Archived: Priory Alliance Care Limited

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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

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 inadequate.

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 25 (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. People’s care plans did not reflect an accurate assessment of their needs. Care plans contained conflicting information, missing information on key health risks and a lack of detail to provide guidance for staff. People’s care plans lacked key information about their health needs. For example, people who had risks with their skin, there was a lack of documentation to safely manage this. For example, there were no records of a person’s repositioning being changed and there was a lack of documented guidance for staff to follow. This significantly increased the risk of harm.

Daily notes repeated short task led entries such as “[person] was fine,” with no description of the support provided or any clinical observations.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Care plans did not contain evidence‑based instructions for managing people’s health conditions. Although several people lived with diabetes, staff had no guidance on recognising diabetic related risks and one staff member could not explain what diabetes was. Records showed that staff had attended internal diabetes training sessions held by the registered manager. People with complex mobility needs who required the use of different equipment had no care plans, risk assessments or clear guidance for staff to follow. This significantly increased the risk of harm to people.

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.

There were no systems for coordinating care. Staff did not receive clear handovers, and there was no evidence of external professional involvement in care planning. The registered manager confirmed call monitoring and checking was not in place, making it impossible to confirm whether scheduled visits took place.

Assessment information was not shared effectively. People’s medical history was missing, incomplete or inaccurate across files. One person’s care calls were reduced without explanation or communication to relatives. And as per the provider’s policy, the persons care plan had not been reviewed and the increased risks to the person was not based on the persons clinical needs but rather persons financial needs.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

People with significant health needs did not have appropriate plans or monitoring. One person’s Waterlow score identified them at high risk but was not reflected in any repositioning plan. The Waterlow Score is a clinical risk‑assessment tool used across UK health and social care to identify how likely a person is to develop pressure damage with a higher score indicating a significantly increased risk of pressure damage.

Another person’s diabetes was described only as “diet controlled,” There was no further information given to staff about how they could support them or what signs to watch out for in the event of hypo or hyperglycaemic incidents. Staff were not guided to look out for signs of associated complications. No body maps were completed for people with skin integrity risks.

Staff did not have guidance about nutrition, hydration or maintaining mobility. Care plans tasks included “leave drinks and snacks “however this was not documented, and no audits were in place which impacted the registered manager’s ability to monitor risks around malnutrition and dehydration. People reliant on equipment were not supported through timely checks or planned reviews. Daily logs did not record clinical observations, repositioning, fluid intake or any proactive health related support.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. There were no systems for measuring outcomes, auditing care quality, reviewing goals or assessing progress. Daily notes were repetitive and did not describe whether support was effective. One person’s mobility support changed daily based on instructions from relatives as there was no formal guidance for staff to follow.

Care calls were often cut short, which analysis during this assessment identified.

The registered manager attributed short calls to “clients sending staff away” however, there was no evidence to support this.

No audits of care plans, medication, training, communication logs, or clinical risk were completed and the registered manager confirmed the only audit carried out was the review of daily logs, however, this was ineffective and not robust.

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

There was an absence of consent forms for any person receiving care. And mental capacity assessments were generic, incomplete and lacked any detail about how capacity had been assessed. For example, one person was recorded as lacking mental capacity to make a decision, but no evidence showed how this conclusion was reached or how best‑interest decisions were being made.

The registered manager told us that manual handling training occurred in people’s homes and that people consented. The registered manager did supply a basic risk assessment, however, there was no comprehensive risk assessment, consent process or mental capacity assessment to evidence this.

One contract contained incorrect signatures, so we could not be assured the person had provided informed consent to their care and treatment.

Staff said they were unsure what consent was, but could describe how they sought it in daily care tasks.