Blue Sapphire Care Limited

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 inspection we rated this key question good. At this inspection 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 did not make sure people’s care and treatment was effective because they did not always have the correct information in their records.

People were not always supported by care plans that fully reflected their assessed needs. We found care plans did not consistently cover all areas of need, some records lacked sufficient detail, and information was not always up to date. This meant staff did not always have access to clear guidance to enable them to provide safe and person-centred care.

For example, a care plan for a person living with diabetes did not contain sufficient information to guide staff. The care plan confirmed the person had diabetes but did not include details of their usual blood glucose levels, signs and symptoms of hypoglycaemia or hyperglycaemia, or clear instructions on when staff should seek medical advice or emergency assistance. Without this information, staff may not have been able to respond consistently or appropriately should the person's condition deteriorate.

These concerns were not isolated. We found care plans did not consistently contain sufficient detail to enable staff to understand and safely meet people's needs. The provider's quality assurance systems had failed to identify and address these issues. As a result, the provider could not demonstrate people were always receiving safe, effective and person-centred care based on accurate assessments of their needs.

During the inspection, the provider recognised these shortfalls and had begun reviewing and updating care plans to ensure they contained the necessary information and guidance.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff worked in partnership with healthcare professionals, including district nurses, occupational therapists, specialist nurses and paramedics, to ensure people's care reflected their assessed needs and current best practice. Contact records demonstrated professional advice was sought and acted upon where required

There was evidence that recommendations from healthcare professionals were implemented to improve outcomes for people. For example, following a near miss involving one person, the provider sought input from the community falls team and acted on recommendations regarding equipment, staffing levels and moving and handling support to reduce future risks.

The provider's policies also reflected recognised good practice, including Stopping Over-Medication of People with a learning disability or Autism (STOMP) principles and the promotion of annual health checks and health action planning for people with learning disabilities. Staff training arrangements included learning disability and autism training to support evidence-based care delivery.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People benefited from joined-up care through effective partnership working with a range of health and social care professionals. Records demonstrated staff worked collaboratively with external agencies to help ensure people's needs were met and their wellbeing promoted.

The provider maintained a contact log which evidenced regular communication with healthcare professionals and other agencies involved in people's care. The records included the date of contact, the professional involved, the reason for the referral or discussion, and the outcome. Professionals involved in people's care included district nurses, occupational therapists (OTs), paramedics and specialist nurses.

We reviewed examples of communication between the service and external healthcare professionals. Email correspondence demonstrated positive partnership working with a specialist nurse and occupational therapist to ensure people received appropriate support and advice. Staff sought guidance when required and worked with professionals to implement recommendations and strategies designed to meet people's assessed needs.

People had access to healthcare services when needed. Records showed professionals were involved in reviewing and supporting people's care, and that advice and guidance provided by healthcare professionals was incorporated into care delivery. Staff followed agreed care strategies and guidelines to help ensure people received consistent and effective support.

The provider had systems in place to ensure important information was shared with staff. Changes to people's care and support needs were communicated through email updates and discussed during staff meetings. This helped staff remain informed of current care requirements and enabled a coordinated approach to supporting people.

These findings demonstrated the service worked effectively in partnership with other professionals, helping to ensure people received coordinated care and support that reflected their changing needs.

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.

We saw evidence of effective multidisciplinary working. The provider identified when people's health needs had changed and made prompt referrals to relevant healthcare professionals. A member of staff said, "If we are ever concerned, we can ask the office to contact the district nurses and they will come out."

Information and advice received from professionals was shared with people using the service and, where appropriate, their families, helping to ensure they were involved in decisions about their health and wellbeing. People told us they had support from staff which promoted their health and wellbeing. One person said, "They come five times a day, making sure I'm doing my exercise and making sure I eat."

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.

Care plans were reviewed regularly. However, records did not always accurately reflect people's current needs and, in some cases, contained conflicting information. We found there was a lack of clear recording of analysis, actions taken and outcomes achieved following reviews. This meant it was not always possible to demonstrate how information had been used to evaluate and improve people's care and support.

Despite this, we saw evidence of effective partnership working with healthcare professionals. Staff made appropriate referrals and maintained communication with external agencies when people's needs changed. Records demonstrated that professional input was used to support people's health and wellbeing and had resulted in improved outcomes for some people.

The provider did not always maintain formal records to demonstrate how people were informed about their rights around consent. However, staff were able to describe how they offered people choice and supported them to make decisions about their care and treatment.

People's care records contained signed consent forms, demonstrating they had agreed to the care and support provided. This helped ensure people's views and decisions about their care were recorded and respected.

Records showed that people’s capacity to make decisions about their care and treatment had been assessed at the point of admission. However, there was no evidence that further Mental Capacity Act (MCA) assessments had been completed if required following admission. As a result, the provider could not demonstrate how people’s capacity had been reviewed over time, what factors had been considered when decisions were made on their behalf, or that decisions had consistently been made in line with the requirements of the MCA. Despite this, staff demonstrated a good understanding of the principles of the Mental Capacity Act and how these applied to the support they provided. One staff member said, "If someone has capacity to make their own decisions, it is important you allow them the independence to do what they wish." This showed staff understood the importance of supporting people to make their own choices and promoting their independence wherever possible.

There was no evidence of best interest decision-making where people lacked capacity, meaning the provider could not demonstrate that decisions made on their behalf were in line with the Mental Capacity Act 2005.

This was an area where recording and documentation could be improved to provide assurance that people's rights were being protected and decisions were made in their best interests where required.