Deep Heart Care Wiltshire

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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained 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 42 (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 was effective. They did not always check and discuss people’s health, care, wellbeing and communication needs with them. People’s care records did not contain all information needed to ensure staff knew how to support them effectively.

Assessments were inaccurate and did not always identify people’s needs. People said they had been assessed when the service started but were less sure these assessments had been reviewed. Comments from people included, “Not sure about an assessment but I can’t fault them [staff]” and “An initial assessment was carried out, they sort of review they ask how the carers are getting on, I am involved.”

The provider did not always plan and deliver people’s care and treatment in partnership with them. They did not follow legislation and current evidence-based good practice and standards. Management of the service lacked knowledge to make sure people received care and support that met all legal regulations.

We found guidance for staff in some people’s care plans and risk assessments was incorrect or unavailable. This meant the provider could not be assured staff always had the knowledge and good working practices to ensure people were safe.

Management did not demonstrate they were able to lead a team of care workers to provide safe and effective care and support.

Where people required support to monitor food and fluids, it was not clear how staff were to carry out this action. For example, where people had recorded guidance for staff to monitor food intake, the visits did not provide enough time for staff to sit with people whilst they ate their meals. This meant staff were leaving people with meals to eat alone which placed them at risk of harm.

The provider did not always work well across teams and services to support people. Management did not demonstrate knowledge of local healthcare professional teams in order for staff to contact them when people needed further support. This lack of knowledge delayed additional healthcare advice for people. Management had signposted staff to various healthcare professionals but not provided contact details for staff to know who or which team to contact.

The provider failed to support people to manage their health and wellbeing, so people could not 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.

Management of the service demonstrated little knowledge on people’s health needs. There was a lack of guidance in people’s health records for staff on specific health conditions such as diabetes. For example, 1 person had diabetes and required insulin to be administered. Management could not tell us if the community nurses visited to administer the insulin or how the diabetes was managed. There was no guidance for staff on what to do in the event of illness relating to diabetes. This placed people at risk of avoidable harm.

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. Where staff had guidance to carry out monitoring, we found this was not consistently happening. For example, 1 person was at risk of choking and required monitoring when they were eating their meal. Care notes for this person recorded staff were leaving the person with their meal on occasions which was not following recorded guidance.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. People’s records did not demonstrate staff were following the principles of the Mental Capacity Act 2005 (MCA). Where people lacked capacity, it was not evident what action had been taken to make sure people’s best interests were taken into account. It was not clear who had been involved in decision making and what options had been considered. This meant in all cases there was little evidence that the least restrictive option had been considered. Staff received training on the MCA as part of their induction.

People told us staff asked their consent before providing care and support. Comments from people included, “They [staff] do what I want, and they do ask for consent. They will do something extra if I ask them” and “Care is what I want. I do as much as I can, and they [staff] do what I want them to do. They ask for consent.”