Care Staff Services Ltd

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

At this assessment we found the provider was in breach of legal regulation in relation to person-centred care.

This service scored 43 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People and their relatives shared mixed views of the care the service provided. One relative told us, “Considering my [family member] is, in every sense, vulnerable and the management know the full circumstances, they should prepare their staff to support [family member]. Well, we’re still waiting.” A person receiving care told us, “They are pleasant but could listen more.” However, some people we spoke with felt the service was personalised and met their needs. One person told us, “It’s a well-practised routine and leaves space to chat and give me a lift (in spirits). They’re decent people.”

We found care records did not always provide direction to staff regarding how people wanted their care to be provided, what made them feel reassured or what gave cause for concern. Whilst records showed some people were involved in their care and reviews, this was not consistent. For those people living with dementia there was no information available regarding how they were involved in developing their care plans, what observations had been made by staff regarding how people responded to different approaches or how information should be shared. This meant opportunities to involve people in how their care and support was provided may be missed.

Daily records were functional and lacking in detail regarding people’s personalised care. They focussed on household tasks and meal preparation rather than how the person was, what they spoke about or any concerns. This meant staff visiting on subsequent visits did not have updates regarding the person’s well-being.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Information in relation to people’s specific health and social care needs was not always recorded and for some people it was difficult to understand why they needed support. Where health concerns were recorded, this did not always provide staff with guidance regarding how to support the person or identify signs of a deterioration in their health or well-being.

Daily records did not always highlight that staff followed up on concerns during subsequent visits to people. For example, where staff recorded people being unwell, staff completing the next care call did not always record how the person was or if there had been any improvement or deterioration in their health. This demonstrated a lack of continuity and monitoring of people’s general health and well-being.

In other instances, we saw there was good communication between health and social care professionals. This included instances where staff had identified skin integrity concerns and had contacted the community nursing team. Systems were in place to ensure people’s care was resumed promptly when they were discharged from hospital.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s care plans contained limited information regarding their communication needs or how information should be shared. This was not in line with Accessible Information Standards which legally require adult social care providers to identify, record, flag, share, meet and review people’s information and communication needs. People’s communication plans did not consistently state how people preferred to receive information or who may advocate on their behalf. Where people were unable to communicate verbally there was no information regarding any alternative communication systems used and no detailed guidance for staff regarding how to meet their communication needs.

In other instances, we found information which may impact people’s communication, such as sight or hearing concerns was recorded along with any support they may require in this area.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Relatives told us they did not feel concerns regarding their loved ones’ care were listened to and acted upon. One relative told us, “I’ve tried (to raise concerns), but it’s in one ear and out the other.” Another relative told us they had raised issues with the service but didn’t feel heard, “It’s like talking to a brick wall as far as I’m concerned.”

The provider had a complaints process in place which highlighted how people could raise a concern. Records showed that whilst issues raised were responded to, there was limited follow-up to check people or their relatives were happy with the outcome or that action taken had been effective.

The approach to monitoring people’s satisfaction with their care was not systematic. Some people told us they received periodic ‘happiness checks’ whilst others said they had very limited contact with the office. Records showed this contact was recorded in different places and was not reviewed to identify trends or learning. The manager told us they had recently sent out ‘client surveys’. However, they told us they were unable to access the results but described these as being as they expected for a service rated inadequate.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We received mixed responses from people and their relatives regarding the timings of care calls. One person told us, “Their timekeeping is chaotic, never really sure when they’ll come but they do, eventually.” In contrast, one relative told us, “They are almost always on time, and if they’re going to be late, they ring to let us know.”

The timings of people’s care calls were not always clearly recorded which meant it was difficult to establish if staff were allocated in line with people’s preferred time for their care. Where staff did record the time they arrived for people’s calls we found this was in line with their call schedule.

Staff told us they felt improvements had been made in the way care calls were allocated as additional time was now given for travel between calls. One staff member told us, “Yes there is enough time, everything is fine now [regarding travel time].”

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People’s care records did not always reflect their needs relating to their protected characteristics under the Equality Act 2010. Although some care records reflected information regarding people’s race, ethnicity, and preferred language, they failed to consider other key characteristics, including people’s sexual orientation, religion and disabilities. This meant there was a risk people’s needs and references in these areas may not be supported and opportunities to improve people’s outcomes and experiences may be missed.

Staff completed training in equality and diversity and responses from some relatives demonstrated staff were respectful of people’s needs in this area. One relative told us, “They know our culture and how [person] wants things to be done. They make that happen.”

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People’s care plans did not contain information regarding the support they wanted at the end of their life, such as if they wished to remain at home, their resuscitation status or any specific requests which were important to them. Plans viewed stated this area of people’s support had not been discussed with them. This meant people were not provided the opportunity to discuss their future preferences for support, medical treatment or end of life care.

The manager told us that although they felt staff had the skill to provide people’s day to day care, they would have concerns regarding staff supporting people at the end of their life or those whose needs became more complex. They told us going forward they would initially assess staff skills prior to providing additional training in this area.