Better Care & Support Ltd

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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 under this registration. This key question has been rated 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 people’s safe care and treatment.

This service scored 50 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider did not always make sure people’s care and treatment were effective because they did not always check and update care plans to provide staff with effective and current guidance on people’s health needs.

We reviewed evidence of a staff messaging group where any changes to people’s care, or other important messages were shared with staff. However, this information was not transferred into care plans and risk assessment to ensure that correct information was recorded to support care staff with caring for people. This meant if staff missed the information shared in the messaging group, there was a risk of incorrect care being given.

These shortfalls placed people at risk of ineffective and inappropriate care which did not meet their needs, wishes or preferences.

People and their relatives told us they had been involved in discussions about their or their loved one’s care needs when they first started receiving support. People also told us they were kept up to date with changes and were consulted when amendments were needed to their care and support. However, this was not demonstrated within care plan documents.

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

When people first started to receive care, relevant staff completed assessments which assessed people’s health and care needs and people’s wishes. However, opportunities were missed to explore these needs, especially as situations changed and staff got to know people. For example, peoples care and support information was recorded in the initial assessment but had not been transferred into the care plans which staff should follow. This meant that people were at risk of not receiving their assessed care and support.

People’s assessment and care plans did not always reflect best practice guidance issued by The National Institute of Health and Social Care Excellence (NICE) or the provider’s own policies for supporting people with specific health care needs, such as diabetes. NICE guidelines recommend home care providers ensure staff understand common conditions affecting people using home care services, for example, diabetes, neurological and health conditions, and physical disabilities and sensory impairments. We found people did not always have care plans in place to provide staff with clear information and guidance on how to support people they visited living with Parkinsons and/or diabetes. This meant people were at risk of receiving incorrect or unsafe care and treatment.

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

People’s needs and risks had not always been assessed to enable full and accurate information to be shared with other teams or other professionals should an emergency occur. There was a lack of documentation to share with services, such as paramedics in case of emergency. Evidence of communication with health and social care professionals was minimal and therefore impacted upon staff knowledge of the people they supported. Information was shared in a messaging group so staff were updated; however, information shared could easily be missed meaning that there was a risk of incorrect and unsafe care being provided.

We received mixed feedback around people being supported by a consistent staff team. One person told us, “it’s usually one of a team of carers, because [person] needs continuity, if there is someone new, we get 3 carers, 2 to do and 1 shadow, so they know what to do, and [person] knows them, it is so important.” A relative told us, “it’s all different carers but they are pretty much on time, and I am sure they are safe with them but sometimes their English isn’t so good and [person] struggles, but they are very good with [them].”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

Records showed people who required support with their nutrition and hydration were supported appropriately, with snacks and drinks left for them in between visits.

Some people and their relatives told us staff supported them to be independent and helped them with the daily living tasks they needed help with. One person told us, “They do all [relatives] meals, but [they are] a picky eater, [they] will only eat ham sandwiches and toast and marmalade but [carers] do offer [them] other stuff, and they make sure [they have] a drink, tea or juice or whatever.” However, another person told us they requested that their relative be given a certain amount of fluids at each visit and this was not followed. This was discussed with the provider who advised that they would address the concerns and liaise with family and professionals.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

The systems in place to keep track of people’s needs and risks were not robust. People’s needs and risks were not properly recorded. Regular reviews of people’s risks were not completed in a structured or consistent way to enable changes to be identified and monitored.

People told us that they were involved in care plan reviews; however, documentation did not always reflect this and care plans were not always updated when people’s needs or the support they received had changed. This meant people were at risk of receiving incorrect care and supporting, placing them at risk of harm.

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

There was a policy in place to guide staff on how to assess people’s capacity to make decisions in accordance with the Mental Capacity Act. However, this guidance had not always been followed. Where there were concerns about a person’s capacity to consent, an assessment of their capacity had not always undertaken to ensure any decisions made were in the person’s best interests. This meant people were at risk of receiving care and support against their wishes or not in their best interests.

The registered manager and staff understood the importance of gaining consent prior to supporting people with personal care. Staff told us they received training on mental capacity and demonstrated and understood how they used this when caring for people.

One staff member told us, “I have received training in the Mental Capacity Act. This means I support people who may lack capacity by acting in their best interests, involving them as much as possible in decisions, and respecting their rights and choices.” People told us consent to care was obtained.