Holistic Care UK

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 this inspection the rating is Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We found the provider to be in breach of 1 legal regulation relating to Consent.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Assessments out of people’s needs did not include detailed information about all health conditions people lived with to enable the provider to establish whether or not they were able to meet these needs effectively and safely.

There was insufficient guidance for staff on how to effectively mitigate risks to people’s safety and protect them from avoidable harm. People’s care plans and risk assessments did not contain sufficient detail in key areas, including Parkinson’s disease, medicines management, dementia, diabetes, mobility and falls, communication, environmental risks, and fire safety.

Staff members told us they could access care plans and acquaint themselves with people’s needs. However, staff were not able to tell us what able to tell us about all of the health conditions people lived with, and the support they required. There was no information to demonstrate that people and their relatives were involved in the creation of people’s care plans.

We were not assured that the review of care plans and risk assessments was effective as there was no evidence of regular reviews taking place. We could not be assured that positive outcomes were being achieved for people’s needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s care and support was not always delivered in-line with best practice guidance. For example, people with a diagnosis of diabetes were being supported without an appropriate diabetes care plan or risk assessment in place.

The provider did not always maintain records demonstrating that they involved people and/or their relatives in planning and delivering their care and treatment, including what was important and mattered to them. This meant people’s changing needs may not always be identified and documented.

People’s care plans did not always include person-centred information about their specific health conditions and how they impacted them as individuals. This included Parkinson’s disease, dementia and diabetes. There was no guidance in place for staff on how to support people with these conditions appropriately and safely.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives or, where possible, reduce their future needs for care and support.

People’s care plans did not document how they were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing.

One person’s care plan stated they required assistance with preparing meals and drinks and for staff to respect their food preferences and cultural/religious dietary needs. However, there was no guidance in place for staff on the assistance the person needed and there was no information about the person’s cultural or dietary needs. There was no guidance for staff on the person’s preferences in relation to food and drink and how staff should support this person to help promote and maintain their health and wellbeing in relation to nutrition and hydration.

Staff completed daily notes, but they contained very limited information and did not detail how they have supported people with their health and wellbeing. For example, people’s care plans did not provide detailed guidance to staff around people’s oral health. Although daily notes documented people needed support with oral hygiene, there was a lack of clear detailed guidance for staff on the individual support people required with oral health, therefore, we were not assured staff were supporting people in a way that met their needs.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, nor that they met health care expectations.

We found there were no records to demonstrate people had goals, aspirations or outcomes, or that people, and their family had been involved in creating or reviewing them. The provider was not able to assure us that they were supporting people to identify goals and aspirations, and monitoring outcomes that met people’s expectations.

The provider did not have a system for recording outcomes or a robust approach to monitoring the effectiveness of people’s care, treatment, and support to continuously improve it.

Although the provider completed surveys for people using the service, there was no evidence this information was used to improve the care delivered.

The provider was not working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager and staff did not have a clear understanding of the MCA and when it should be applied. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty.

Information in care records about whether or not whether people had capacity to make decisions was unclear. Two people had been diagnosed with dementia, for one person no mental capacity assessment had been carried out as the registered manager told us that they deemed them to have capacity to make complex decisions. We were not assured that care plans included clear information about whether people had the capacity to make decisions about their care. Decision specific mental capacity assessments were not always in place to demonstrate whether people had capacity or not to make decisions around the delivery of care.

For the other person, the registered manager told us they had been to a ‘memory clinic’ and the diagnosis was that the person had a cognitive impairment and ‘forgot things. However, the registered manager told us that they did not agree with this diagnosis as they knew the person and had carried out their own mental capacity assessment. However, there was no appropriate assessment to explain how they had come to this conclusion despite both people having a diagnosis of dementia and staff confirming that the person could forget things.