Care Staff Services 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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes. The service was in breach of legal regulation in relation to consent.

This service scored 33 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.
The registered manager told us supervisors completed assessments with people before starting care calls. The registered manager also said, “If the needs are complex we return the package.” However, we found despite some people’s needs changing to being more complex, these care packages were still taken and continued. For example, for 1 person experiencing multiple seizures, staff noted “we were concerned that our carers might not be able to deal with these episodes and we requested for [the person] to be transferred to complex care”. However, we found no evidence of actions taken following this. This did not demonstrate a concise system and process was in place to ensure people with complex needs could always be safely supported by staff according to their assessed individual needs. There was also a lack of evidence any care and treatment needs had been discussed with this person to ensure they were effectively supported and safe to continue using this service.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.
We found people were at risk of neglect. For example, one person had not eaten for 4–5 days, leading to fainting and the involvement of ambulance services, who raised a safeguarding alert for neglect against this service. The carers had failed to report the lack of nutrition or seek timely support. The registered manager/provider did not provide evidence of any follow-up action or supervision to address this critical incident or to assure that the implicated staff member was fit to continue caring for other vulnerable service users.
 

The provider did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.
One professional told us, “Actual evidence of routine multi-agency collaboration in care planning is limited.” We found the provider did not always communicate directly with external teams and services to support people with their needs. For example, one person who was new to the service was noted to have a “bad sore”. They confirmed they received treatment from their previous care agency and were under the care of district nurses. We found the service did not directly work together with the previous agency or the district nurses to establish what the assessed needs were, to ensure treatment was continued in continuity according to the individual needs. This put the person at risk of being unsafely assessed and treated.
 

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.
We found staff did not always seek immediate advice and guidance from healthcare professionals where people required support. For example, we found a person refused personal care due to experiencing abdominal pain. We found no follow up information or actions were recorded to demonstrate this person was supported to manage their health and wellbeing. The person later went to hospital themselves. However, this did not demonstrate staff supported the person at the time of being aware of the health problem to ensure they were appropriately treated.
 

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.
The provider used a specific team to monitor people’s care. The registered manager confirmed this team reviewed daily notes, contacted medical professionals when needed, and followed up with people after incidents, sometimes up to 48 hours post-incident.
However, we found examples where this team failed to escalate clinical risk. One carer recorded critically low oxygen levels for a person but failed to call for help. The carer recorded this for the ‘monitoring team’ to follow up; however, the team failed to do so. Consequently, the person required an ambulance the next day. This reflected the registered manager/provider did not ensure adequate clinical oversight. They failed to respond to deteriorating health indicators promptly. The structure, competency, and accountability of this team was not clearly defined, placing people at increased risk of harm. This meant people’s care and treatment was not continuously monitored to ensure positive and safe outcomes.
 

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.
We received whistleblowing information indicating capacity assessments were being completed with no involvement or direct contact with people using the service. The dates of the assessments were reviewed against daily care notes for those dates, and these also revealed no evidence that any assessments had taken place in practice.
We also found capacity assessments were uploaded onto people’s care records on the day of our inspection announcement, despite people having been service users for significant time. This did not demonstrate this information was always readily available for staff. Furthermore, we found the capacity assessments lacked clear identification who conducted assessments, which meant there was a lack of assurance around the assessor’s training and competency to complete these.
The provider failed to demonstrate valid consent was obtained from people prior to delivering care and support. Capacity assessments were also found to be generic, lacking evidence of involvement with people and multiple complex decisions were being made without consultation. There was no evidence alternative communication methods were attempted, or assessors recognised where individuals may retain capacity for some decisions but not others.
Capacity assessments were found to be presumptive, frequently concluding lack of capacity solely “due to dementia”. For example, when questioned about delaying a decision, the assessor stated, “There is no need to delay the decision as the service user is in a constant mental state,” reflecting a failure to consider fluctuating capacity or alternative assessment timings. The provider did not ensure they completed these assessments in line with the Mental Capacity Act 2005 to ensure decisions were made in best interest of people with appropriate safeguards in place. This did not demonstrate people’s rights were considered, upheld and respected.