Peartreelifecare 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.

This is the first assessment for this supported living 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 58 (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’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
The provider did not always assess, plan and review people’s needs in a consistent and person‑centred way. This meant people and their relatives were not always meaningfully involved in decisions about their care.
Care plans were in place and reviewed every six to twelve months. However, they did not always contain accurate or up‑to‑date information. For example, some care plans described people enjoying activities or equipment that were not available, and others did not reflect people’s living environments. Audits had not identified these issues. Relatives gave mixed feedback about involvement. One relative told us, “I’ve not seen [relative] care plan. All the information was handed over by the other care provider.”
 

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.
The service used recognised clinical tools, such as Waterlow risk assessments, (a tool used to identify individuals at risk of developing pressure ulcers) to review people’s needs. Care plans referred to National Institute for Health and Care Excellence (NICE) guidance and showed staff working alongside healthcare professionals. Staff had completed relevant clinical training, including Percutaneous Endoscopic Gastrostomy (PEG), Bilevel Positive Airway Pressure (BiPAP) and medicines competencies, supported by nurses and external specialists.
 

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
The service worked with a range of professionals, including GPs, local authorities, specialist nurses and allied health professionals. Records showed evidence of multidisciplinary working and positive feedback from external professionals. Staff told us care plans and risk assessments contained enough information for them to support people safely. However, we were not assured due to the shortfalls we identified in people’s care plans.
Relatives confirmed staff generally knew people well and worked consistently with professionals involved in their care.
These arrangements helped to promote joined up care, although better recording of outcomes would strengthen this further.

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

People were supported to attend health appointments and had received annual health checks. Records showed timely referrals to healthcare professionals and evidence of multidisciplinary meetings. Relatives gave examples of staff identifying changes in people’s health and responding appropriately.
Care plans did not always consistently include clear guidance on how people wanted to be supported with specific health needs, such as oral care or hair washing. These gaps were discussed during the assessment. However, staff demonstrated a good understanding of people’s health needs and worked closely with families, GPs and specialist services to promote wellbeing.
 

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

Health action plans and outcome focused tools were in place, and the service had introduced designated champions to support improvement. However, care plans often lacked clear, agreed outcomes, and care notes did not consistently record sufficient detail to evidence progress, for example in relation to catheter care.
Audits had not identified these issues prior to the assessment. This meant the provider could not be assured people’s outcomes were being consistently reviewed or improved. The registered manager acknowledged these concerns and described actions taken during the assessment to strengthen recording and auditing processes.
Records showed professional involvement, and people’s health needs were reviewed with referrals made when required. Staff knew people well and understood their communication needs. However, it was not consistently evident people were fully included in reviewing their care or supported to work towards longer term aspirations. These concerns were discussed during the assessment, and the registered manager told us steps would be taken to improve how people’s involvement is evidenced in care records.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.
People and relatives told us staff asked for consent before providing care, and we observed staff seeking consent before supporting people. Staff understood how to check Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) status, and relevant policies and training were in place.
However, Mental Capacity Assessment (MCA) documentation did not always clearly record the questions asked, the decision making environment or people’s involvement. Best interest decisions did not consistently show how people or their relatives were involved. These issues were discussed during the assessment, and improvements were made at the time of this assessment. Further work was needed to ensure consistent, clear recording.