Care 4 All Limited

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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.

At our last assessment we rated this key good. At this assessment the rating has changed to requires improvement.

This meant people’s needs were not always met.

This service scored 43 (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 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.

We found that some areas of people’s care plans were person-centred, ensuring that care was provided in accordance with people’s individual needs and preferences. For example, people could choose the most suitable times for their care calls, select the activities they wanted staff to engage in. For 1 person, this included watching television and listening to music together and supporting with their iPad. However, we also identified areas where care records would benefit from more information to ensure people’s physical, mental, and emotional needs are comprehensively planned for. For example, 1 person’s general risk assessment highlighted a diagnosis of arthritis, but this was not mentioned in their personal care plan; this meant staff did not have guidance on how best to support the person.

Staff confirmed they had access to people’s risk assessments. However, during our review, it became evident that there were very few risk assessments in place. This meant that people’s care was not being tailored to their needs.

Another person’s care plan contained a risk assessment record relating to outdoor outings. There was a risk that this individual could become distressed during these outdoor activities. The risk assessment stated that staff should look out for signs or triggers that may result in the individual becoming distressed, but the record did not describe how these signs or triggers would present.

Our concerns regarding the lack of risk assessments were communicated to the registered manager during our second visit to the location, and we provided them with the opportunity to review all risk assessment records; however, no further information was received from them. The lack of comprehensive risk assessments meant people’s needs and potential risks were not clearly identified or planned for, placing them at risk of receiving care that was not safe or met their individual needs.

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

Staff had not always received the necessary training to develop the skills required to meet people’s care needs effectively. For example, in areas such as children’s safeguarding, manual handling (practical), and autism awareness training. For autistic people and people with a learning disability, staff must have the right level of training to be able to provide high-quality support. A lack of processes and records meant we could not be assured appropriate systems were in place to ensure care met the needs of the people being supported.

There was not always a joined-up approach to people’s care and support. The registered manager told us they did not always record care review information from other partners in care. There was a risk that people might not be receiving the right level of care, particularly for those people at greatest risk of a poorer care experience, such as people with learning disabilities, dementia or other cognitive impairments. (See the ‘how staff, teams and services work together’ section for more details).

Although care records described the support in place from relatives, the detail could be further enhanced to ensure the informal support is recognised and well integrated with the formal care. Including specific tasks, the amount of care the unpaid carer provides, and ensuring the plan is person-centred and co-produced.

However, feedback from relatives confirmed the service worked flexibly with their loved ones to ensure people received the care they needed.

One relative told us that the service will no longer schedule more than 4 different carers as it would be too much for their loved one, due to a diagnosed health condition. Another relative said, “They come to me if there is a problem and ask me what I think. The best thing is they’re good and good for me. Other people don’t understand.”

The provider did not always supply appropriate, accurate, and up-to-date information in formats tailored to individual needs.

We found that health action plans had not been implemented in an easy-to-read format with pictures and simplified text for individuals with a learning disability, as per the provider's policy, nor had people’s care and support plans been implemented in the same format. This meant we could not be assured that people using the service could make decisions about their care, because information was not presented in a user-friendly, understandable format.

The provider’s AIS policy did not include the name of the policy lead, which posed a risk that the service would struggle to identify, record, flag, share, and meet the communication needs of the people they supported.

However, the registered manager has staff who speak additional languages and could be paired with people who do not speak English. Some staff members are bilingual, enabling them to communicate with people in their native language. If required, documentation can be provided in easy-to-read large print, audio, and braille formats.

Relatives told us their loved ones were supported by staff who spoke their language. A relative said, “I would recommend them to others. They speak the same language. We did have another service that we didn’t like because communication was difficult. My relative did ask, “How are they going to talk to me?”

The provider made it easy for people to share feedback, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

However, there was a risk that people’s care was not always being delivered in line with relevant best practice guidance, such as ‘Right support, right care, right culture.’ The registered manager also demonstrated a significant lack of understanding regarding relevant legislation and best practices related to the Mental Capacity Act 2005. (See the ‘consent to care’ section for more details).

People and their relatives were given the opportunity to provide feedback on the service during quality monitoring visits completed by the registered manager and by completing a satisfaction survey 6-monthly. In the main people reported positive experiences, however at the time of the last survey there were a few concerns relating to punctuality, this was addressed within the providers action plan. We found the feedback captured during quality monitoring visits had not always been recorded. (See the ‘monitoring and improving outcomes’ and ‘governance, management and sustainability’ sections for more details).

We spoke with several relatives to gather feedback on the quality of the service, and none had any complaints to share. They all confirmed that the registered manager regularly liaises with them. A relative said, “The registered manager, [Person], is a good listener and most helpful; I am comfortable talking with them. I am very pleased with the service.”

Staff were able to describe the importance of listening to people. A staff member said, “If a person or relative is unhappy, I listen carefully and calmly to understand their concerns. I explain how they can raise a complaint and offer to help with contacting the manager, ensuring their concerns are taken seriously.”

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Relatives had been provided with the registered manager’s and the office’s telephone and email contact details verbally, enabling them to contact a member of staff in the event of an emergency. However, the provider's ‘service user guide’ provided to each person when their care commenced was not suitable for its intended purpose. This document did not include any telephone or email contact details for the service or the on-call system people should use for urgent matters outside of office hours.

However, the registered manager ensured that people could access the care and support they needed, for example, in emergencies and during winter times, when the weather is bad. They were able to take over from the staff and provide personal care if needed.

Staff were able to describe aids and adaptations in place to ensure people can access their care and support effectively. A senior staff member said about end-of-life care provided previously, “I have access to necessary equipment such as pressure-relieving mattresses, hoists, and medical supplies and collaborate with healthcare professionals, palliative care teams and other partners to provide appropriate support and interventions, ensuring safe and dignified end-of-life care.”

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Whilst gathering feedback from a member of staff, we became aware of an alleged safeguarding incident relating to possible unsafe moving and handling. Another staff member provided details of a person who fell during a care visit while being transferred from a chair to a bed. Both incidents were discussed with the registered manager, who was unaware of them at the time. (See the ‘learning culture’ and ‘safeguarding’ sections for more details).

People’s care was not tailored to their individual needs and preferences. The registered manager lacked knowledge of how to support autistic people and those with a learning disability. They confirmed they would request previous care records about individuals and learn from these to devise the best way to care for each person, involving everyone in putting together a relevant care plan. They said, “What we are qualified to do is personal care; we rely on professionals and family, they are the experts.”

However, the registered manager confirmed that, as far as they knew from speaking regularly with relatives, no persons had experienced any inequality of experience with the service or in the wider community. Relatives organise their own community health appointments but always discuss them with the registered manager afterwards. Unfortunately, this information was not recorded in people’s care records when care staff were absent, which meant there was a risk that people’s care would not be tailored to their individual needs.

Staff knew what to do if a person expressed dissatisfaction with their care. A staff member said, “I once supported a client's relative who was concerned about care routines by helping them raise the issue with management, who then addressed it promptly.”

People were not always supported 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.

The registered manager informed us that relatives were approached to plan for important life changes, so they could have enough time to make informed decisions about their loved one’s future, including end-of-life care.

The registered manager said, “I have had conversations with relatives, but have not recorded this. However, there is no one in that category at present. No end-of-life wishes had been recorded in people’s care plans.” The failure to record conversations which took place did not demonstrate that the registered manager understood how people’s needs could change quickly. This meant we could not be assured that staff would be aware of any previous conversations which may have taken place.

The registered manager was aware of the support that palliative care nurses can provide within the community. And knew of our support service available, including counselling and sit-in services.

The registered manager had implemented ‘health action plans’ for people with a learning disability/or autistic people, which included information on what staff are required to do in an emergency medical situation.