Jewel Home 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.

This is the first assessment for this newly registered service. 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.

This service scored 42 (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 did not always have a care plan in place or have access to their care plan and it was not clear that care plans had been regularly reviewed in line with people’s changing needs. One person told us, “There isn’t a care plan, but I try to get [staff] to do what they are supposed to do.”

Another person said, “I have not seen a care plan. The previous company had a folder, but I haven’t seen a new folder.”

Relatives echoed this feedback, with one saying, “There is a care plan, but it hasn’t been reviewed. [Staff] didn’t shower [family member], but after pushing them, they now shower [family member] once a week.”

The lack of robust care plans meant staff did not have access to essential guidance to deliver effective care to the people who used the service.

Some care plans we reviewed did have good amounts of detail in them, however this was not the case with all of them, and we identified some to be lacking important information, or requiring the information to be more detailed.

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

The provider failed to ensure people’s changing needs were consistently assessed and support plans fully reflected all the person’s needs, including health, personal care, emotional support, social interests and activities and cultural, religious and spiritual needs.

Leaders did not understand national tools, and when these should be used to maintain effective oversight of care delivery.

We identified a person who was at risk of malnutrition to not have a Malnutrition Universal Screen Tool (MUST) score which should be regularly reviewed. This meant staff did not have an accurate current score for the person, or the opportunity to regularly review and monitor this to ensure there was increase in score, which would indicate an increased risk of malnutrition.

Another person, who was at increased risk of skin breakdown, did not have a Waterlow Score in place. A Waterlow Score helps care providers assess a person’s risk of developing pressure ulcers. This meant staff did not have the baseline score and could not take action to help the person avoid pressure sores and their possible complications.

We found one example of a Waterlow Score having been completed for another person, however this had not been reviewed or updated in over 12 months and so we could not be sure of its accuracy, and that staff have the correct information.

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.

A person who required assistance with manual continence care, had been receiving care from staff who did not have the correct training. The provider had failed to raise this, and request this training from specialist healthcare services prior to the commencement of the package.

Concerns were also raised by the Local Authority regarding how the service worked with them to ensure people received effective care in line with their commissioned care.

Some records of communication between GP’s and District Nurses were observed within people’s records.

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

People’s day to day health and wellbeing needs were not always met. A relative said, “If [staff] spot anything, they point it out to me and I ring the doctor for an appointment. [Staff] won’t do it themselves. The carers couldn’t collect a specimen, and I had to do it. [Staff] don’t use their own initiative.”

We also reviewed another person’s care records, which identified them as being at high risk of skin breakdown. The care plan stated staff should support the person to reposition every 2-3 hours. However, the planned care visits did not always align with this repositioning care plan, meaning staff were unable to fulfil this need. This had not been identified by the provider and did not support the person to reduce their future needs for additional care in relation to skin breakdown.

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Staff completed daily records for people, however these were found to lack detail and information, such as the volume of drink a person had been made or offered. We saw evidence of the deputy manager contacting staff to remind them of the importance of this, especially for people who were approaching the end of their lives.

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

The majority of people using the service did not require capacity assessments to be completed in respect of their care. This was because they either did not have any impairment of the mind or brain, or the provider had no reason to doubt the person’s capacity.

The provider had completed a mental capacity assessment for a person which deemed them to lack capacity in a particular area of their care, however, a Best Interest Decision had not been completed. This meant staff did not have accurate information on how best to support the person, and the provider was not operating in line with the Mental Capacity Act 2005.