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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 service. This key question has been rated requires improvement. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

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

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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

The registered manager told us they completed checks to identify people’s needs, prior to them receiving a service. However, these discussions and checks had not been formally recorded so we were not available to review their effectiveness. Care plans contained limited information and were effectively a 1-page profile which didn’t contain robust and detailed information about the person’s care needs. Some staff we spoke to reported that they hadn’t seen care plans but referred to lists of tasks to complete in people’s homes instead. Consequently, we were not assured records contained adequate information or guidance for staff to be able to meet people’s needs and mitigate known risks to keep them safe from harm. These concerns formed part of the breach of legal requirements relating to governance, which is reported on further in the Well-Led section of this report.

People’s communication needs had not been fully assessed, which meant their care could not be delivered as effectively as possible. For example, one care plan indicated that the person ‘communicates well, however can be confused at times and deliver abrupt responses. The care plan contained no information on what might potentially trigger a negative response or how to deescalate this situation if it arose. Furthermore, no consideration was given in relation to other methods of communication.

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

People and their relatives told us that the provider included them in any decisions around care and treatment. However, care plans lacked person-centred detail regarding people’s nutritional and hydration requirements, and associated health conditions. They did not reflect current evidence-based guidance.

Due to the limited care plan documentation available during the inspection, we could not be assured that reviews of people’s care were routinely undertaken.

The provider did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.

The provider used a social medica platform and diaries which were located in people’s homes to communicate information between staff. However, due to the lack of information provided within care plans and risk assessments we could not be assured information would be shared or handed over to other agencies safely to ensure a smooth and consistent transition. Care plans did not contain robust information to identify where people received additional support from separate agencies.

The provider did not always 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.

Staff told us they would contact the registered manager if they had concerns about a person's health or in the event of a medical emergency. While this demonstrated an awareness of escalation processes, the guidance available to staff within care and risk management plans was minimal. This lack of detailed instruction limited their ability to respond effectively to changes in people’s health and placed people at risk of harm of not having their needs met.

We found examples where insufficient guidance placed people at risk. The service supported one person in monitoring the input and output of their catheter. A catheter is a medical device which is inserted into the body and primarily used for draining fluids, however it can be used for other purposes too. We reviewed the care plan and found no risk assessments or guidance for staff, for example relating to infection control, skin integrity or recognising the signs of complications. Whilst we found no evidence of harm and staff were not responsible for changing the catheter, the lack of information for staff meant they might not recognise the signs of complications with the catheter or infections, in order to escalate these concerns in a timely way.

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.

The provider did not have a robust approach to monitoring the effectiveness of people’s care, treatment, and support to continuously improve it. There were ineffective systems in place to monitor people’s care and treatment. We identified one person who was at risk of developing pressure damage to their skin due to not being able to mobilise independently. Although no harm was identified, there was no formal documentation or recognised tools in place to monitor the person’s skin integrity. These concerns formed part of the breach of legal requirements relating to governance, which is reported on further in the Well-Led section of this report.

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

People and their families told us that staff asked for consent before providing support, and we received some positive feedback about this. However, we identified shortfalls in the provider’s understanding and application of the Mental Capacity Act 2005 (MCA).

There was no Mental Capacity Act policy in place and care plans did not contain mental capacity assessments or formal records of decisions made in people’s best interests. The registered manager confirmed they do not complete these assessments but referred to the Local Authority or GP if they were concerned.

Staff informed us that they had concerns about the overnight care provision for one person whose capacity they described as “fluctuating”. There was no evidence in the person’s care notes to indicate that this information had been followed up with any formal request for an assessment of their mental capacity. The person’s care notes stated “Contact [solicitor’s name] in the case of any POA issues”, and “[registered manager] is my legal next of kin since 2022”. It was not clear who had legal authority to provide consent for various aspect of care. Furthermore, the fact that the nominated individual and registered manager is recorded as being the legal next of kin presented a conflict of interest.

Similarly, care records for another person who was living with a dementia contained no information on their ability to make decisions or provide consent.

The provider’s online training included a specific topic about dementia, which the registered manager told us included a module about the Mental Capacity Act 2005. However, not all staff we spoke with were confident that they had undertaken Mental Capacity Act training.