Delight Supported Living Ltd

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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.

The service was in breach of legal regulation in relation to need for consent.
 

This service scored 62 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. We received positive feedback from people about the assessment process. A person’s relative told us, “[Staff member] came out and did the plan and has reviewed it. I trust [staff member], they are good. The first time they asked all about what [person] liked and what [person] didn’t.” Another relative said, “[Care co-ordinator] came out and did a full assessment. They spent a couple of hours here and went through all the information in a lot of detail. [Care co-ordinator] was very nice and I would feel comfortable going to them.” Assessments were used to develop care plans, which in some cases had a positive amount of detail, in key areas such as mobility support or communication. More work was needed to ensure all care plans had the same level of detail and personalisation throughout.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. People had their needs met in relation to nutrition and hydration and had a choice of meals where the service provided this support. A staff member told us, “Sometimes we take 2 or 3 meals in to [person] a tray. We offer them the 1 they like, and they select and we prepare that one.” A relative said, “The care workers do the food for [person], and it works very well.” Daily care notes clearly recorded staff supporting people to drink enough to reduce the risk of dehydration, including refreshing water bottles throughout the day and ensuring they were in easy reach. For example, 1 person’s care notes stated, ‘[Person] was encouraged to maintain hydration and was offered a glass of water and a cup of tea.’

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. We received positive feedback from people and professionals about working together to support good outcomes. A professional who works with the service told us how office staff had persevered and advocated for a person to ensure they could access transport to a hospital appointment. The professional said, “[Staff member] has gone above and beyond in [their] efforts to support this patient, ensuring they have the opportunity to receive the treatment [they] very much need.” The service kept detailed notes to support effective handover between the office team and the on-call team who were contactable outside of usual working hours. We also received positive feedback about good continuity of care when people were discharged from hospital. A relative said, “[Staff member] met us here at home as the ambulance arrived bringing [person] from the hospital; it was good service and they spent time with us.”

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. Where people required support with exercises to build muscle strength and tone, we saw evidence of this taking place in daily care records. The service made referrals as required to external professionals such as the occupational therapist (OT) to help people remain as independent as possible, and to ensure they had the correct mobility equipment. A relative told us, “[Person] uses a [transfer aid] and [care workers] know exactly how to help.” Staff also supported external assessment processes, providing input with their knowledge of people’s needs. A professional who works with the service told us, “[Staff] were courteous and helpful on the telephone, and in person they provided a professional service to the adult they were supporting.”

The provider routinely monitored people’s care and treatment with the aim to continuously improve it. However, as care plans and risk assessments did not always hold sufficient information, this made monitoring processes less effective. Records were kept in relation to clinical care and support provided, as well as some basic information on quality-of-life metrics for some people. However, this needed further development to ensure it always captured how people were feeling at each visit, to reduce the risks associated with low mood. Information was available on a mobile phone application (app). A relative said, “[Delight Supported Living Ltd] have an online app which gives updates on the daily log and [person’s] mood.” Another relative said, “I have access to the app; I can see the rota and the daily notes too, it’s good.” When asked about clinical monitoring for food and fluid intake, the registered manager told us, “We encourage our care workers to document everything, encouraging, refusing, and let us know any issues.” This could then be followed up as required at subsequent care visits.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. Although staff told us they offered people day-to-day choices, and this information was recorded in some care plans and daily care notes, wider legal requirements were not met. A staff member told us, “When it comes time to dressing, [people] choose what they want to wear, and the same applies to meals.” However, there were no mental capacity assessments (MCAs) in place for anyone using the service at the time of our inspection, including those who might not be able to consent to all aspects of their own care and treatment. For example, 1 person living with dementia did not have any MCAs in place in relation to medication support provided by staff, personal care, or the use of Closed-Circuit Television (CCTV) cameras inside their home. Other people were seen to consume alcohol to the extent where they may no longer be able to consent to care provision, but there was no information to guide staff on fluctuating capacity or best interests decision making. Additionally, records showed a person who was able to communicate decisions having medicines placed into their food. It was not clear whether this medicine was being given covertly, as there was no evidence of their involvement. We recommended the provider seek additional support to ensure legal requirements were met in this area.