Better Care & Support Ltd

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service under this registration. This key question has been rated requires improvement.

This meant people’s needs were not always met. The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 54 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Whilst some people spoke well of their regular staff who supported them and people had formed good working relationships of respect with these members of staff.

People’s care records were not person centred. Care plans either did not contain any information about people care and support needs or lacked guidance for staff to follow on how people liked to be supported. People told us they were happy with the care; however, care plans did not provide details of their likes, dislikes and preferences. We also noted people’s preferences were not always recorded. For example, when people liked to have their wash, what food and drink they preferred, or preference on their environment. This meant it would be difficult for care staff to provide person-centred care.

Staff, including the registered manager, had up to date knowledge of people’s needs and any changes in the support they required. Formal reviews of people’s care had not taken place and care plans had not been updated with any relevant changes such as when people had been discharged from hospital, or when mobility needs had changed. This meant information in people’s care plans was not up to date and they were at of receiving incorrect care, putting them at the risk of harm.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Care plans did not contain specific information regarding people's diverse health and care needs. For example, care plans did not contain information around diabetes to guide staff on what signs and symptoms to look for. This was raised with the provider during the assessment who informed us they would act on this.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Some people told us they had access to an electronic system where planned care and daily notes could be viewed; however, this was not widely known by people who used the service. In addition, some people told us they were provided with rotas of call times and staff who would be attending, whilst others did not. This meant there was an inconsistent approach to information sharing by the service.

Staff told us they had access to policies and procedures in respect of their role.

Although people and their relatives knew what care had been agreed, how and when their care was to be delivered which indicated appropriate information had been shared, care plans did not document the person’s wishes and preferences.

There was a policy in place relating to complaints, which included timescales on complaint responses. Complaints reviewed had been responded to in line with this policy.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. The provider involved people in discussions about their care but did not always document these discussions.

The registered manager and staff were knowledgeable about people’s needs and any changes to their care, but this information was not always documented in the appropriate way. The registered manager and staff were able to be fully involved in regular conversations with each other regarding changes to care and support needs at the time of the assessment. However, this did not negate the need for sufficient recording and review systems to be in place to enable important information to be properly documented.

People did tell us they felt listened to by the service and their views and opinions were valued, however when reviewing care plans, we found no evidence of conversations with people, or of people being including in care plan reviews. This shows that discussions may have taken place, but the documentation had not been completed to ensure people’s views had been listened to.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Staff were clear about how to report concerns. They recorded concerns on the provider’s electronic system, and told us they had confidence that the provider would address any concerns.

People told us they had confidence in the care staff to get support if it was needed. One person told us, “I tried to ring the Social Worker, but they had changed and I didn’t know but 4Life got it sorted for me.” Another person who needed to make changes to their care told us, “You can just ring them up, the office is local to me as well. It’s easy to speak to them. I spoke to them about needing less visits and it was no problem at all, all very easy.”

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their support in response to this.

The provider had appropriate policies in place, such as Equality and Diversity, lone working, complaints and safeguarding to guide equitable practice. Staff had completed training in equality, diversity and inclusion which helped them better understand and reduce inequalities which may be faced by people using the service.

People using the service told us they felt listened to by the provider and the support provided was tailored to their wishes and preferences. People’s experience of the service was positive. People and relatives felt the support met their or their loved one’s needs.

The provider did not always provide support to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

An effective system was not fully in place to support people to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of the assessment, the people whose care we reviewed had not been asked about their end-of-life preferences. We did not see evidence or information on record of if people had advanced directives and ReSPECT forms in place. A ReSPECT form (Recommended Summary Plan for Emergency Care and Treatment) is used to record a person's wishes and preferences for their care, so that in an emergency, treatment can be provided in line with what matters most to them. This meant that people were at risk of receiving emergency care against their wishes.

Management staff explained that further training and work in relation to this important area was needed.