Care Staff 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 assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

At our last assessment the provider was in breach of the legal regulation in relation to consent. Improvements were not found at this assessment, and the provider remained in breach of this regulation. In addition, at this assessment we found the provider was in breach of the legal regulation in relation to person-centred care.

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 were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The manager told us that since our last assessment people who had complex support needs had found new care providers to support them and those who continued to be supported by the service had lower-level needs. However, our review of people’s care records showed this was not an accurate description of the service. We identified a number of people whose needs were complex and required detailed care plans and support from staff with good knowledge and experience. Despite this, we found some people’s care plans and risk assessments had not been reviewed since our last assessment. This included important changes in the needs of some people which whilst detailed in their care notes, had not been added into their care plans. This meant staff may not be aware of the most recent and most significant information when supporting people and that the management team were unaware of the complexity of people’s care.

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

Best practice tools to monitor people’s wellbeing in areas including nutrition and hydration, skin integrity and pain management were not used. Whilst we did not identify any direct impact on people’s care, there was a risk that health concerns may not be identified in a timely manner. The manager told us they intended to introduce these tools as part of the process in moving records over to a widely used care planning system. They felt this would give them a greater oversight of people’s needs and ensure risks were identified at an early stage.

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.

Staff did not always work effectively with professionals to ensure advice and guidance was communicated to staff and followed. Where the community nursing team had made recommendations regarding people’s health, such as guidance for supporting people with their skin integrity, diabetes and catheter care, staff had recorded this in people’s daily care notes. Whilst staff told us they would also inform the office, we found care plans and risk assessments were not always updated with this information. This meant advice from professionals may not be known or followed by all staff, placing people at risk of harm.

In other instances, we saw that guidance from professionals was shared with the team supporting the individual and staff recorded this was being followed during care visits. Staff told us they felt communication systems had improved since our last assessment which had led to improved teamwork. One staff member said, “We can speak with the manager now and they are trying to make things good for us. We’ve had meetings to share how we feel and we are working as a team.”

The provider did not 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.

Systems were ineffective in ensuring care plans and risk assessments reflected people’s care needs. As a result, staff did not always have the information they required to support people safely with their health and wellbeing. This included gaps in records regarding the emotional support people may need and which professionals were involved in people’s care. Although staff told us they were able to contact the office for advice, due to the significant reduction in office staff and their limited knowledge of people’s needs, there was a risk this support would not be available or appropriate to the individual.

Adequate records were not maintained when people were discharged from hospital. People’s discharge summaries were not consistently held on file. We found there was no record as to the treatment people had received, a reason for their admission, any changes in their needs or advice staff should follow. No review was completed regarding the reason for the person’s admission to monitor if lessons could be learnt to reduce future admissions.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Relatives told us they were not confident of staff’s ability to understand people’s health outcomes and the support they required. One relative told us, “Whenever there is an issue, the carers pass the buck and ring emergency services so [family member] ends up in hospital and is discharged the next day. It happens far too often when all [family member] really needs is a bit of care.” Records for the person confirmed there was little guidance for staff regarding when emergency services should be called or when other services may be more appropriate and minimise disruption to the person.

Outcomes set within people’s records were generic and were not person centred. It was not clear how these outcomes had been discussed with people or how they were measured to ensure care and support was being provided in line with people’s wishes and aspirations.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The provider had failed to implement systems to ensure people’s rights were upheld in line with the Mental Capacity Act 2005 (MCA). We found systems had not changed since our last assessment and people continued to receive care without consent being established or best interests’ decisions recorded.

Records showed that capacity assessments were not decision specific, were not discussed with people and did not determine how decisions regarding people’s capacity had been established. The wording within some people’s records showed the staff member completing the assessment had made presumptions regarding their capacity rather than having followed a process to determine this. There were no best interests’ decisions recorded to show what decision had been reached, who had been involved or to ensure the least restrictive option was followed.

Records showed that staff had completed MCA training. However, staff we spoke with did not demonstrate an understanding of the legislation or how it impacted on the support they provided to people.