Northamptonshire Domiciliary Care Agency

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 safe care and treatment. Staff did not always understand how to meet people’s current needs because people’s care plans and risk assessments did not provide adequate information and guidance. This meant the provider had failed to have systems in place to ensure staff had all the up-to-date information they needed for people to receive consistent care.

This service scored 38 (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.

People’s needs were assessed before they started using the service to ensure they could be appropriately supported. However, we were not assured care plans, risk assessments and other records contained adequate information for staff to be able to meet people’s needs and mitigate known risks and keep them safe from harm. For example, we found that care plans and risk mitigation plans for bowel health, catheter care, diabetes, Prader-Willi syndrome, dementia and communication either did not exist or did not have adequate guidance for staff to be able to support people effectively, meet their needs and mitigate known risks.

There was no formal process in place to continue to assess people’s needs after they started using the service. We were not assured that the review of care plans and risk assessments was effective as there was no evidence of a review beyond a change of date on the records to demonstrate these had taken place. We could not be assured that positive outcomes were being achieved for people’s needs.

Records did not demonstrate people, their relatives, or representatives, had been adequately involved in creating or reviewing their care plans and risk mitigation plans, incorporating all that was important to them. The registered manager told us, there would have been evidence in old records of people’s involvement in creating care plans, however, they could not evidence this and there was no evidence they were involved in the review of the current care plans.

There was a lack of adequate oversight from leaders in relation to assessing on-going needs and care planning. This meant people were at risk of not receiving safe care that met their needs.

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.

Some people were at risk of developing the nutritional complications associated with their known medical conditions. For example, one person was at risk of the nutritional complications of Prader-Willi syndrome and another person the nutritional complications of diabetes.

Although people’s weight (where required) was being recorded by the service the provider did not use an evidence-based practice tool (for example, malnutrition universal screening tool or MUST) or have their own methodology to assess and determine if people were nutritionally at risk. A relative told us, staff, “Don’t understand the health implications of obesity.”

Although there were some nutrition and hydration care plans and risk assessments in place, these did not triangulate to other information held by the service in relation to people’s known risks. For example, people’s weight was not triangulated to the nutrition and hydration support plans and did not identify if the current weight indicated a nutritional risk. This meant that staff did not have up to date information on how to manage and mitigate people’s known risks.

We were not assured that people were not at risk of developing nutritional complications, as the provider did not have systems and processes to ensure staff had the knowledge, skills and tools to adequately assess people’s nutritional risk.

The provider did not always work well across teams and services to support people.

Staff told us that they felt they were a good team, who generally worked together well to provide good care to people. We found during our assessment that there was a friendly atmosphere in the homes and staff worked well together.

It was evident through our observations that staff knew the people they were supporting well, however, they did not have sufficient information available to them in care plans and risk assessments to understand how to mitigate all risks and reliably provide care that met people’s current needs.

There were some concerns that leaders did not work as part of the team and that the provider’s central support functions were not visible locally. One staff member said, “If we had more support then we would run a better service”. This meant we were not assured that all the provider’s team worked together.

Staff did not always understand how to meet people’s current needs. This meant the provider had failed to have systems in place to ensure staff had the information they needed, and people received consistent care.

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.

People were supported to access healthcare services and staff worked collaboratively with external professionals to support people to attend medical appointments, and we saw evidence of regular dental, podiatry and optician appointments. However, we identified some concerns around one person’s routine health screening and the decision not to progress with the screening. We were concerned by the lack of a supporting mental capacity assessment and best interest decision for this, and the lack of staff advocating on behalf of the individual. We shared our feedback with the manager and asked them to review all routine health screening decisions.

We were not assured that staff had received adequate training in people’s specific medical conditions to be able to manage people’s health and well-being. For example, at one home a person was diagnosed with diabetes, however, the staff had not received any specific diabetes training.

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.

We found there were no records to demonstrate people had goals, aspirations or outcomes, or that people, and their family or representatives, had been involved in creating or reviewing them.

The provider had a system for recording outcomes. However, this had not been implemented effectively locally, and the provider was not able to assure us that they were supporting people to identify goals and aspirations, and monitoring outcomes that met people’s expectations. A manager told us the service was, “Not doing enough to record outcomes.”

The provider did not have a robust approach to monitoring the effectiveness of people’s care, treatment, and support to continuously improve it.

We raised our concerns with the registered manager during our assessment who told us they were not able to evidence outcomes on the electronic system as this had not been used to record people’s goals and outcomes. We gave the registered manager a further opportunity to consider how they could provide evidence of people’s goals, aspirations and outcomes in paper-based documentation, however, there was no further evidence submitted.

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

People had a range of mental capacity assessments and best interest decisions in place; however, we were not assured the providers system had effectively established the 2-stage test of capacity set out in the Mental Capacity Act. For example, mental capacity assessments we viewed inadvertently indicated people who lacked capacity to make a decision; were actually able to make the relevant decision themselves.

There was no evidence in people’s mental capacity assessments and best interest decisions to evidence how the people, their relatives or representatives had been involved, or where applicable, how people with communication needs had their wishes considered.

We raised our concerns with the registered manager during our assessment who told us they had shared our feedback and there was a commitment to review the format of the mental capacity assessment questions.