SQ Carers 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 changed to requires improvement. This meant people’s outcomes were not always consistently good, and people’s feedback confirmed this.

This service scored 50 (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

The provider’s approach to storing information meant some information was not readily available. Some information was held on their electronic care planning system for care planning and risk assessments, while other information was retained separately by the registered manager. This inconsistent approach meant staff did not always have access to complete and up-to-date information required to support people safely and effectively. Our visit found some people’s needs had been identified or planned for, and care plans had not always been updated to reflect people’ s current needs. People and relatives feedback showed they were not always included in developing and reviewing their planned care. Where spot checks on care calls were completed, people’s feedback was not always sought.

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 nutritional and hydration needs were not always clearly risk assessed or recorded in care plans. This included when people needed a specialised diet.The International Dysphagia Diet Standardisation Initiative (IDDSI) Framework is a global, standardised system of 8 levels (0-7), which describes food textures and drink thicknesses for people with dysphagia (swallowing difficulties). It aims to improve people’s nutritional safety by providing a common language for everyone to use. One person required a modified diet and thickened fluids to reduce their risk of choking and aspiration. The registered manager told us the person required level 1 consistency of fluids, but their care plan and Speech and Language Therapist advice (SALT) documented another. There was no clear guidance for staff on what the consistency should be or look like. One member of staff told us the person’s representative would be responsible for guiding staff verbally.

Although the care plan stated recommendations had been provided by the (SALT) team, evidence of these recommendations conflicted with what the registered manager told us. This increased the risk of inconsistent practice, and the person may not receive fluids of the correct consistency. Records completed by staff did not evidence what consistency people’s foods and fluids had been given to them. This meant the provider could not assured, people received modified diets and fluids safely.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Communication systems were not always effective. Some system alerts were being managed and signed off on the provider’s electronic care planning system by an external business. During our visit, we saw some alerts had been closed off, but neither staff working in the office or the registered manager was able to tell us who was doing this or how it was happening. This meant there was potential for risk, system alerts to be overlooked, as well as risks to confidentiality. Commissioners had raised concerns to us about how the service worked across teams, especially related to care call times and the overall quality of care. Commissioners told us they made several attempts to request information, with communication not always responded to with urgency. We saw some health professionals had been involved with people’s care, such as GP’s and SALT. However, records did not always accurately reflect their recommendations, and staff were not consistently aware of the advice given. This increased the risk that care and support would not be delivered in accordance with people's assessed needs.

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

People were not always supported to achieve and maintain the best possible health outcomes. This was because the provider’s systems for identifying, monitoring and responding to changing health needs was not robust. Peoples agreed care call times and when they received support, caused some people difficulties in managing their day to day life. One relative told us, “They come in as new staff and train on the job, they shadow staff but are not given enough verbal instruction. They learn what to do from the service users and their families. Sometimes they do not understand dementia and the need for continuity of care.” One person told us how they did not feel supported. They said, “Some of the carers (staff) are not used to operating the hoist, I have to train them how to use it. A couple are a bit heavy handed, when they put me into bed, they let my head go. They need reminding to be careful when they are putting my legs on the plate of the wheelchair because it is very painful for me”.

One person told us they had experienced difficulties but found for them, some improvement. They said, “Staff seem to know what they are doing now. They had a refresher course in early June, before they did not know enough about PEG feeding (a tube delivering liquid food, water, and medications directly into the stomach through a small opening in the abdomen) and nutritional feeds.”

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.

Whilst care plans had been reviewed, staff responsible for reviewing records did not have sufficient knowledge or information to ensure records were accurate and person led. One member of staff, who had recently reviewed care plans and risk assessments, was not able to fully answer our enquiries about people’s skin integrity or dietary requirements. They told us they would have to consult care staff. There was no documented evidence people, or their relatives had been involved in reviewing their care package to prove it remained in line with their expected outcomes. Staff who reviewed and updated care plans, told us they had not been trained to undertake care reviews, and sometimes, they did not know the person whose plan their were reviewing. The provider’s monitoring systems had failed to identify concerns we found in people’s care records which meant people’s needs were not always effectively monitored.

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 were not always supported to understand their rights under the Mental Capacity Act 2005. The provider had not ensured mental capacity assessments for people who lack capacity had been completed in relation to specific decisions being made in their best interest. They did not include information on how the person had been involved, or attempts had been made to involve the person, in making the decision. This meant people were not supported to understand information, communicate and make decisions in line with the MCA.

However, care staff spoken with understood the importance of gaining people's consent when performing care tasks and regularly documented consent had been verbally obtained.The provider utilised the support of an external business but had not considered the impact when sharing people’s data and confidential information. The registered manager said they had not asked people’s consent to share their information. We could not be confident, the registered manager safeguarded people’s information. Work related activities held on the provider’s system, were accessed by people not always known to the registered manager. A failure to understand and act, to protect their data could put the people and the service at risk. We told the registered manager to seek immediate advice to remedy this situation following our visit. We asked them to clarify how people’s consent was protected, but the registered manager did not respond back to us.