Ethica Care Hemel Hempstead & St Albans

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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.

Feedback from people and relatives did not demonstrate that all staff shared a good understanding of people’s needs. People commented that due to the lack of experience of some staff, or having multiple different staff attending, then those strengths and needs were not consistently met.

People and relatives mostly told us they were involved in the initial assessment for their care. One relative commented that “They all know what they are doing. They know what [person] needs. When we filled in the form at the beginning, they asked what tasks needed to be done, and we said help in the shower. It gives me peace of mind.” Although not all people said they were part of on-going reviews. One person said, “I have no care plan. Perhaps that’s something I should think about. I will ask about the care plan.” A second person said, “Yes, I have a care plan, but we have not? had a review.” Initial assessments were completed and identified a variety of health or support needs, for example diabetes or dementia. Care plans were not then consistently developed from that initial assessment.

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

Care plans did not include key information about some of peoples identified needs. The assessment for 1 person identified diabetes as a need, but the care plan did not provide information for staff about how to support and monitor this risk. We saw further examples where those support needs were not planned for, particularly in other areas such as dementia, skin integrity or pressure care. Care plans for those cared for in bed or at risk noted, ‘Any observations of changes in skin, such as redness, mottled tone, bruising, or other abnormalities, must be reported immediately.’ This didn’t guide staff to be aware of high-risk areas, specifically over bony prominences (heels, hips, sacrum). Staff were not guided to encourage people to change position or encourage them to sit at a tilted angle to reduce pressure.

However, people did not raise concerns regarding any harm from the lack of assessment and delivery of evidence-based care. Staff told us they discussed risks and sought guidance from professionals including GP’s and district nurses and followed their instructions when needed.

At the time of this inspection no person was receiving personal care who lived with a learning disability or autism. However, the provider was registered to provide this specialised care and did have the necessary policies or statement of purpose in place to reference, ‘Right support, right care, right culture.’ This meant we could not be assured that the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

Where care plans were completed, these contained good levels of details to instruct staff. For example, with personal care, the instructions were person centred, clear and contained clear information about what was important to the person.

The provider did not always work well across teams and services to support people.

The support people received was inconsistent based on the type of personal care they received. Some people were supported for a short period in hospital to regain their independence. We saw evidence from people’s care records that staff liaised with the discharge team at hospital, health professionals, social workers and family when appropriate. Staff followed the tasks within the discharge summary, although did not plan or assess themselves how to meet those needs, most relied upon external assessment and review.

For people who received longer, more permanent care package staff did not work well across teams. For example, people received care from a range of different staff, teams or services but was not always co-ordinated effectively. We saw throughout this inspection issues with ensuring people had their medicines ordered on time. Examples were identified where delays between care staff or care co-ordinators based in the office led to those delays.

Staff used a variety of systems to maintain daily contact both with each other and with the office. However, staff told us they felt there was not always effective communication across the team. This was caused to some degree by a lack of consistency within the staff team. Some relatives also said they felt communication with the office staff could be improved. One relative said, “It’s still early days. I asked if [person] could have a routine with fewer carers. I haven’t had any feedback from [staff member].”

Care records seen for all did not assess or plan for transition or discharge to other services to consider people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Failing to plan for discharge increases the risk of patients experiencing poor outcomes, including readmission, harm, or reduced quality of life after leaving an inpatient setting.

The provider 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.

We found examples where staff had supported people to maintain their independence and health and wellbeing. Although care plans did not always include people’s preferences on how they would like their healthcare needs to be supported, this did not mean people were not supported. For example, 1 person told us, “I have balance issues so can’t do certain things. They help me prepare food, things like that. Sometimes they will stay outside the shower. They are there to help me. If I ask them to move things, they generally say yes. Some people do a bit more.” A relative said, “The carers did physio and we have had the hoist for about a month. They give some pain relief before using the hoist] and take their time. It’s [persons] choice to get out of bed.”

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.

We found feedback from people and relatives was varied about how staff supported them to achieve positive outcomes. For example, 1 relative shared their experience and said, “I think they do encourage independence. I hear them saying things, encouraging [person] to do things like put a vest on, they don’t take over. They encourage with how to place their feet to walk which makes it safer when walking.” However, another person’s view summarised the views of other people using the service. They said, “I just want a nice quality life without confrontation. I am not getting the service I am paying for, at all.”

We found that care plans and assessments were not in place, therefore it was difficult for managers or staff to monitor people outcomes when those needs had yet to be fully assessed and monitored.

The provider had not always ensured consent was sought from people who were unable to make their own decisions about their care.

Peoples feedback was that all staff sought their consent on a day-to-day basis and explained what task they wanted to carry out. One person commented, “They just ask me, ‘what do you need’?” People and relatives said they felt in control of their care and the choices that they made.

However, where people lacked the capacity to make decisions in their own best interest, records did not show how people’s capacity and ability to consent was considered. For example, one person relative told us their family member lacked capacity to make decisions relating to areas such as agreeing to care, health matters and taking their medicines. They had raised the fact their family member lacked capacity with the care co-ordinator on several occasions. However, the capacity assessment continued to note they had capacity with no assessment completed. The newly employed manager was aware of this improvement and as part of their review of all assessments were supporting staff to address this.

The provider had not ensured they verified the validity of people’s appointed power of attorney. This meant there was a risk that decisions may be taken by those not legally appointed to act on people’s behalf for either financial or health related matters.