Orbital 4 Support Limited

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 changed to required 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 46 (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 ensure people’s care and treatment were effective because they did not consistently check or discuss people’s health, care, wellbeing and communication needs with them. Although assessments of need were in place, there was no effective system to ensure these were regularly reviewed or updated. Information in people’s records did not always demonstrate their involvement in planning their care. Some terminology used in care records was outdated, and where risks were identified, it was not always clear what actions had been taken to reduce them.We were not assured people had up to date comprehensive assessments of need which had been created by all relevant people to ensure peoples voices were heard.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not consistently ensure care and support were planned and delivered in line with current legislation and evidence‑based practice. There was a lack of effective understanding and application of the Mental Capacity Act (MCA) to support people with choice and involvement in their care, and the principles of Right Support, Right Care, Right Culture had not been embedded into everyday practice. Further exploration and implementation of current evidence‑based approaches would help strengthen outcomes for people receiving care and support.

The provider did not always work effectively across teams and services to support people. They did not consistently work well with other agencies to ensure people received coordinated and effective care. Feedback from some professionals was mixed, including professionals sharing concern over how actions were documented or evidenced by the provider. The provider expressed frustration about delays by external professionals in resolving people’s outstanding needs. This did not mean people were receiving poor care, but it indicated that improvements were needed in the provider’s relationships and communication with key external professionals.

The provider supported people to manage their health and wellbeing and encouraged people to live healthier lives. Staff promoted healthy eating by supporting people to buy and prepare fresh food, taking account of their health and dietary needs. People were supported to spend time outdoors, and staff encouraged regular exercise.

People had access to healthcare professionals and were supported to attend appointments that monitored their health needs.

Although some people told us they were supported to be independent, there was limited written evidence in daily care records to demonstrate and evidence how people were consistently enabled to maximise their independence, choice and control.

The provider did not always routinely monitor people’s care and treatment to support continuous improvement. They did not consistently ensure that outcomes were positive, reliable or aligned with both clinical expectations and the expectations of people themselves. Although there were systems in place for staff to communicate and share updates about people’s wellbeing, the provider did not have a comprehensive system to document and evidence how people’s health needs were monitored and responded to.

Where a person’s health needs had increased and a risk had been identified at night, it was not clear what actions had been taken to reduce this risk. The provider told us a new electronic records system was being implemented to improve the accuracy and availability of care records. However, during the inspection we found inconsistencies in both the quantity and quality of the information being recorded which increased the risk of any changes in people’s health and wellbeing not being identified or addressed in a timely manner.

The provider did not always tell people about their rights around consent and did not consistently respect these rights when delivering care and treatment. The provider and staff did not demonstrate an effective understanding of the principles or application of the Mental Capacity Act (MCA 2008). Decisions made on people’s behalf did not clearly document how the decision had been reached or show how the person had been involved. We were not assured that the provider had fully considered people’s best interests when making decisions, and the rationale for decisions was not always clear.

Financial decision‑making also lacked transparency. For example, it was not clear how people were supported to agree the settling of shopping bills or payment of utilities, there was no documented evidence that people had been given choice or that their best interests had been considered.The provider told us they had made changes to increase people’s involvement in their care, but further improvement was needed to ensure decisions were clearly documented and transparent. This was a breach of Regulation 11 (Need for Consent) of the Health and Social Care Act 2008.