records reviewed showed one person was assessed as having capacity to make decisions about their care and support. However, three consent records on the electronic system had not been signed. The provider could not demonstrate how the person’s consent had been obtained and recorded for a representative to sign agreements on their behalf, despite records indicating no formal legal authority was in place.

The basis for representative involvement in decisions was therefore not consistently evidenced within care records. This meant the provider could not always demonstrate consent arrangements were clearly documented or records accurately reflected people’s wishes.

The provider had reviewed these arrangements following inspection feedback and developed actions to clarify representative involvement and document consent arrangements more clearly. However, these improvements were still being implemented at the time of assessment.