Capital Staffing Services Ltd

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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 inspection we rated this key question good. At this assessment the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 demonstrate effective or consistent ongoing review of people’s needs, which affected confidence that care was always based on the most current information.

Evidence from the assessment showed people’s needs were not always assessed and reviewed in a timely or consistent way. Care plans for several individuals had not been updated when their circumstances had changed. Some care plans had not been reviewed or updated for many months in some cases no update had occurred despite a hospital discharge.

Although feedback from people and relatives was generally positive, we received mixed feedback about the frequency of reviews of care plans. One relative told us, “The care plan has not been updated regularly. I believe they have hired someone to get on top of things.” However, another relative said, “The care plan changes frequently and we are always involved.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them.

Staff delivered specialised care for people with complex health needs. External professionals consistently described staff as competent. For example, one professional reported that they were “satisfied they are managing clinical risks effectively” and highlighted regular communication and involvement in multiagency reviews, demonstrating adherence to evidence based clinical pathways and partnership working.

Although we found multiple issues with quality of care plans some aspects of care were more robust. Several people were receiving nutrition and fluids through a percutaneous endoscopic gastronomy (PEG) which is a tube surgically placed in the stomach of a person to help with feeding in cases when they cannot eat or swallow food safely. There was guidance in place to ensure staff could perform feeding plans safely.

Most people told us staff delivered care safely and consistently, with one parent stating, “I feel totally confident the care is safe… they are a really good nursing team.”

The provider worked well across teams and services to support people. There was strong evidence of effective multidisciplinary collaboration. External professionals told us communication with the provider was regular, clear and responsive. One professional stated that the provider “communicates really well… we talk often,” highlighting ongoing coordination around complex care packages, including regular reviews with continuing care teams and specialist respiratory and palliative care teams.

People and relatives echoed this, describing well-coordinated care, with senior leaders and nurses working jointly with them to resolve issues promptly. They reported effective teamwork and coordination with multi-disciplinary teams. One relative told us, “There is paediatrician, neurology, physiotherapy, occupational therapist and speech and language involvement.”

Despite our concerns about care planning, record keeping and auditing, the direct evidence from people and partners suggests strong operational teamwork that supported continuity of care.

The provider supported people to manage their health and wellbeing and manage complex health conditions. People were supported to access healthcare services when required.

Feedback from people, relatives and professionals indicated care was delivered by staff who understood their medical conditions and the day-to-day interventions required to maintain their wellbeing. In most cases relatives described staff who were knowledgeable, attentive and skilled.

Staff supported families in managing deterioration in health and maintaining routines that promoted stability and comfort. Parents described staff as encouraging familiar, consistent care relationships, which improved people’s sense of security and emotional wellbeing.

The combined evidence from professionals and families shows that staff actively supported people to manage their health and maintain the best possible quality of life.

The provider engaged with external partners and took part in the annual review of people’s care. Despite this, the frequency of review of care plans by staff was not in line with current best practice. We also found numerous issues with the daily recording which meant we could not be assured staff were consistently monitoring all aspects of people’s care in line with the care plans.

Audits of care plans and records were not taking place often enough to identify the shortfalls we found. The cumulative effect of these weaknesses meant the provider did not have reliable or comprehensive oversight of whether care delivery was meeting intended outcomes, nor did they maintain sufficient evidence to drive continuous improvement.

The provider sought people’s consent. People and relatives reported being consulted about their care and support needs with 1 relative noting, “I was fully consulted about the care plan, and I am happy it covers everything”, illustrating respect for decision-making and involvement.

Where people lacked capacity, care plans typically recorded who should be consulted in their best interests, although some improvements were required in documenting the two-stage capacity test and incorporating competency assessments for children under 16 to determine if they could consent to their care and treatment.

Overall, while documentation could be strengthened, the evidence demonstrates staff respected people’s rights around consent and delivered care in a way that recognised their choices and legal rights.