IECC CARE

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 requires improvement. At this assessment the rating has remained 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 consent to care and treatment. In cases where people’s capacity was deemed to be lacking, no Mental Capacity Act (MCA) assessments had been undertaken to establish whether individuals were able to retain, use, and weigh information in order to give informed 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 was effective. People’s health, care, wellbeing and communication needs were not always monitored, checked and discussed with them. Relatives told us they were not always involved in care plan reviews. One relative said, “[Person’s] care plan states it was reviewed on 14 February 2026, but I was not aware of this being reviewed and have not been involved in any previous reviews.” The provider confirmed the care plan review had taken place and acknowledged the relative had not been involved, but moving forward relatives would be formally invited and included in all future care plan reviews.

The provider did not have effective systems in place to ensure staff were kept up to date with relevant legislation, national standards, or evidence-based good practice. Feedback from relatives about staff knowledge and competence was inconsistent, particularly when people had specific or complex needs. Several relatives expressed concern that staff lacked sufficient understanding to support people with specialist needs, including diabetes, dementia and brain injury. One relative stated, “There have been times where I have said [Person] is diabetic and nurse does their insulin, and staff seemed surprised. They should know it; it is in [Person’s] care plan so they should be reading it. Not all of them do.” While some relatives reported good personal care skills and safe moving and handling by regular staff, this practice was not consistent across the workforce.

Care plans did not always include sufficient, up-to-date guidance to support staff in meeting people’s specific needs, such as the management of diabetes and Huntington’s disease. Staff had not received adequate specialist training in these areas. As a result, people’s care, treatment and support were not always planned or delivered in line with national standards and evidence-based good practice.
 

People’s care plans reflected the service had worked in partnership with a wide range of external specialist services to ensure their care and support was tailored to their individual needs, including GPs, district nurses, occupational therapists. However, relatives told us, staff did not always follow advice from health professionals. For example, a relative commented, “Staff don’t always offload [Person’s] heels as instructed by the district nurse. They are supposed to do this. [Person] has no current pressure ulcers but has in the past as diabetic feet can be a problem.”

Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. However, risks to people’s health and wellbeing were not always being identified and prioritised to prevent deterioration. Referrals to appropriate health services were not always being made quickly when people’s needs changed. One person told us, “I have been coughing a bit the last couple of days. I have to be a bit careful about what I eat so I don’t choke.” We observed the person had access to a large tub of assorted biscuits, which they ate throughout the day. Dry, crumbly biscuits are recognised as high risk foods for people at risk of choking as they can crumble in the mouth, leading to coughing or airway obstruction. In March 2024, staff had identified concerning signs that the person was beginning to choke on certain foods during a review of their malnutrition and dehydration risk assessment. A referral to speech and language therapy (SLT) was reportedly made via the person’s GP at that time. However, there was no documented update to confirm whether the referral had been received, whether an assessment had taken place, or what interim actions had been implemented to reduce the risk of choking. The review documentation showed no changes from the 2024 assessment. The provider confirmed that no SLT assessment had been completed. A further referral was made on 17 February 2026, and professional advice regarding swallowing and dietary recommendations was sought to support the person’s safety in the interim.

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. Review of people’s records showed staff were monitoring their health, including fluid input and output, food intake, continence and skin integrity. However, recording needed to improve. Daily care records focused mainly on tasks, not on the person. They did not explain how the person spent their day, how staff supported their independence, or how care supported their wellbeing. The records were split between paper and digital systems, which made them confusing. They did not clearly show everything that happened over a full 24‑hour period. Records often did not explain what staff actually did or what part of the person’s care they were checking. Because the records were unclear, it was difficult to tell whether people were consistently receiving safe, effective, and good-quality care.

The provider did not consistently inform people of their rights in relation to consent and did not always respect these rights when delivering care and treatment. Care plans recorded people’s capacity under ‘Communication and Cognition’ as having full, partial, or no capacity; however, there was no evidence of mental capacity assessments being completed in line with the Mental Capacity Act (MCA). For example, one person’s ‘Communication and Cognition’ record stated they had partial mental capacity, but it did not explain how this impacted their day-to-day decision-making or their ability to consent to care and/or treatment. There was no supporting documentation to demonstrate how their capacity had been assessed. In particular, there was no evidence to show what information had been provided, whether the person could understand, retain, and weigh up that information, or how they communicated their decision, as required to determine whether they had capacity or lacked capacity for specific decisions.