Care 4 All Limited

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 good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation to the need for consent to care.

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 always make sure that people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing, and communication needs with them.

People’s needs were assessed before they began using the service, and we found that this information was transferred to people’s care and support plans. However, the information contained within the initial assessment document was not robust and would not enable the registered manager to populate a fully personalised care plan.

For example, there were some inaccuracies and incomplete sections. Allergy information for 1 person was missing despite their care plan stating they had allergies. For the same person within the nutrition section of the initial assessment, a specific dietary need had been identified; however, it was stated that there was no risk present, despite the person being borderline diabetic and requiring a healthy, controlled diet.

Furthermore, a generic risk assessment (also referred to as an initial assessment by the service) completed for another person was found to be missing information regarding nutritional risks. The generic risk assessment had not recorded the level of choking risk for 1 person, stating ‘no risk identified’ despite staff comments highlighting that there are occasions when pureed foods are required due to difficulties swallowing. A standalone risk assessment was implemented on the same day; however, the generic risk assessment record, which remains a live document, was not updated to reflect the newly identified risk. (See the ‘supporting people to live healthier lives’ section for more details about choking risks).

The provider failed to have effective systems in place to fully assess people’s care and support needs. There was no evidence that other professionals had been contacted, particularly for those people with a learning disability and/or autistic people, to gather additional information regarding the specialist support required and any known risks. This meant that the provider could not be sure they could meet people’s care needs before care commenced.

The registered manager confirmed that they maintained regular communication with people and their relatives through formal and informal meetings to ensure their care and support remained responsive and person-centred. Care reviews typically occurred every 6 to 12 months, or more frequently if necessary. Care staff maintained daily verbal contact with families during their visits and relayed any feedback or concerns to management.

One relative informed us that the registered manager had recently completed a care review with them, and their loved one’s care and support needs had changed. Following the review 2 carers now attend to their relative. Staff confirmed that people’s care is usually reviewed every 3 to 6 months, or sooner if their needs change or in an emergency.

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

The registered manager was not always aware of relevant best practice guidance, such as ‘Right support, right care, right culture.’ For example, care records for 2 autistic people included an autism profile; however, they both lacked details and did not include a person-centred summary of their individual unique strengths, challenges, and sensory needs. Information relating to communication preferences was available, and although it described the tools used to communicate, it did not provide guidance on how staff should utilise these tools effectively.

There was a significant lack of understanding regarding relevant legislation and best practices related to the Mental Capacity Act (MCA) 2005. Although some records were in place relating to people’s capacity to consent to their care and the sharing of information, these had not been completed correctly. Where relevant, no best interest meetings had been organised with external professionals.

Since 2016, all organisations that provide publicly funded adult social care have been legally required to follow the Accessible Information Standard (AIS). The standard was introduced to ensure people receive information in a way they can understand. The standard applies to all people with a disability, impairment, or sensory loss and, in some circumstances, to their carers.

The provider’s AIS policy included details of the legal framework; however, the registered manager was initially unable to describe how the service met this standard during an interview. After some prompting from the inspector, the registered manager was able to describe how they delivered care and support in line with this standard. (See the ‘providing information’ section for more details).

However, staff were able to describe how they would use national tools when there was a requirement to understand people’s needs. For example, the Malnutrition Universal Screening Tool (MUST), which assists with nutritional assessment, and the Waterlow Score, which can identify individuals at risk of developing a pressure ulcer.

The provider did not always work well across teams and services to support people.

The registered manager told us that various health and social care professionals visit people in their own homes; however, this information was not recorded in people’s care records if care staff were absent at the time.

Furthermore, the registered manager confirmed that when a local authority care review was due, they were not responsible for arranging or documenting these. This meant there was a risk that important information relating to people’s care and support needs might not be known, which could impact the effectiveness of the care provided. This would also affect the continuity of care if people transitioned between services.

However, a member of staff told us, “The service communicates and works closely with external partners, promoting continuity of care, though occasional delays in information can occur.”

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

We found no records indicating external support from health professionals, including speech and language therapists (SALT), occupational therapists, and specialist clinicians, despite the registered manager advising that meetings took place outside scheduled visit times. This meant the provider could not be assured they were providing the right care in line with health professional advice and recommendations.

The provider’s systems and processes to ensure care records and risk assessment reflected the support needs of people were ineffective. It was not always clear how staff should appropriately support people in managing their health and wellbeing. For example, a person’s care plan detailed several day-to-day health, and well-being needs that staff were required to support, including assisting with moving around the home whilst utilising mobility aids to reduce the risk of pressure sores, and providing support when the individual showed signs of pain. However, care staff were not provided with the guidance they needed to support this person’s mobility, to recognise when they were in pain, or to understand how they were required to support other care needs, as detailed in the plan. There was a risk that staff would not be able to provide appropriate support to prevent deterioration in health.

A staff member said, “One person has diabetes, so we help them follow their recommended diet plan.” We were not provided with a copy of this diet plan. (See the ‘assessing needs’ section for more details).

Another member of staff told us, “Some clients have specific dietary needs, such as swallowing difficulties. I meet their needs by preparing meals safely, providing the correct textures, monitoring their intake, and supporting them according to guidance from healthcare professionals.”

However, we reviewed this person’s care records. Although a choking risk assessment was in place, the registered manager had not referred this person to the speech and language therapy (SALT) team for an assessment. The SALT team are the clinical experts trained to assess and manage swallowing disorders.

The choking risk assessment included some measures to control the risk; however, there was no guidance for staff on how to support this person safely with eating and drinking. Including the safe textures of food and the thickness of drinks required for this individual, nor any information on what staff should do in the event of a choking incident. The absence of specialist advice and guidance meant we could not be confident that the registered manager was ensuring people received food and drinks that met their individual needs and requirements.

The service did not support people in attending medical appointments, such as GP visits. For autistic people and people with a learning disability, care records did not indicate whether they had received an annual health check. This meant there was a risk that potentially serious, treatable health issues might go undetected, increasing the risk of deteriorating health and care needs.

The provider routinely monitors people’s care and treatment to continuously improve it. However, the approach to monitoring the effectiveness of people’s care and support, as well as the actions taken to improve it, was not robust.

The registered manager confirmed they telephoned people weekly to gather feedback on the care they received. However, these calls were not recorded, and it is therefore unclear what was discussed, whether people were satisfied with their care outcomes, and whether the care they received promoted a good quality of life. Without relevant evidence, it was unclear whether people’s outcomes were positive and consistent, or whether they met both clinical expectations and the expectations of people themselves.

We were advised by the registered manager that they had visited 5 people on the same day to discuss the quality of their care and check on expected outcomes; however, even though the record provided for these visits listed the initials of all people receiving care at the time of our assessment, it only contained data relating to 1 person. We found that the checks in this record were generic and captured only the voice of 1 person who had previously used the service. This meant that the quality of care feedback captured from the other 4 people could lead to people’s preferences, concerns and wishes not being addressed.

Health Action Plans were in place for all people using the service. However, the plans were not appropriate or suitable for autistic people and people with a learning disability. The primary purpose of a Health Action Plan is to support individuals in maintaining their health and accessing the necessary services and support. It is a mechanism to link an individual with the range of services and supports they need to achieve better health. The plan is primarily designed for individuals with a learning disability. It is usually co-produced with them, helping people maintain and improve their own health by focusing attention on relevant health issues, identifying concerns and how to address them. This was not the case with the evidence we reviewed.

Care staff confirmed they monitored clinical outcomes by recording individuals' food and fluid intake, observing any changes in their health, and providing extra support when people’s needs change.

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

At our last assessment, we found no evidence of mental capacity assessments (MCAs), indicating that people’s rights and decisions regarding consent were not understood and respected. During this assessment, we identified similar concerns.

The registered manager did not understand their responsibilities regarding the Mental Capacity Act 2005 and failed to ensure the principles were followed.

Several MCAs had not been completed. We identified that the service had only completed MCAs for decisions relating to staff supporting with personal care. For example, decisions are also required regarding access to the community, moving and handling, finances, and maintaining a healthy diet. This meant people were at risk of having choices and decisions made without their knowledge or input, or in their best interest.

Where people lacked the capacity to make a decision, the registered manager had not organised any decision meetings. For example, a mental capacity assessment had been completed for 1 person to consent to receiving care and treatment and sharing personal data. The outcome of this assessment was that the person was unable to make the decision described. However, the registered manager did not follow the decision-making process and involve other professionals and relatives in this decision.

Consent to care and treatment and the sharing of personal data records were in place for all people using the service; however, the information contained in these records was incomplete, inaccurate and at times conflicting. The registered manager had arranged for relatives to sign a record consenting to care and treatment, and to the sharing of personal data records for their loved one, both of which are an integral part of the legal MCA framework; despite no relatives holding a Lasting Power of Attorney (LPA).

However, a member of staff told us, “People’s consent is sought continuously throughout their visits. We never assume, we always explain what we are going to do step-by-step and ask for their permission.” We found staff knowledge regarding day-to-day decisions around choice and control was good.