Accolade Support and Care Ltd

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 remained Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People and their relatives were involved in the assessment process and consent was gained to provide support. People’s individual abilities and needs were assessed and developed into a plan of how to safely deliver their care.

People and their relatives told us the assessment process had been thorough and had given them confidence that they would be supported in the way they wished. Comments included, “The manager came to do an assessment with me and my [relative]. I have since had discussions with the manager to increase the amount of support” and “I was involved initially and am kept informed of any changes in [relative’s] needs.”

The registered manager was very clear that new assessments or reviews following hospital discharges needed to be planned safely to ensure the best outcomes for people. The registered manager said, “We carefully review all information provided by social workers and proactively query any uncertainties at the very first stage of onboarding a new client with social workers and hospital discharge teams to ensure information is accurate and consistent. We also follow robust internal processes, including initial assessments and shadowing [for staff], and we do not rush or compromise this process.”

Following the initial assessment the care package was reviewed with people 6 to 8 weeks after the start of their care package to ensure they were happy and receiving a service that supports them well. Following this, regular communication continued on a 3 monthly basis with an annual review of their care needs or earlier if required.

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.

People received care, treatment and support that was evidence-based and in line with good practice standards. Where required and when people consented, staff would record observations around people’s bowel movements or skin integrity needs on body maps and provide any further input if needed.

The registered manager and members of the staff team had created individual moving and handling videos for some people who had very specific needs around their support. These videos had been created with the person’s consent and enabled staff to learn and ensure consistency and best practice.

People were supported with their nutritional and hydrational needs by staff. We raised with the registered manager that some people did not have many food and drink preferences recorded in their care plans, in case they transferred into a setting with staff that did not know them as well or they were unable to say. We were told that most people were able to state their choices and for people less able more information would be recorded in these circumstances, but this could be revisited.

Staff were confident in managing any dietary requirements people had and we saw information on allergies clearly recorded throughout care plans. One staff member said, “I did used to go to a diabetic client who would have dietary restrictions and specific meals and nutrition as well as another client in the past who was only able to eat pureed meals so we have to make sure we would adhere to this when we were preparing their meals. The SALT assessment and requirements information was always available.”

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.

We saw communication notes were recorded when people had interactions with professionals, so care staff had access to these to inform their care practices. Feedback from external professionals was positive and cited good working relationships with the staff team. One health and social care professional commented, “Recently, a customer who may have cognitive changes emerging and is at high risk of self-neglect needed a hospital bed. [Staff] supported the co-ordination of the visit by District Nurses, alongside the removal team who took away the person's old bed. This went smoothly because of [staff] oversight.”

Staff told us they had good relationships with other practitioners including district nurses and social workers and felt confident to share information where needed. Staff said, “Sometimes we will speak to a GP when they visit for example, and they will ask us questions when we are there. We always ask for ID to ensure they are the professional we are expecting to speak to.” and “Communication with external professionals is good as well. For example, if equipment is no longer working, we will raise this and it will be referred to the occupational therapist.”

People and their relatives felt confident concerns would be raised and shared with the appropriate professionals when required. We received comments such as: “Staff will raise concerns with the office and sometimes we have a problem with [medical equipment], and they get in touch with the district nurse. Staff are quite good at picking things up.” and “Staff support with other healthcare professionals and will call the GP if necessary.”

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

People were involved in regularly reviewing their health and wellbeing needs where appropriate and necessary. We saw an oral health assessment had been completed to establish any support needs people had in this area. This included if people had a dentist or needed help sourcing 1, if they had received a check up recently as well as their oral care routine to enable staff to assist with people’s oral needs.

Staff understood the importance of encouraging people to make healthier choices where able and told us, “When we make a shopping list we will encourage people to make healthy choices but not tell them what to eat but we advise” and “We had a client who was housebound for a while and we were able to encourage them to start taking walks every other day and encourage them to go outside. They now go for a walk up the road to get fresh air and exercise. They go shopping as well and we encourage healthy meals, although ultimately it is their choice.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People’s support was delivered consistently by staff, in a person-centred way that was specific to their needs. Staff we spoke with demonstrated good knowledge about people and how to support them effectively; saying, “I monitor people's health by observing their actions and how they carry out the normal day to day tasks such as self-care, how mobile they are and whether they struggle with eating and drinking.”, I monitor changes in behaviour, appetite, mobility, and general condition. I have training to recognise signs like pressure sores and infections, and I report concerns promptly” and “By looking out for signs deterioration on each visit. This could be for skin breaking down, confusion, pain, changes in appetite, unusual tiredness and behaviour changes. Any changes are documented on our birdie app and ‘raise a concern’ which is a function on the [electronic system] and it alerts the office.”

We saw the importance of monitoring people’s health needs was part of meetings and conversations with staff. The registered manager had recorded in meeting minutes the importance of people’s well-being and checking presentation including physical and mental changes, nutrition and medicines. Where staff had communicated back any observed changes, we saw that action was followed up to support people including making a referral to an appropriate health care professional or increasing times of visits, so people did not feel rushed.

Health and social care feedback praised staff for recognising changes commenting, “Accolade are great atreferring to partner agencies e.g. to OT for mobility assessments, District Nurses for pressure care issues, or to GP practices to express concerns about deterioration. This is very helpful as it means [professionals] can rely on them to work as a team in improving challenging situations.”

Although in practice staff were very diligent and knowledgeable; we noted that there was not always specific information recorded on signs and symptoms for people with specific health conditions, to enable staff to identify any deterioration in a timely way. We spoke with the registered manager about ensuring this information was available for staff and tailored to the person. The registered manager was responsive to developing plans further to include this and had started working on a health needs document to capture this information.

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’s capacity was assessed by the service at the point of gaining consent to provide care and support. We saw this included specific decision making for care, medicines support and for sharing information where necessary. For any decisions needing to be made after this time where a person lacked capacity or had fluctuating capacity, we saw these were not reviewed or undertaken in line with the Mental Capacity Act 2005 (MCA). The registered manager explained that in principle the decision-making process was followed with health care professionals and the person’s family involved to reach a best interest’s decision, but this had not been appropriately recorded through a mental capacity assessment. We were told that the appropriate action would be taken to record this in line with the MCA.

Staff understood how to support people who lacked capacity to consent to daily care and make decisions commenting, “As we get to know clients, we will have ways to build rapport and encourage them. We include them in the process and allow them to input into their own care for example washing their own face and we give words of encouragement. We include them in the whole process.” and “Do not presume a person lacks capacity until proven. Supporting a person who lacks capacity means making decisions in their best interest while keeping their dignity and previous wishes. Provide information that is easy to understand, allow plenty of time, make sure the environment is comfortable. Encourage them to take part in decisions.”