Elite Care 24/7

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• 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.
 

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 ensure people's care and treatment were effective.

Although people's needs were assessed and discussed, this did not always result in care plans, risk assessments and daily care records containing sufficiently detailed and accurate information to guide staff in delivering consistent care and support.

People's needs were assessed before they started using the service. However, some people and relatives told us their care and support arrangements had not been reviewed regularly. One person said there had, "not been any reviews for a long time".

The registered manager told us the implementation of a new electronic care planning system had prompted a review of people's care records. They explained care plans were being updated with plans to involve people and their relatives in regular reviews of their care to help ensure records accurately reflected their current needs and preferences.

Most care plans contained relevant information about people's health, care and communication needs and supported staff to deliver care that promoted positive outcomes.

However, where people had more complex needs, records were not always sufficiently detailed. For example, one person's care plan identified complex health conditions, communication needs and behaviours of concern, but did not provide clear guidance for staff on how these needs should be met in practice.
This meant staff may not always have had access to the information needed to provide consistent, person-centred support. The lack of detailed guidance increased the risk of inconsistent care, particularly when support was provided by staff who were unfamiliar with the person's needs.
As a result, the provider could not always demonstrate that assessed needs were translated into clear care planning and support arrangements to ensure effective outcomes for people.
 

The provider planned and delivered people's care and support in partnership with them, taking account of their preferences, individual needs and what was important to them.

People told us staff supported them in ways that reflected their wishes and preferences. One person said, "They (staff) always ask how I am and, if I am not well, take a little more time to chat with me."

The provider sought to match staff with people based on their preferences such as gender, age, language and interests. This helped people build positive and trusting relationships with staff and supported the delivery of care that respected their individual identities and preferences.

People spoke positively about the relationships they had developed with staff. One person told us, "They (staff) have been teaching my loved one to Bhangra dance, which they really enjoy."

People told us they received effective support with eating and drinking. People said staff respected their choices and supported them to have meals and drinks they enjoyed. This helped ensure support reflected people's preferences and contributed to positive outcomes.
 

Staff worked well together and maintained effective communication with families to support people’s care and wellbeing. One staff member told us, “We work very well as a team, I feel proud to help people.”

Staff supported people to access healthcare services and regularly accompanied them to hospital and healthcare appointments to ensure their health needs were met. During hospital admissions and emergency situations, staff worked closely with families and healthcare professionals to share information and maintain continuity of care.

The provider worked with external professionals to help ensure staff had the skills and knowledge needed to meet people’s needs. For example, social work professionals delivered specialist training to staff to enable them to support a person with complex needs safely and effectively. Staff told us this increased their confidence and understanding, helping them provide more personalised support.

However, the provider did not always work proactively with external professionals to maximise outcomes for people. We identified an occasion where a person may have benefited from specialist equipment, but a referral had not been made to the appropriate professional for assessment. This meant opportunities to further enhance the person's independence, and comfort had not been fully explored.
 

The provider supported people to manage their health and wellbeing in ways that promoted their independence, choice and control. Staff supported people to live healthier lives and, where possible, reduce their future needs for care and support.

Staff monitored people's health and wellbeing and generally responded appropriately when changes were identified. Records showed changes in people's health needs were recorded, reported and acted upon.

Staff sought advice from relevant healthcare professionals, including GPs and specialists, to support people to access treatment and care. However, we identified occasions where opportunities to seek specialist advice or intervention were missed, which may have resulted in avoidable anxiety or distress for people.

Most people and their relatives were satisfied with the support they received to manage their health needs. People told us staff monitored their wellbeing and communicated any concerns promptly. One person told us, "They always let my family know if I have been unwell and make sure I am ok before they go."

However, information within the electronic care record system did not always provide staff with sufficient detail about people's health conditions and how these affected their care and support needs. The registered manager explained that detailed health information was currently maintained within paper-based care plans held at each service. Whilst we found relevant information within these records, there was opportunity to add further detail to ensure a comprehensive overview of people's health needs was available for staff.

The provider acknowledged this and confirmed enhanced health information would be incorporated during the rollout of the new electronic care record system.

The potential impact of this was reduced because people were generally supported by a consistent staff team who knew them well and understood their individual health needs. As a result, people continued to receive support which reflected their known health conditions and preferences.
 

The provider did not always have effective systems in place to routinely monitor people's care and treatment and use this information to continuously improve outcomes.

As a result, they could not always be assured that people consistently received support that met their needs and expectations.

Although the provider completed audits of care plans and medication administration records (MARs), these processes were not always effective in identifying concerns or driving improvement. For example, staff had recorded incidents within daily records; however, these had not been transferred to the incident monitoring system or reviewed by the registered manager.

This meant patterns, risks and opportunities to review people's support may not have been identified in a timely manner.
As a result, opportunities to ensure people received the most appropriate care, support and treatment were missed.

We discussed this with the registered manager during the assessment, who acknowledged the concerns and took immediate action to review the incidents and strengthen oversight processes.
This demonstrated that governance and quality assurance systems were not always sufficiently robust to effectively monitor care and drive continuous improvement in outcomes for people.
 

Staff generally sought people's consent before providing care and treatment and offered choices in relation to their daily support.

Staff told us they always asked for consent and respected people's decisions wherever possible. They explained that when a person had difficulty communicating or lacked capacity to make a specific decision, they still involved them as much as possible in the decision-making process.

People spoke positively about the way staff supported them to make choices. One person told us, "The staff always ask me if they can help me with a wash and if I want my tablets. They help me with my meals too and always ask me what I would like."

Staff had received training in the Mental Capacity Act 2005 (MCA). Where people lacked capacity to make specific decisions, capacity assessments and best-interest decisions had been completed. However, these were not always completed in line with MCA principles and did not consistently demonstrate that less restrictive options had been considered before decisions were made on a person's behalf.

This meant the provider could not always demonstrate that people's rights were being fully protected in accordance with the MCA.

Although staff sought consent in day-to-day practice and people told us they were offered choices, improvements were needed to ensure mental capacity assessments and best-interest decision-making processes were consistently completed in line with legal requirements.