Nottingham DCA

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 good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

Whilst people and staff told us their care was effective as they were included in reviews and discussions about their care and wellbeing, documentation did not always evidence this support or people’s desired outcomes. The provider did not always make sure people’s care and treatment were documented effectively and quality and audit processes in place had not identified this concern. For example, some people required support with routine medical screening such as smear tests. People’s care plans did not contain any details about this support. At some locations people told us they had discussed this need with staff and been supported with information to make a choice on medical screening. However, in other locations staff acknowledged they had not considered this aspect of care. This meant people were not always supported effectively and at were at increased risk of harm.

Despite care plans lacking elements of person centre details, people and staff told us the provider planned and delivered people’s care and treatment with them, including what was important and mattered to them and they did this in line with legislation and current evidence-based good practice and standards. One person said, “Top marks for staff, they are lovely. I have an appointee who helps me to manage my finances.” Another person had a communication book which explained their preferred method of communication including pictures of choices to promote independence. Their care plan also included guidance of what sounds and gestures the person used to communicate.

The provider worked well across teams and services to support people. They made sure people were supported to access services and other medical professionals as required. One person said, “I love living here, I have never had a family, and this is one big family. I’m supported with my mental health and my relationship with my psychiatrist has improved because of it.” Another person said, “I’m supported with all my appointments and attend them regular now because of staff.”

Other professionals we spoke with from the NHS and the local authority praised the service and support provided by United Response. One professional said, “Individuals shared with us how United Response have built their confidence, understanding of other’s limitations and life stories. It has really given them a voice. I think they are a really proactive team, there are always looking at new opportunities for those they support.”

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. For example, one person had chosen to undergo a medical procedure to support them with an eating difficulty. The person described how staff had supported them with the decision making and with their care since their procedure. They said, “I attended about 3 appointments before making the decision and its early days but I’m happy.”

The provider did not always routinely monitor and record people’s care and treatment to continuously improve it. They did not always ensure that outcomes met clinical expectations. For example, one person’s care plan stated they needed to have their diabetes reviewed every 3 months by a GP. When staff were asked when this had last occurred, they were not aware of this requirement and could not confirm the last time the person had seen the GP in relation to their diabetes. Additionally, some people’s care plans stated they required their weight monitoring by monthly weight checks and there was no evidence this was being undertaken. This meant that people were not supported effectively or safely but we were assured that no one had come to any harm due to this concern.

Whilst people and relatives told us the provider was proactive in seeking consent to care and treatment, records did not always accurately reflect this. The provider worked proactively with the local authority for people who had a deprivation of liberty safeguard (DoLs) order in place to ensure people were not restricted unfairly or unsafely. However, where people had varying capacity and staff had supported with best interest decisions these were not always clear. Records did not always demonstrate that other professionals, family or advocates had been involved to support the person in making the decision. People’s responses were not accurately recorded and there was no evidence staff repeated the conversation to check people’s understanding. This meant we could not be sure that people were supported effectively to consent to their care and treatment.