Closer Care Services - Main Office

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• 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 54 (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.

Although people’s needs were assessed before they began using the service, we found some support plans contained conflicting or outdated information and did not always reflect people’s current needs.

People’s communication needs had not been identified, considered or recorded.There was a limited understanding of the sensory needs associated with autism. The provider did not have guidance in place to support people’s sensory needs.

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

Whilst people were involved in their care and support planning, the provider did not always ensure evidence‑based care was consistently provided.For example, 1 person was known to be at risk of skin breakdown and had an active pressure sore at the time of the inspection. However, their risk assessment for skin, last updated in November 2025, only referred to dry and flaky skin, and not the risk of skin breakdown. The risk rating was scored as ‘low’. This was discussed with the registered manager who agreed this was not correct and person was not ‘low’ risk for skin breakdown risks. Additionally, risk reduction measures for skin breakdown did not robustly describe how the risk of skin breakdown could be reduced for the person. This meant staff did not have the guidance to support the delivery of effective care to meet the person’s needs.

The provider did not always 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.

People and their relatives told us the service contacted various partner agencies on their behalf. We saw evidence of the provider liaising with other professionals such as GP’s and Social Workers.However, as care records did not always contain accurate, up to date information about people’s care needs, risks associated with their care, or communication needs, the likelihood of incorrect information being shared with partner agencies was high.

The provider supported people to manage their health and wellbeing, so people could maximise their independence, choice and control. Staff supported people to live healthier lives, and where possible, reduce their future needs for care and support.

There was evidence in some people’s care plans which showed they had access to external healthcare providers.

One relative explained if their family member had a medical appointment, they could telephone the registered manager to reschedule their care visit, to ensure their family member could still receive care, and did not miss their appointment.

The service did not always routinely monitor people’s care and treatment to continuously improve it. This meant there was no robust approach for assessing the effectiveness of care, and appropriate actions were not always taken to improve outcomes. For example, monitoring tools were not in place to identify known or emerging behavioural needs, for example, where 1 could demonstrate distressed behaviour with staff, address concerns, or take action to improve outcomes for these individuals.

In addition, when people using the service required behaviour support plans to help manage their behaviour, these were not in place.As a result, staff did not have the necessary guidance to promote positive behaviour or respond appropriately when challenges arose.

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

People were not supported to fully understand their rights around consent and decision making; and care plans did not always identify the choices and decisions people could make for themselves.

Improvement was needed in the registered manager’s knowledge and understanding of the Mental Capacity Act 2005 and the associated codes of practice.

The registered manager advised mental capacity assessments had not been completed for 1 person who they knew could not consent to particular aspects of their care.

Where mental capacity assessments had been completed, best interest decisions did not clearly record the rationale for why the decision had been reached, why it was in the person’s best interests, and the risks if the decision was not made.

A relative told us staff offered their family member choices, “[Family member] will say I don’t want to wear this, or I want to wear that. If [family member] is cold, [they] can ask for particular clothing.”