Willow Home Care Ltd

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 inadequate. At this assessment the rating has remained inadequate.

This meant there were widespread and significant shortfalls in people’s care, support and outcomes.
 

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At our previous assessment we had concerns because people’s care plans and risk assessments did not provide consistency or correct information of people’s needs. At this assessment we found little improvement had been made.

The registered manager told us people’s care and support needs were assessed when they first started using the service. However, these assessments were not always kept up to date. People’s care plans had not always been reviewed following changes in their condition or circumstances, which resulted in a care plan which did not reflect their current needs. One person’s care plan stated they were waiting for a hoist to be delivered, despite this having been delivered and staff were using it. The person therefore had not been assessed, and staff did not have guidance for the safe use of the hoist. One relative told us, “Nobody came from Willow [Home Care Ltd] to do an initial assessment, the staff just turned up. It was down to me to tell the staff what was needed and how to look after [Person’s name]. Someone eventually came from the office about a week later to do an assessment.”

Important information about people’s care and support needs had been omitted from some support plans. We found contradictory information across peoples care records with regards to their medicines, catheter care and risks. One person had started using the service after being discharged from hospital with a fractured arm. Their care records did not state which arm or arms were injured and what impact this had on their care, independence and ability to perform daily tasks. Therefore, staff did not always have access to consistent or clear guidance on how to support people in line with their assessed needs.

People and relatives did not always feel involved in the assessment of their needs. Most people remembered being involved with setting up their care plan but then told us they were not aware of any reviews of their care. Staff also told us they were not aware of every person being involved in reviewing their care plans. One staff member told us, “I don’t know who updates the care plans, I’m not involved and I don’t know if the clients are.” Another staff member told us, “The seniors update the care plans, but the carers and clients are not involved that I’m aware of.”
 

The provider had not applied national standards or evidence based frameworks such as National Institute of Clinical Excellence (NICE) guidance when they planned and reviewed people’s care. People’s care plans did not reflect best practice guidance in relation to support with specific health care needs, such as medicines management, catheter care, diabetes and skin integrity.

No formal assessment tools were used to evaluate people’s ability to maintain adequate nutrition and hydration. One person’s dementia risk assessment stated they needed prompting and supervision to maintain adequate hydration and nutrition. However, their care plan stated they had full ability to cook for themselves. The registered manager told us the person’s ability to maintain their own nutrition and hydration fluctuated, but this was not reflected in their care records. This meant staff did not have accurate or consistent information to support the person safely and effectively.

We had concerns about how the provider monitored people’s skin, especially when there was deterioration of their pressure areas. Staff did not always escalate skin concerns to senior staff, and we noted in 1 person’s daily care record staff had recorded the person had 3 open wounds. This was after numerous entries of them experiencing sore skin. A senior staff member told us no body charts were completed to record injuries, and they had no way to monitor progress other than the daily care records. No best practice guidance was used to assess, monitor and escalate skin concerns.

Risk assessment tools which were in place were not used correctly to get an accurate picture of a persons’ specific health need. One person’s mental health risk assessment had been incorrectly scored as low risk. When the assessment tool was used correctly, the score would have placed their mental health risk at medium, not low. We found this was the same for multiple risk assessments. This failure to follow the provider’s own assessment tools meant people may not be supported effectively.
 

The provider failed to demonstrate how they shared information across different services for the benefit of people. When people had no medicines and therefore missed their doses, health professionals were not always contacted. Care plans did not contain essential information to identify where people received additional support by separate services. One person had a personal assistant who shared care responsibilities; however, this information was not recorded in their care plan.

The lack of robust systems and documentation meant information available to share with other services and health professionals was not available or comprehensive. For example, where staff had failed to record how a person coped with a specific activity, there was no information available to be shared with the health professional who had asked for this to be recorded. This prevented effective monitoring of the person’s progress and limited the health professional’s ability to review and adjust care appropriately.

Staff failed to share key information with managers, including high blood sugar readings, incidents of skin breakdown, and when people ran out of medicines. This failure to share within the organisation meant consistency in people’s care could not be achieved effectively.
 

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

People's care plans for people did not always contain information about what people were able to do for themselves to encourage them to stay as healthy as possible. Some people were at risk of skin breakdown, and their care plans encouraged staff to reposition them “regularly”. However, the care plans did not state what “regularly” meant and staff did not always record if they had repositioned people. Where people had diabetes, their care plans stated staff were to ensure the person’s skin integrity and foot care were monitored regularly but again, there was no evidence of this. People’s ability to manage their own oral care had not been assessed and guidance was not always to staff on how they should people with their dental hygiene. This did not support people to reduce their future care and support needs.
 

The provider did not routinely monitor people's care and treatment to continuously improve it. They did not ensure outcomes were positive or positive or that they met clinical expectations and the expectations of people themselves.

People were at risk of poor outcomes and there was little evidence of care having a positive impact on people’s needs over time. One person’s care plan gave instruction for care staff to document how well they coped with a specific activity. These records could then be viewed by an external health professional so they could review their progress. However, the provider had not ensured staff completed these records which prevented effective monitoring of the person’s progress.

People’s outcomes were not effectively monitored, which resulted in missed opportunities to identify and improve poor care. The provider had failed to recognise care call times affected the safe administration of one person’s medicines until we highlighted this during the assessment. The person’s medicine was prescribed with a minimum 4-hour interval between doses. However, staff frequently arrived late for some care calls, while subsequent calls took place as scheduled. As a result, doses were recorded as not administered because the required time interval had not been met. This failure to monitor outcomes and identify the impact of missed and delayed care meant the person experienced poor care outcomes.
 

At our previous assessment we had concerns with how the provider obtained people’s consent. At this assessment, although some improvement was found we still had concerns.

There was little evidence of people’s capacity to consent to their care or evidence the provider had followed the Mental Capacity Act 2005 (MCA) to obtain people’s consent. The provider could not show how decisions about care and treatment had been made. Where people were living with dementia, their care plans did not guide staff about how to support decision making or if they had capacity to make their own decisions. One person’s risk assessment stated they had been assessed as having “medium cognitive risk” but there was no information on what this meant. There was also no evidence of any capacity assessment having been completed.

People’s care plans lacked any information regarding their preferences for decision making or how they had been supported to make their own choices around their care. Care records did not detail if there had been any conversations with them or their family around consent. Where relatives made decisions on behalf of people there was no evidence this was their choice or preference as no consultation or meetings had taken place to include the person in this decision.

The provider’s training matrix showed staff had not received training on the Mental Capacity Act or supporting people with consent. However, staff told us they had. Staff knowledge around MCA was basic and staff we spoke with told us the people they supported could make their own decisions and consent to their own care.

However, feedback from people indicated staff asked for their consent and involved them in the day to day decisions about their care. One relative told us, “Staff help [Person’s name] make a choice for dressing and washing.”