Caroline Cares for You 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

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 outstanding. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People and relatives told us they were involved in assessing and reviewing people’s needs. However, the provider was often unable to evidence this. Care plans covered all aspects of people’s care, including cultural and spiritual needs. Although, care plans and risk assessments were often vague and lacked key information and guidance for staff.

Staff kept records of the care they provided to people, each time they provided care. The quality of recording was variable, and many entries would not effectively support monitoring and reviewing processes.

The provider did not always plan and deliver people’s care and treatment using best practice guidance or upholding relevant legislation.

Some people had involvement from external professionals, such as Speech and Language Therapists. The outcome of this involvement was included in people’s plans and assessments, and where changes were made to someone’s care, this was communicated to staff, for example, during team meetings.

The provider was using tools such as the Braden Scale Pressure Sore to assess the risk of pressure ulcers and guide care. However, the provider did not always understand and embed best practice guidance and legislation, such as the Mental Capacity Act (2005) into their work.

The provider worked well across teams and services to support people.

We found that the team, both in the office and out delivering care to people, worked well together. Communication between staff and managers was frequent and clear. This included detailed and in-depth documented handovers when a manager or leader returned from leave, and channels on a social messaging app. There were daily updates provided by the management team to ensure any important information regarding people’s care was distributed to the staff promptly. There was positive feedback on this from staff and relatives.

The provider did not use agency staff, as the care team always worked together to ensure care was covered by someone from their team. The Registered Manager said that “if someone calls in sick, or knows they need time off in advance, the team work together to cover the rota to ensure it’s a familiar face looking after our clients.”

Additionally, we received positive feedback from external health professionals who had recently worked with the provider. One professional told us, “As a [profession] team, we have good communication with [Registered Manager] and the carers.”

There was room for improvement to ensure they reported all incidents and events to the relevant external agencies, such as Local Authorities.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People’s health needs were being met, and this often involved external health professionals. Where it did, the information provided by the health professional was distributed to staff and included in people’s care plans. There was room for improvement to ensure that the information was written clearly enough, including all relevant information, particularly to aid new staff.

People were encouraged to meet all their needs, such as oral health, even where people were independent with this, staff would still encourage and prompt people to complete these tasks.

They did not always ensure that outcomes were positive and consistent, or that they met the expectations of people themselves.

There were systems and processes in place to monitor outcomes, including daily notes audits, and regular reviews or communication with people and relatives. People and relatives told us they were involved in reviews of people’s care, however, there was little evidence of this, and processes such as daily notes audits were not always utilised to monitor people’s care and contribute towards improving their outcomes.

Goals and outcomes within people’s plans and assessments were generic and not person centred. Instructions for staff on how to support people to achieve the listed goals and outcomes were vague. For example, one person’s long-term goal was to continue living with their relative and pets and remain as independent as possible. The guidance for staff was “carers to encourage [person]’s goals”.

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

The provider told us they received consent to care at commencement of care packages, however there was no evidence of this.

We found that there were restrictive practices in place, such as people’s medication being locked away so they could not access them independently, without the proper processes being followed around consent, or mental capacity.

Some people had relatives who held lasting power of attorney. We were not assured the provider fully understood this role in relation to people receiving care.

We were not assured that the provider understood or embedded the Mental Capacity Act (2005) into practice and found that staff had insufficient knowledge in this area either. The provider supported 33 people at the time of the assessment, many of whom were living with Dementia. At the commencement of our assessment, there were no mental capacity assessments (MCAs) or best interest decisions in place, and the provider felt that because people were happy with their care, they didn’t need to do these.

We found that the provider had been party to the implementation of a GPS tracking device on someone using the service. There was no consent in place for this, or MCA and best interest process in place. Following our feedback, the provider completed this process, however there was room for improvement to ensure it was in line with legislation or best practice guidance.