Cognacity

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• 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

This means we looked for evidence that the service met people’s needs.

This is our first inspection of the service. This key question has been rated requires improvement.

The service was in breach of Regulation 17 Good governance. The provider had not ensured that accurate and contemporaneous records were maintained in respect of each patient, meaning that information needed to deliver safe care and treatment was not available to staff. The provider did not share information with the relevant bodies.

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.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

We spoke with 8 patients and 5 carers. Their feedback was positive overall, with several sharing examples of the service being flexible and responsive to their needs. One person told us: “They’ve taken account of my wishes, thoughts and fears. It’s a really individual treatment rather than one size fits all”. One person said that online consultations suited their needs well, while another preferred to attend in person. Several people appreciated the quick response times and flexibility of appointments around their work or studies. However, one person told us they had not been offered face-to-face appointments, which was their preference.

Some people also shared examples of how staff empowered them to make their own decisions about their care and treatment. One patient told us about discussing their treatment options and side effects with their prescriber. They said they felt fully informed and would review how the plan was going in their next appointment.

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

When appropriate, the service supported patients around their education or work. Some patients we spoke with explained that they accessed the service through their employer. One person shared how the service supported their relative with continuing their studies, and another told us they received support with some upcoming changes at work.

Staff enabled patients to involve their families and friends in their care and treatment, depending on their wishes. Some people shared examples of this, such as supporting their relative to take their medication, or having joint family sessions.

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

The provider had not ensured that accurate and contemporaneous records were maintained in respect of each patient. This was not in line with the national guidance and provider’s own policy. During our inspection, no clinical records were kept on the provider’s electronic record system for 3 patients, meaning that information needed to deliver safe care and treatment was not available to staff.

The service did not make all required notifications to CQC, for example following 2 safeguarding referrals. The provider’s serious untoward incident policy contained some incomplete or inaccurate information about CQC statutory notification requirements. The provider did not ensure that lost prescriptions reported by patients were recorded in the organisation’s incident reporting system. This meant the provider did not share information with the relevant bodies in line with the current guidance.

However, staff ensured that patients could obtain information on treatments. At the time of our inspection, the service was in the process of making patient information leaflets on medicines available online.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

The provider had a complaints policy in place. Staff knew how to handle complaints and 93% had completed the mandatory complaints training. Staff told us that people could complain by telephone, email, or via the recently introduced QR code.

We reviewed the service complaint log. In the past 12 months, the service received 10 complaints. Nine had been investigated and closed, and one was awaiting the outcome of an external body referral. Common themes were around care provision. The provider acknowledged each complaint promptly, in line with the policy.

However, the service did not always follow its complaints policy. The outcome of each complaint was not clearly recorded. Only one complaint outcome was recorded as ‘partially upheld’, while in others the outcome was recorded simply as ‘letter sent’. No learning was identified from 2 complaints, despite the complainants raising issues around their care provision.

We spoke with 8 patients and 5 carers. Nine people told us they did not know the complaint process, although some thought they could find out if needed. One person said they would likely complain to their referring organisation rather than directly to the service.

The provider shared bulletins with learning from complaints with staff. Some learning was related to record keeping. However, with no roles, responsibilities or timeframes identified, and no audits taking place, it was not clear how actions were monitored and whether improvements were made.

Complaints were a standing item on the agenda of quality assurance and governance meetings. However, the complaints discussed in the June and September meetings did not match the number or content of complaints recorded for the corresponding period.

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

The service was based across 4 floors which were accessed by stairs. Staff mitigated this by offering a ground floor consultation room to patients with mobility needs identified during assessment. The service had a ramp available for wheelchair users to access the main entrance and staff had been trained in operating it. Staff told us that patients could also be offered appointments at the provider’s accessible location in Buckinghamshire or online consultations.

The service had a form to complete personal emergency evacuation plans (PEEPs) for any individuals requiring assistance during emergency evacuations. No PEEPs were in place at the time of our inspection.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The provider had undertaken equality impact assessments of its policies and procedures to ensure they did not place vulnerable people or people with protected characteristics under the Equality Act 2010 at a disadvantage. Staff received mandatory training in equality and diversity and 95% had completed it. Additionally, 96% staff had completed the Oliver McGowan Tier 1 Mandatory Training on Learning Disability and Autism.

Patients and carers we spoke with did not raise any concerns about discrimination.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

The provider had not ensured that all relevant services were involved in planning the care and treatment of people with complex needs. The doctors working for the provider did not consistently liaise with GPs and other healthcare professionals when providing treatment. Comprehensive assessments, evidence-based treatment plans and risk assessments were not available for 3 patients whose records we viewed. This was not in line with the best practice guidance. Although some staff shared examples of involving other professionals, for example GPs and hospitals, there was limited assurance that patients’ care was planned consistently.

However, we saw evidence that staff created personalised care plans to account for patients’ needs and wishes. A patient we spoke with shared how staff supported them with planning for some upcoming career changes.